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Mobiles in Malawi - Antiretroviral Texting

Josh sitting with Grace Kamera, who coordinates St. Gabriel's hospital's ARV provision

Grace Kamera runs the HIV treatment program at St. Gabriel's. She oversees antiretroviral therapy (ART) for the catchment area; which includes 250,000 people and an HIV prevalence rate of 15%. While there are a few government-run health centers in the area, St. Gabriel's Hospital is the only facility offering HIV tests and the only place to get treatment.

Many of the CHWs are ART monitors; they are trained to check in on HIV patients, to see if they're complying with the treatment regimen. Noncompliance reduces the treatment's efficacy and contributes to drug resistance. Given a limited number of choices for drugs, patient adherence is critical.

Before FrontlineSMS and the accompanying cell phones arrived, Grace was receiving 25 paper reports per month from the ART monitors. With 21 ART monitors equipped with cell phones and trained in text messaging, she's received 400 adherence updates since the outset of the project (15/week).

If the paper trail had continued, each report would have been hand-delivered by a CHW. The average round trip is about 6 hours, so the SMS program has saved ART monitors 900 hours of travel time.

If Grace receives an SMS regarding a patient's missteps, she will counsel that patient when he returns for more drugs. The patients are well aware that the CHWs have cell phones, and they're grateful for the connection to the hospital (and Grace). Of all the patients who enroll in the ART program, 80% agree to be monitored. The remainder fear stigmatization within their communities.

Some patients do not turn up to receive their HIV medication. Grace says this is rare – "They usually come a day or two late" – but it happens. She's used the SMS network to track 25 patients who have failed to show, asking the nearest CHWs to report on their status. Sometimes they've left, other times they're unable to travel or they've passed away.

The hospital and the people it serves can't afford a lack of connectivity. With Grace at the reins, ART monitors will continue serving their communities, 160 characters at a time.