the distribution of cell phones to mothers of eid hiv positive infants in haiti :
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The distribution of Cell Phones to Mothers of EID HIV positive Infants in Haiti : A model for Increasing Adherence ?. Background : EID. Test every infant born to an HIV + ive mother . The DNA PCR = HIV D x from 4 wks of age. Rapid ELISA = 18 months of age – Maternal antibodies - PowerPoint PPT PresentationTRANSCRIPT
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The distribution of Cell Phones to Mothers of EID HIV positive Infants in Haiti:A model for Increasing Adherence?
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Background : EID• Test every infant born to an HIV +ive
mother. • The DNA PCR = HIV Dx from 4 wks of age. • Rapid ELISA = 18 months of age –
Maternal antibodies • Early diagnosis Early treatment • Untreated, mortality is over 50% < 2 years.HIV positive child < 2 years old age to start
ARV treatment upon diagnosis.
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• The number of children infected is the ultimate measure of the success of the PMTCT program• Without the EID its impossible to
know when the “Elimination of Transmission From Mother to Child” has been met.
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2011 - 20122010
20092008
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Pregnant women HIV +ive OPTION
B +ARVs
Birth & Feeding
PlanInfant
Prophylaxis(AZT/NVP
6 WKS)
Infant PCR 4-6
Wks
Positive Infants Start ARVsNegative
Infants re-test after weaning
FP Discussion
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Methods May 2010• Given to mothers of newly diagnosed HIV + infants
through the PCR program• Regularly communicate with the mothers about
the child• Mothers who gave consent and signed “Contract” • Consent of Mothers with pre-existing cell phones • Contacted weekly - health status, appointments,
drug adherence.
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Results# Sites # Women
Given Phones# Women
Own Phones# Active Phones
20 70 38 76/108(70.4%)
# Phones Inactive
# Phones Stolen
# of Children with phones in active follow up, on ARVs
and Adherent
21/108(19.4%)
11/108(10.2%)
76/76(100%)
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QuestionnaireWhy were you given a phone?
50 Respondants of 70 Given
90% to check if my child is healthy/ ok/ to check on my
child’s health
74% ‘ to remind me of my appointments’
60% ‘ to contact someone if my child is sick or needs help’
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• Why were you given a phone? • 50
What do you feel when you are called by the team?76 respondents
( 50 donated phones and 26 own phones )
76 Felt Positive about being contacted100%
Does being contacted by the team help you? 76 Respondents
Yes 75 No 1
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Why is it helpful to be called?76 Respondents
61 (80%) It was helpful as an appointment reminder
63% It helped them to remember medication for their
children
51% It was helpful when their children were ill.
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What problems have you had with the phone?76 Respondents
75% Problems buying credit or minutes for their phones.
40% Difficulty in charging the phone.
25% Poor phone reception
21% Fear of the phone being stolen
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Limitations• Small Sample Size :The EID program
diagnoses 150 children per year in Haiti • No biologic markers of adherence • No Pre and Post follow : Given phones
close to the time of diagnosis. • Not a randomized controlled trial. We did
not want to risk losing children to follow up.
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Anecdotes LOOK away if Offensive!• Phones given close to the time of diagnosis,
Phones helped start treatment earlier.• When children become acutely ill, mothers can
ask for advice esp : cholera epidemic. • Links to health agents : drugs shortages/
transport issues• One Mother planned to commit suicide, but
because of regular contact she felt more positive about the future.
• One of our mothers was beaten by her partner• Phone as a security deposit for food.
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Other uses of Mobile technology in Haiti EID program
• Live, online spreadsheet that is linked to the reference labs.
• In 2010 median of 1 day for result transmission to the providers. 2000 children. Smart Phone Access the spreadsheet
• Communicate with Pregnant Women • Adolescent Outreach
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Conclusions• Using cell phones with families of HIV-positive
children has helped monitor these children. • Approx. 20% of PCR positive children identified
are lost to follow up within 12 Months• Phones 20 USD in Haiti; not prohibitively
expensive. The use of cell phones, as part of an active
community tracking program has benefitted the Haiti EID program.
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Thanks and AcknowledgmentsMSPP
USAID/ PEPFAR Voila Foundation
Caris Foundation Directors