2013BUSINESS PROPOSAL

LIV+

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LIV+ | 3

EXECUTIVESUMMARY

LIV+ is a revolutionary social ecosystem that connects doctors with patients and patients with communities. Based in South Africa, home to the world’s largest HIV infected population, LIV+ aims to address the endemic problems of drug adherence, continuity of care, and social stigma associated with HIV/AIDS. LIV+

is a service that takes a three-pronged approach to help people with HIV meet these challenges: the Passport, the Reminders, and the Social. And the best part? It’s free.

LIV+ brings something new to the ongoing fight against HIV/AIDS in South Africa. Our service uses simple technology, SMS texting, to connect our HIV+ clients with both their doctors and their peers, and create a support network for our clients help them maintain their treatment. More specifically, LIV+ provides clients with a private electronic medical record (the Passport), text message reminders to their medications (the Reminders), and a peer support group (the Social).

Our revenue comes from selling SMS text advertising packages to companies that cater to customers with HIV. Through LIV+, these advertisers have access to a massive audience of their target consumer.

We expect to have a positive cash flow by the end of Year 2 and expect to be profitable before the end of Year 4. By Year 10, we expect to have tapped 6.9% of the market and earned $2,406,573.

We plan to launch LIV+ in two different parts of South Africa: Messina, a large town on the border of South Africa and Zimbabwe, and Johannesburg, the capital city of South Africa. We chose Messina for its high migrant population and high HIV infection rate (40%), and we chose Johannesburg for its huge population and high HIV infection rate (26%). By launching in these two cities, we hope to target the most people who will benefit from our service, as well as immediately entice companies to advertise through us. We plan to market and advertise both through public ad campaigns and individual doctors, hospitals, and clinics.

The service provided by LIV+ is unique and invaluable to the millions of South Africans living with HIV/AIDS. We hope to eventually expand to the smartphone market and to markets in other countries with high infection rates of HIV/AIDS and high cell phone penetration rates. As a mobile service, we can adapt to challenges and new situations quickly and seamlessly as we strive to reach our goal of helping our members live their best lives. We look forward to showing you our business proposal and welcome your feedback.

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A SOLUTIONNOT A PRODUCTWe have developed three revolutionary products that turn a fragmented and disorganized culture of HIV care in South Africa into a unified social ecosystem that connects doctors with patients and patients with communities.

PASSPORTA new way for doctors to access and input patient information and store it securely and confidentially in the cloud.

REMINDERSAn SMS-based reminder system that aims to improve patient drug compliance and make healthcare more interactive.

SOCIALAn SMS-based social network between people living with HIV/AIDS that allows patients to form anonymous and confidential local support groups.

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PASSPORT changes the way HIV clinical information is stored by physicians and retrieved by patients. After enrolling with

LIV+, the first thing a patient receives is a Passport, accessible by a unique Identification Number. Patients are enrolled by their physician, who then creates a patient profile that is stored securely in the cloud. Our prototype passport contains a brief summary of the patient’s medical information, including basic demographic, diagnostic, and treatment data. This concise summary can be texted to the patient at any time he or she wants a real-time update on his or her health information. Passport compiles a patient’s laboratory work into a concise and aesthetic graphic. This can help a physician modify or continue a treatment plan. Passport also includes up-to-date information on what drugs a patient is on, when those drugs

should be taken, and what dosages should be consumed. This information syncs to the Reminders feature. Finally, given the complex immunological issues faced by HIV patients, Passport tracks local epidemics and co-infections that may affect individuals infected with HIV, such as tuberculosis.

Unlike a paper record, this record is secure and accessible anywhere. Thus, Passport allows patients to receive continuity of care from any physician who knows how to use the service, thus untethering patients from the doctors in their immediate vicinity or community. This helps patients who fear discrimination from family or community members remain discreet, and finally brings an accountable health records system to the large population of migrant workers in South Africa, migrant workers who can now track their care in the long term rather than receiving whatever fragmented care exists

Unlike traditional medical records, Passport’s design is clean, simple, HIV/AIDS specific, and can be accessed anywhere.

6 | LIV+

in the various locations in which they live. Smart phone penetration in South Africa is about 33%, while mobile phone penetration is 99.6%.1 Presumably, doctors will have more sophisticated technology available to them, such as smartphones or computers, and will be able to input information using an application or website interface. We will introduce Passport on the iPhone App Store, Android Market, and as a full-featured and mobile website so that it is accessible on as many platforms as possible. On the other hand, the technological requirements that are necessary for patients to access Passport information are far more minimal: simply a mobile phone capable of sending and receiving SMS messages, a feature virtually every South African has. By working with existing infrastructure, we feel that we are in a competitive position to grow our enrollment quickly. Furthermore, we are fully aware that the rapid pace of technological innovation and increased accessibility means that in a matter of years, even people at the bottom of the pyramid will have smartphone access. We anticipate and welcome this trend. We are actively working to make the transition from LIV+ services on SMS to smartphones, where we hope to bring even more

functionalities to patients. During an interview, an anonymous South African with HIV said, “If I keep a record, people will find it, and I will be finished”.2 That’s why Passport is so innovative. By keeping records securely in the cloud and accessible from the palm of one’s hand, patients no longer need to worry about writing down their information in a place where their relatives and community members can find it. Passport not only improves the accountability and professionalism of care, but also makes strides in reducing the stigma associated with keeping an updated record of care.

Passport provides physicians with a revolutionary interface to track HIV patient information over time and establish effective, continuous care for patients all over South Africa.

We are committed to updating our user experience on all platforms that are used by doctors and patients in South Africa.

1 “South African Mobile Market,” last modified January 2011, http://www.mnodirectory.com/ame/South_Africa.htm2 Alta C. Van Dyk, “Antiretroviral adherence in South Africa: are we burning our bridges?” (inaugural lecture presented by Prof. Alta van Dyk, Department of Psychology, University of South Africa, November 1, 2011).

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REMINDERS provides HIV patients with conversational and friendly alerts based on the treatment information stored in

Passport. Reminders aims to maximize drug adherence rates by alerting patients to maintain their prescribed treatment regimens. Lack of adherence not only worsens patient outcomes and reduces the ability of HIV patients to manage their disease over the long term, but also leads to the evolution of more virulent, drug-resistant strains of HIV which can worsen the scope of the global epidemic. Thus, Reminders addresses both an individual and global concern.

A Reminder is an SMS text message that contains the name of the drug to be taken, the correct dosage, and other related information (such as whether the drug should be ingested with food). In addition, it includes a fun fact or some form of positive reinforcement. Reminders will be available in all 11 of South Africa’s Official Languages, and Reminders are written in a fun and conversational voice consistent with local dialects. In a 2010 survey of 450 antiretroviral users in South Africa, among individuals who maintained less than 90%

adherence (non-adhering group), 23% cited difficulty with dosing schedules as one of their top reasons for non-compliance.1

Reminders accomplishes the basic, necessary task of keeping patients on track with their treatments while also providing psychological support when patients need it most. In addition, Reminders takes into account cultural and lifestyle issues that can affect drug adherence. In the aforementioned survey, among the non-adhering group, 22% thought that adhering to the regimen would interfere with their social lives while 21% said that they forgot to take their treatments when they consumed alcohol.2 Reminders use cultural and patient-specific research to tailor its script to each individual.

Finally, patients can also access a patient summary from their Passport simply by sending a text message to LIV+. This allows them to have effective real-time access to their health information, and maintain better knowledge and control of their own health.

Right now, the adherence rate for anti-retrovirual therapy (ART) in South Africa is

Reminders automatically generated from the prescription within a patient’s Passport as well as a Passport summary can be sent via SMS.

From: Dr. SmithTime 2 take tenofi-vir! Did u know u have 2 take >90% of ur meds to repress harmful viruses & replenish ur im-mune system? Text HELP for dosage instructions.

From: Dr. SmithHi John Doe, this is ur reminder to take 3TC 2night. Take it now b4 u head out for the night! Every treatment counts :)

From: Dr. SmithYOUR RECORD SUMMARY:John, your HIV was diag-nosed in 2007. Your latest CD4 count was 450. You are currently on a regi-men of tenofivir, 3TC, and efavirenz. Text HELP for dos-

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23%of South Africans cited difficulty with dosing schedules as a top reason for non-adherence.

21 %of South Africans forgot to take their treatments when they consumed alcohol.

22%of South Africans believed that adhering to their treatments would interfere with their social lives.

75%of South Africans cited stigmatization as a major cause of non-adherence to drug therapy.

of South Africans adhere to their prescribed HIV drug regimens, undermining the treatment

40-50%estimated to be between 40% and 50%, consistent with the adherence rate for most chronic diseases.3 We hope this double this number with Reminders and help patients become more informed about their health and interested in maintaining it.

A person living with HIV/AIDS must adhere to 90% or more of their drug treatments for them to be effective.

WE HOPE that Reminders will help improve drug compliance among South African patients. In the initial months of establishing our venture, we will

implement a double-blind study spanning a time period of four to six months in both Messina, South Africa and Johannesburg, South Africa, our two pilot cities. We will compare complaince rates among patients who have enrolled with LIV+ and have access to Passport, Reminders, and Social along with those who have not yet enrolled. We will be looking for differences in adherence to the prescribed treatment regimen. In addition, we will conduct a social study on the emotional effect that our products are having on

individuals who live with HIV. We will analyze all of the data collected over the time period of the study and publish it in a forthcoming report. Our expectation is to double the adherence rate from about 40-50%, where it stands today to at least 90%. The literature clearly indicates that a lack of adherence not only worsens individual outcomes, but also allows the virus to develop resistance mutations that can have negative implications on the national or global pandemic. We are committed to rigorously putting our products to the acid test of a double-blind study in order to confirm that we are having the impact we desire on the communities in which we operate.

ACHEIVING BETTER COMPLIANCE

1 Alta C. Van Dyk, “Antiretroviral adherence in South Africa: are we burning our bridges?” (inaugural lecture presented by Prof. Alta van Dyk, Department of Psychology, University of South Africa, November 1, 2011).2 ibid3 ibid

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BECAUSE OF STIGMA...

SOCIAL connects our HIV+ members with each other, and allows them to form local, anonymous peer support groups.

While Passport and Reminders provide positive steps in improving coherent treatment programs and drug adherence, a large barrier to comprehensive HIV care is social stigma. 75% of patients being treated for HIV said that stigmatization was a major cause of non-adherence to drug therapy.1 This invisible barrier can cause HIV patients to hide their drugs or diagnosis from friends and family, and prevent them from finding support groups due to the fear of discovery. At the same time, studies have consistently shown that individuals living with chronic diseases need help coping with depression and stress and with interpreting their own symptoms.2 These individuals would largely benefit from the support of their peers -- others who share their medical and emotional burdens. A culture of secrecy has left HIV positive individuals without the emotional resources they both want and need.

Social uses SMS text messages to create

local social networks where patients can share information and ideas. LIV+ anonymizes all patient data and information and connects groups of five to fifteen individuals. Social functions as a group chat, with each message being sent through a group alias and then blasted to other members of the group, obscuring the sender’s original number. Because the support networks are local, patients can give specific advice on the best doctors, clinics, and pharmacies in a particular town or village. They also have the option of meeting in person if desired. If the demand exists, we hope to introduce a new feature that groups homosexual individuals together to form support networks to combat the additional stigma associated with homosexual individuals affected by HIV.

One major potential impasse LIV+ will encounter in South Africa is that South Africa has eleven official languages. This situation has already made providing education and publicizing information about HIV/AIDS difficult for the South African government, NGOs, and other HIV/AIDS-related ventures. This problem will be easy to solve

With anonymous, digital support groups, we eliminate the fear of stigma and discrimination against people living with HIV/AIDS.

of South Africans living with HIV surveyed did not keep accurate health records..

43%

of South Africans living with HIV surveyed did not join support groups.

31%

of South Africans living with HIV surveyed said that they did not have treatment supporters.

26%

10 | LIV+

in terms of LIV+’s text message reminders by requiring the doctor who creates a member’s passport to select which language the patient speaks. In group messages amongst support groups, members have the option of joining groups by region, gender, sexual orientation, and other affinity, with each group subdivided by language. We do not anticipate literacy to be a major issue. The adult literacy rate as of 2010 is estimated to be between 80% and 89%, and the youth literacy rate is estimated to be between 90% and 100%.

WE ARE proud to offer Passport, Reminders, and Social free of charge to physicians and patients. In order to cover the costs of developing these

features and allow our growing company to become financially sustainable, we finance our venture using paid mobile advertisements, drawing our inspiration from the Google and Facebook business models. In this sense, all the HIV positive clients we enroll become a new and specifically targeted market. We plan on leveraging their mobile phone screens as an ideal advertising space for pharmaceutical companies, public health departments, local NGOs, and awareness promoting campaigns.

When clients sign up with LIV+, they are asked to agree to receive SMS text advertisements from a number of companies and NGO’s. By simply consenting to these advertisements, which inform them of products or deals that are targeted to their lifestyle, our clients receive the service for free.

We will sell advertising packages of 6 texts per month to all our clients, however a company will be free to purchase several packages. We will cap the number of advertisements a client receives per day at 10, both to be respectful of our clients, as well as to assure our customers that their ads receive the clients’ undivided attention. For more information on the pricing of our advertising packages, please see our Finance Section.

1 Alta C. Van Dyk, “Antiretroviral adherence in South Africa: are we burning our bridges?” (inaugural lecture presented by Prof. Alta van Dyk, Department of Psychology, University of South Africa, November 1, 2011).2 Heisler, Michele, M.D. Building Peer Support Programs to Manage Chronic Diseases: Seven Models for Success. N.p.: California HealthCare Foundation, 2006.

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12 | LIV+

THERE ARE 5.6 MILLION PEOPLE LIVING WITH HIV IN SOUTH AFRICA, MORE THAN ANY

OTHER COUNTRY ON EARTH.

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99% 30%

Smartphone penetration

Mobile (Feature) phone penetration

WHYSOUTH AFRICA

IN SOUTH AFRICA, 5.6 million people have HIV, making it the country with the highest number of HIV positive people in the world. To make matters

worse, even though HIV care and prevention are priorities of the South African government, the country’s death rate due to HIV/AIDS continues to grow. When our team considered where LIV+ would have the most impact, South Africa was the clear choice.

The mobile phone penetration rate in South Africa is 99.6%, and the smartphone penetration rate is 33%, one of the highest among African nations.1 Thus, LIV+ can reach virtually any HIV patient in South

Africa through SMS text, and increasingly via smartphone application as well. As smartphone penetration increases, our Reminders and Social features will function less through SMS texting and more through smartphone apps.

LIV+’s primary clients will be migrant workers at the bottom of the pyramid (BOP). While our venture focuses on helping the poor manage their HIV for altruistic purposes, we also focus on this population for practical reasons. Wealthier clients see less appeal in a free service, and because half the country’s population lives below the poverty line, it is no surprise that the majority of HIV positive South Africans are

South Africa’s uniquely high HIV infection and cell phone penetration rates make it the ideal market for LIV+.

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in the border town of Messina, where we are piloting our venture.

MIGRANT WORKER POPULATION

40%

among the partners of migrant workers.

HIV INFECTION RATE

21%

in migrant workers who travel to find work.

HIV INFECTION RATE

26%

members of the BOP. Targeting this income bracket simply brings us more clients.

LIV+’s mobility allows migrating workers, one of the most at-risk populations for HIV/AIDS, to maintain consistent treatment plans. Migrant workers are common because mining is one of the country’s major industries; South Africa is the world’s largest producer of platinum, gold, and chronium. In 2007, about 493,000 South African men moved from one cheap motel to another for their work in the mines,2 although other studies claim this number should be in the millions.3 In addition to the miners, South Africa is experiencing a large influx of immigrants from neighboring countries, especially Zimbabwe. These immigrants have roots in South Africa, and so, despite the 25% unemployment rate, they traverse the country trying to find work.4

Migration facilitates the spread of HIV; one study found that without migration, HIV prevalence would be less than 5% for both migrants and non-migrants. In reality, the prevalence rate is 26% among migrant men and 21% among their partners.5 Therefore, LIV+’s passport feature is especially

important for migrant workers who change doctors, pharmacies, languages, and treatment plans as they travel. This population needs control over their own medical records, and thus will be more receptive to our service. As they travel, our reminders help them maintain a schedule, and our social component allows them to connect to peers in each new place to get location specific advice.

Keeping in mind our prospective market, we will launch our venture in two different parts of South Africa - Messina, a large town on the border of South Africa and Zimbabwe, and Johannesburg, the capital city of South Africa.

Messina is a town with a population of 20,000, but with an HIV infection rate of 40% (over twice the national rate).6 A huge number of migrant workers live, at least temporarily, in Messina. Half of the Messina population migrates to Zimbabwe for farming jobs that last half the year.7 At the same time, many Zimbabweans flee over the border and into South Africa to live as illegal immigrants. It is thought that at any given time there are at least 10,000 immigrants settled in Messina,

Launching LIV+ in Johannesburg and Messina targets the largest and most at risk HIV/AIDS popiulations, respectively.

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trying to figure out where to go from there, as they try to survive in a country with a 25% unemployment rate.8 As our service is especially useful to migrant workers, Messina is a uniquely ideal place to launch our service.

Johannesburg is the largest city in South Africa and home to 3.6 million people. 26% of its residents are infected with HIV.9 The draw of Johannesburg is simply the vast number of people with HIV and the compressed nature of an urban environment that allows us access to many more people per doctor. The goal is to reach as many people who will benefit from our venture as quickly as possible, since the only way to entice companies to buy our advertising packages is to have a large number of clients almost immediately.

As our venture requires no infrastructure, we can implement our venture in both locations simultaneously. We also hope that as our venture gains popularity and brand recognition we will be able to expand throughout South Africa, and possibly to other countries struggling with HIV/AIDS..interdum.

Messina

Johannesburg

Population

Johannesburg

3,600,000

9,360,000

Urban

No

HIV+ Infected Population

Environment

Migrant Workers

Messina

20,000

8,000

Rural

Yes

1 “South African Mobile Market,” last modified January 2011, http://www.mnodirectory.com/ame/South_Africa.htm.2 Mathews, Charlotte. “South Africa: Mining Investment Shows Recovery.” AllAfrica. Last modified November 7, 2007. Accessed January 15, 2013. http://allafrica.com/stories/200711070356.html.3 Louw, Matthew. “HIV Danger to Migrant Workers.” Health 24. Last modified May 7, 2007. Accessed January 15, 2013. http://www.health24.com/medical/Condition_centres/777-792-814-1762,33326.asp. 4 “South Africa.” In The World Factbook. Central Intelligence Agency. Last modified January 7, 2013. Accessed January 15, 2013. https://www.cia.govlibrary/publications/the-world-factbook/geos/sf.html. 5 Alta C. Van Dyk, “Antiretroviral adherence in South Africa: are we burning our bridges?” (inaugural lecture presented by Prof. Alta van Dyk, Department of Psychology, University of South Africa, November 1, 2011).6 Langa, Lungi. “High Rates of HIV Among Farm Workers.” Health-e. Last modified November 11, 2010. Accessed January 15, 2013. http://www.health-e.org.za/ news/article.php?uid=20033022. Limpopo Provincial Government Limpopo Department of Health. Care-DiscussionTargeted Adherence Strategies for Provision of Cross-Border Antiretroviral Therapy (ART) to Migrant Farm Workers in Musina, South Africa. By T. Matambo, C. Mwongera, L. Wilkinson, G. Van Cutsem, A. Bauernfeind, C. Metcalf, R. Sirwali, and H. Bygrave. 8 UN Office for the Coordination of Humanitarian Affairs. “SOUTH AFRICA: Migrants face unlawful arrests and hasty deportations.” IRIN: Humanitarian News and Analysis. Last modified February 14, 2012. Accessed January 15, 2013. http://www.irinnews.org/Report/94865/ 9 Health.” Joburg, My City, Our Future - Official Website of the City of Johan-nesburg. Last modified January 15, 2013. Accessed January 15, 3. http://www.joburg.org.za/index.php?option=com_content&task=view&id=41&Itemid=69.

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COMPETITIVEADVANTAGE

WE ARE competing in the realm of electronic medical records, and we believe we possess several advantages

over our competitors. We have deeply studied the challenges in implementing EMR systems and examined the flaws in these systems, especially Google Health. We then built Passport, the LIV+ akin to most electronic medical records, to address Google Health’s shortcomings. However, our true competitive edge comes from the fact that we add the functionalities of Reminders and Social, something we believe no one is currently doing. Furthermore, we provide our service at no cost to the end user, giving us a financial advantage over competitors.1234

Here are the flaws in other EMRs that we attempted to overcome:

EMRS LIKE GOOGLE HEALTH FAILED BECAUSE DO NOT INVOLVE DOCTORS.

The ability of patients to control their own health information is paramount to our philosophy; however, noting the failure of EMRs that are too patient-controlled or bottom-up such as Google Health, we have opted for a model where data is inputted and updated through physicians. Our service, while serving patients, is administered through physician hubs, and we aim to expand our service by reaching physicians who we hope will enroll their patients subsequently. When a patient with

a Passport sees a doctor not affiliated with LIV+, our easy-to-use database allows the new doctor to enter the patients profile at the appointment.

PHYSICIANS FIND EMRS TOO BURDENSOME TO USE AND FEEL THAT EMRS ARE RESTRICTIVE.

Changing the way a physician practices medicine can be a large burden that impedes the successful implementation of electronic health records, especially if the physician is in a population-dense area and is already overwhelmed by a large number of patients or complicated disease. Furthermore, the EMR can be restrictive by giving the physician less freedom to input information and forcing him to choose among the available buttons and menu options. Finally, physicians may not feel that the EMR is clinically appropriate to their specialty or practice. The LIV+ passport addresses all three of these weaknesses. First, we make our Passport, Reminders, and Social services easy to use and provide easily accessible instructions and tutorials, removing the high barrier usually associated with transitioning to EMR systems. Second, we work with communities to put into place a gradual and appropriate implementation program that addresses every clinic and community’s specific needs. Second, by tailoring our service to one specific disease, we are able to make our applications as clinically specific as possible. Given that HIV treatment consists primarily of putting together a drug regimen

LIV+’s unique combination of services and radical affordability already gives us our competitive advantage. However we also strive to make our individual services competitive by learning from past failures in EMRs and peer support groups and improving upon them.

LIV+’s Reminders and Social features make it a unique service in health management.

LIV+ | 17

and determining appropriate dosage our system gives physicians enough freedom to make clinical decisions on their own. Finally, by keeping local physicians as consultants on our payroll and conducting active market research as we introduce our services, we can implement on the ground customizations that increase ease-of-use and accessibility for South African physicians.

HIGH COSTS CAN BE A RESTRICTIVE FACTOR IN THE IMPLEMENTATION OF EMR SYSTEMS.

We understand that this can be a huge problem, especially for those at the bottom of the pyramid. As we will mostly be marketing LIV+ to very poor people, we are very aware that high costs become a non-starter for the implementation of new technologies. That is why we are providing all three of our services: Passport, Reminders, and Social completely free of charge to the end user: the patients. Instead we are relying on our advertising packages to allow us to provide essential services to HIV patients at no-cost while still operating at a profit after five years.

EMRS LIKE GOOGLE HEALTH FAILED BECAUSE THEY WERE NOT SOCIAL ENOUGH.

Our largest competitive advantage is the inclusion of the Social feature which takes all of the patients that we enroll and connects them through local social networks. With Social, patients can anonymously join an SMS-based support group of local patients. This gives patients a resource more powerful than any one physician or technology, the ability to share experiences and encouragement with peers facing a similar situation. We think that Social is the missing link that has plagued vertically designed EMRs and can revolutionize the healthcare experience in South Africa.

WE ALSO believe that though there are in-person peer support groups for people with HIV, we have

a competitive advantage for parts of the South African population who hide due to HIV stigma.

PEER SUPPORT GROUPS ARE AVOIDED BECAUSE THEY ARE TOO PUBLIC AND CAN BE DISCOVERED.

LIV+ understands that when it comes to HIV, privacy is paramount. Fear of discrimination was the main reason why 31% of HIV positive South Africans do not belong to support groups. LIV+ eliminates this problem by anonymizing group chats in support groups. This same fear causes 43% of HIV/AIDS patients in South Africa to not keep treatment records.5 We keep our members’ medical records safe in our database and anonymous by issuing each member a user ID number. By recording all our anonymous services in a mobile phones, we give our clients the power to manage their disease with confidentiality and peace of mind.

Reminders automatically generated from the prescription within a patient’s Passport as well as a Passport summary can be sent via SMS.

1 Chase, Dave. “Why Google Health Really Failed—It’s About The Money.” Tech Crunch. Last modified June 26, 2011. Accessed January 15, 2013. http://techcrunch.com/2011/06/26/why-google-really-failed-money/.2 Dolan, Brian. “10 Reasons Why Google Health Failed.” Mobi Health News. Last modified June 27, 2011. Accessed January 15, 2013. http://mobihealth-news.com/11480/10-reasons-why-google-health-failed/.3 McGee, Marianne Kolbasuk. “5 Reasons Why Google Health Failed.” Infor-mation Week Health Care. Last modified June 29, 2011. Accessed January 15, 2013. http://www.informationweek.com/healthcare/electronic-medical-records/5-reasons-why-google-health-failed/231000697.4 Sharp, Adam. “Why EMR Is a Dirty Word to Many Doctors.” Kevin MD. Last modified February 2, 2012. Accessed January 15, 2013. http://www.kevinmd.com/blog/2012/02/emr-dirty-word-doctors.html.5 Alta C. Van Dyk, “Antiretroviral adherence in South Africa: are we burning our bridges?” (inaugural lecture presented by Prof. Alta van Dyk, Department of Psychology, University of South Africa, November 1, 2011).

18 | LIV+

CONDOM COMPANIESDurex in South AfricaMax Sense condomsChoice Condoms distributed by Department of health Health4Men is an NGO that distributes free condoms

HEALTH FOOD AND VITAMIN COMPANIESVital Health Foodse’Pap – Ready-to-eat affordable food with “nutrient repleteness”FoodstateVitamin Research Products South Africa

NGOS ADVERTISING TO HIV PATIENTSNurturing orphans of AIDS for HumanityHomes for Kids in South AfricaChildren in Distress NetworkAIDS Law Project is a “legal ‘bull terrier’” protecting people with HIVTreatment Action Campaign campaigns for the rights of people with HIV/AIDS.Centre for Aids Development, Research and Evaluation conducts research on HIV

WHY ADVERTISEWITH US?

COMPANIES and NGO’s want to send SMS text advertisements because, in the past decade, SMS text advertising has proved

to be a successful marketing technique. Studies show that 97% of text message advertisements are opened, and 83% are opened within the first hour.1 As evidence of this, one mobile service provider in the UK called Blyk sent 6 SMS text advertisements to their 200,000 customers every day. They enjoyed a 29% response rate to their advertisements.2 Blyk is an especially apt comparison because, like LIV+, its customers agree to receive text advertisements instead of paying their a service, which in Blyk’s case is free phone calls.

We believe our mobile advertising strategy will be as successful as Blyk’s because SMS text advertising is widely used in South Africa already. In fact, the country is “ranked top 5 globally in terms of mobile

advertising impressions [or texts] served”.3

Advertisers have realized the effectiveness of this strategy and will see the value of our service. Google, too, is also betting on the growth potential of mobile advertising. The multibillion dollar company recently paid $750 million to buy AdMob, a global mobile advertising network that helps advertisers design cell phone-friendly ads.4

Why do our customers not feel spammed by these advertisements? Because our advertisements are optional and in line with our clients’ interests. According to a regional partner for Ogilvy Interactive, an international advertising and marketing agency, “too often, SMS is treated as mass medium rather than a personalized medium.” The CEO of mobile advertising company Trumpia says unwilling customers may perceive ads as annoying intrusions.5 Optional advertising sets our venture apart. Secondly, advertisements have a high risk of alienating customers if not useful. By giving

WHO WOULD ADVERTISE WITH US?

LIV+ | 19

advertisers access to only their target market, we eliminate their task of customer profiling.

Finally, by helping to maintain our clients’ drug adherence, advertisers can trust our clients to live longer. People properly treated for HIV have a full life expectancy, which is 60 years in South Africa. Untreated, patients’ diseases progress five times faster.67 Without proper drug adherence, patients progress to AIDS in 7 years and die in the next 3. If they maintain proper drug adherence, life expectancy increases fourfold. Thus, it is in the financial interest of pharmaceutical companies to advertise to our clients, for they will earn 75% of their revenue as our clients live--and use their drug--until age 60.

97%of SMS text advertisements are opened

83%of SMS text advertisements are opened within the first hour.

The potential additional profit to a drug company if a patient adheres to his prescribed treatment.

75%

NGOS THAT EDUCATE ABOUT HIVSoul City Institute for Health and Development Communication Nkanyiso Nutrition and HIV/AIDSCare South Africa - LesothoAids Foundation of South AfricaAids ConsortiumHope Worldwide AfricaSouth African People Living HIV network: NAPWAAvert: AVERTing HIV and AIDS

THE SOUTH AFRICAN GOVERNMENT

PHARMACEUTICAL COMPANIESAspen Pharmaceuticals received ~$327 mil from the 2012 tender from the South African government to produce generic ARVMylan Pharmaceuticals received ~$127 mil from the same tender for the same purposeCipla Medpro South Africa Limited received ~$166 mil from the same tender for the same purposepeople with HIVTreatment Action Campaign campaigns for the rights of people with HIV/AIDS.Centre for Aids Development, Research and Evaluation conducts research on HIV

5 thSouth Africa ranks

fifth in the world in the number of SMS text advertising

1 Cohen, Mark. “Text-Message Marketing.” The New York Times (New York, NJ), September 23, 2009, Small Business.2 Ahonen, Tomi T. “The Engagement Marketing Primer for 2013 - E Equals M 2 C - Engage-ment Equals Mobile To Community - Or How to Get 30% Response Rates With Your Next Campaigns.” Communities Dominate Brands: Business and Marketing Challenges for the 21st Century - the Blog of the Book by Tomi T. Ahonen + Alan Moore. Last modified January 10, 2013. Accessed January 15, 2013. http://communities-dominate.blogs.com/brands/sms/.3 Strike Media. “Mobile Advertising.” Strike Media. Accessed January 15, 2013. http://www2.strikemedia.co.za/Services/MobileAdvertising.4 Hof, Rob. “Google Buys AdMob in Bid to Boost Mobile Ads.” Bloomberg.com. Last modified November 9, 2009. Accessed January 15, 2013. http://www.businessweek.com/the_thread/techbeat/archives/2009/11/ google_buys_adm.html.5 Madden, Normandy. “The Promise and Problems of SMS Marketing.” Ad Age, December 2, 2002. Accessed January 15, 2013. http://adage.com/article/digital/promise-problems-sms-marketing/36379/.6 Harvard Health Publications. “Life Expectancy After HIV Infection: Getting Better All the Time.” msn Healthy Living. Last modified 2013. Accessed January 15, 2013. http://healthyliv-

ing.msn.com/diseases/aids-hiv/life-expectancy-after-hiv-infection-getting-better-all-the-time-1.7 cas, Gregory. “Antiretroviral adherence, drug resistance, viral fitness and HIV disease progression: a tangled web is woven.” Journal of Antimicrobial Chemotherapy 55, no. 4 (February 18, 2005): 413-16. Business and Marketing Challenges for the 21st Century - the Blog of the Book by Tomi T. Ahonen + Alan Moore. Last modi-fied January 10, 2013. Accessed January 15, 2013. http://communities-dominate.blogs.com/brands/sms/.3 Strike Media. “Mobile Advertising.” Strike Media. Accessed January 15, 2013. http://www2.strikemedia.co.za/Services/MobileAdvertising.4 Hof, Rob. “Google Buys AdMob in Bid to Boost

20 | LIV+

WE HAVE DEVELOPED A BUSINESS MODEL THAT ALLOWS

THE BOP TO ACCESS OUR SERVICE FREE OF CHARGE.

LIV+ | 21

FINANCIALSTATEMENT

THE The first step in outlining the economics of the venture is determining the size of our market. The population of

Johannesburg is about 3,900,000. Of these people, about 1,014,000 are HIV positive (26% of the population) and a mere 283,920 are seeking medical treatment.1 Assuming we tap just under 1% percent of this market—a very conservative estimate—we would have 2,500 clients in Year 1.

As for costs, the most significant is the cost of developing apps and software, which totals $150,000. Specifically, this is to pay three engineers to design a computer software for doctors to create patient profiles, a smartphone app so doctors and patients can access these profiles, and an automatic SMS reminder function. These engineers will remain with us in the following years to update and maintain our

systems. Our data is stored in an Amazon EC2 server, which initially costs $4,600 per 25 gigabytes of space.2 The cost increases each year to accommodate more patients and to store past years’ data. Marketing and sales costs are set at 7% of revenue for the first five years, which is the ideal percentage for a small business. By the time we have 80,000 clients in Year 6, marketing and sales costs become 11% of revenue, where they remain. A part-time medical advisor specializing in HIV earns a salary of $20,000 to ensure our decisions are in the best interest of HIV patients. LIV+ offers its services for free, and so our single source of revenue is the sale of SMS text advertisements. If the customer is interested in the product or service being advertised, they have the option to respond by typing back a short phrase. Responding

0.2%Year 1 32 4

0.3% 0.6%1.3%

2.5%

5 76 8

5.0%

6.9%

8.4%

9.4%

9 10

10%

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

6300%Over a period of ten years, we anticipate growing from 2,500 patients in pilot projects in Johannesburg and Messina to 160,000, representing 10% of the South African HIV+ population actively seeking treatment.

INCREASE IN CLIENTS

MARKET SHARE is shown above the absolute number of clients we hope to enroll in LIV+ services over a period of ten years.

22 | LIV+

gives them additional information, such as a code that enables them to purchase at a discount. We measure clients’ purchasing behavior by these response rates, charge advertisements per response, not per number of impressions. Thus, a company does not pay to advertise to uninterested clients.

When it comes to pricing advertising space, the key question is how much advertisers are willing to pay. Consider the cost of an advertisement for pharmaceuticals. The average South African with HIV spends $13 per month on medication. We can conservatively assume that 20% respond because Blyk, a similar mobile advertising company described above, has a 29% response rate. By this estimate, advertisements through our SMS system could bring a pharmaceutical company more than $6,600 per month. So an advertising package that costs 90% of that at $6,000 per month is potentially profitable for the company.LIV+ sells advertising at a monthly rate of $150 per package. The price is significantly lower because we must take into account that no single pharmaceutical company will be the beneficiary of all the advertising revenue. Note that we price advertisements at 30 cents per response, not per impression. As our venture grows and advertisements become more expensive, the price per response rate remains at 30 cents. An advertising package includes 6 messages sent per month to our entire client base, but a company can choose to buy multiple packages for a greater impact. As we cap the number of ads received per day at 10, we can sell up to 50 packages. However, we can reasonably expect to sell 30 packages in Year 1 and 40 in Year 2. At the end of Year 3, our revenues exceed our costs, and cash flow is positive. The venture becomes profitable at the end of Year 4, earning $360,000 and tapping into 7% of the Johannesburg market. By

Year 10, we will have expanded beyond Johannesburg to tap 10% of the South African market, earning $5,700,000.

Marketing and sales costs are set at 7% of revenue, the ideal for a small business.

We expect to have a positive net worth by the end of Year 4.

1 UNAIDS 2008 Report on the Global AIDS Epidemic. N.p.: The United Nations, 2008. Accessed January 15, 2013. http://data.unaids.org/pub/GlobalReport/2008/jc1510_2008_global_report_pp235_324_en.pdf.2 Amazon.com. “Amazon Elastic Compute Cloud (Amazon EC2).” Amazon Web Services. Last modified 2013. Accessed January 15, 2013. http://aws.amazon.com/ec2/.

LIV+ | 23

COST

Net Annual Cost

Data Server

Software Engineers

Marketing & Sales

Medical Consultants

YEAR 1

4600

150,000

3780

20,000

178,380

2

4600

150,000

10,080

20,000

184,860

3

4600

150,000

25,200

20,000

219,800

4

4600

240,000

50,400

40,000

335,000

5

4600

240,000

100,800

40,000

385,400

6

4900

240,000

316,000

40,000

601,700

7

5100

300,000

429,000

60,000

794,100

8

5500

300,000

541,000

60,000

906,700

9

5600

300,000

594,000

60,000

959,600

10

5700

300,000

627,000

60,000

992,700

REVENUE

Net Annual Cost

Clients

Ads per day

Impressions

Responses

YEAR 1

2500

6

5.48M

1.10M

54,750

2

5000

8

14.6M

2.92M

146,000

3

10,000

10

36.5M

7.30M

365,000

4

20,000

10

73.0M

14.6M

730,000

5

40,000

10

146M

29.2M

1.46M

6

80,000

10

292M

58.4M

2.92M

7

110,000

10

402M

80.3M

4.02M

8

135,000

10

493M

98.6M

4.93M

9

150,000

10

547M

110M

5.48M

10

160,000

10

584M

117M

5.84M

Price Per Response 0.05 0.05 0.05 0.05 0.05 0.05 0.05 0.05 0.05 0.05

over a period of ten years.IN NET WORTH

20.3M

ANNUAL PROFITNET WORTH

-124K -124K-38.8K -163K

145K

-18K

394K 377K

YEAR 1 32 4

1.07M 1.45M2.31M

3.76M3.20M

6.97M

4.02M

11.0M

5 76 8

4.51M

15.5M

4.83M

20.3m

9 10

5M

10M

10M

15M

20M

24 | LIV+

ADVISORYBOARD

JOHN D. DANNEREntrepreneur

Princeton University

PAUL FARMER, MDCo-Founder

Partners in Health

THOMAS S. MURPHYFmr. Chairman & CEO

Capital Cities/ABC

MAUREEN GOODENOWHIV/AIDS Expert

University of Florida

JAVIER OKHUYSENCo-Founder

SalaUno

CARLOS ORELLANACo-Founder

SalaUno

DAVID GREENFounderAurolab

OMAR HAMOUIFounder & Fmr. CEO

AdMob

CHARLIZE THERONCelebrity Actress

Activist

LIV+ | 25

OURTEAM

SARAH PATONChief Executive Officerspaton@princeton.edu

Sarah will graduate from Princeton University with a degree in Religion in 2013. As the driving force of the organization, she oversees major initiatives of the company and works to build high-level relationships with advertising clients in order to ensure financial sustainability. In her role as CEO, she works closely with all of the product, marketing, and advertising teams in order to make sure they are working together. She sits on the boards of several HIV-related NGOs and Philanthropic organizations in an effort to revolutionize the way that education and awareness-promoting organizations can align their own goals to those of the company.

GRACE MURPHYChief Financial Officergmurphy@princeton.edu

Grace will graduate from Princeton University with a degree in Economics in 2015. She oversees the finances of the organization. Her main role is to design and develop advertising pricing packages for the business and modify them as our business and brand grow. She also uses her experience and contacts to analyze industry trends, allowing the company to make long-term financial decisions.

ELIZABETH LIANChief Operating Officerelian@princeton.edu

Elizabeth will graduate from Princeton University with a degree in Anthropology in 2015. As COO, Elizabeth oversees all parts of the company and makes sure that all teams are working in a way that promotes corporate synergy and maximizes efficiency. She is an integral component in ensuring that all of the product, financial, and operation moving parts of the company are moving smoothly.

TEJAS S. SATHEChief Innovation Officertsathe@princeton.edu

Tejas will graduate from Princeton University with a degree in Molecular Biology in 2013. As Chief Innovation Officer, he is committed to providing the best user experience possible across all products and platforms. He works closely with the product development teams in order to create a unified product experience across all LIV+ services, creating a social ecosystem that dramatically improves the HIV patient experience.

26 | LIV+

Secrecy, stigmatization, and disorganization are the past. The integration of mobile technology

and health is the future.

LIV+

LIV+ | 27

THANKYOU

AFTER sorting out any problems with the practical application of our service in a trial, LIV+ will use an advertising campaign of our own, featuring a HIV positive South African celebrity, to spread awareness of our services and increase our reach. We expect that by Year 10, we will not only have lengthened the lives of 160,000 South Africans, but also have made

a significant cultural impact. We hope, in the future, to expand throughout South Africa and to other countries struggling with HIV/AIDS.

We are not a traditional online medical record, drug support system, or peer-group. We are LIV+, bringing cultural awareness and affordability to a simple and sustainable technology. It is possible to revolutionize the health industry through a basic profile. It is possible to lengthen a life with nothing more than a cell phone. It is possible to provide emotional support while maintaining strict privacy. It is possible to live as an HIV positive person. Live positively. LIV+

LIV+

LIVE POSITIVEPlease do not hesitate to contact us at any time with further inquiries. We look forward to hearing from you soon.