Abstract
BackgroundCommunity-based strategies to test for HIV, hepatitis B virus (HBV), and sickle cell disease (SCD) have expanded opportunities to increase the proportion of pregnant women who are aware of their diagnosis. In order to use this information to implement evidence-based interventions, these results have to be available to skilled health providers at the point of delivery. Most electronic health platforms are dependent on the availability of reliable Internet connectivity and, thus, have limited use in many rural and resource-limited settings.ObjectiveHere we describe our work on the development and deployment of an integrated mHealth platform that is able to capture medical information, including test results, and encrypt it into a patient-held smartcard that can be read at the point of delivery without the need for an Internet connection.MethodsWe engaged a team of implementation scientists, public health experts, and information technology specialists in a requirement-gathering process to inform the design of a prototype for a platform that uses smartcard technology, database deployment, and mobile phone app development. Key design decisions focused on usability, scalability, and security.ResultsWe successfully designed an integrated mHealth platform and deployed it in 4 health facilities across Benue State, Nigeria. We developed the Vitira Health platform to store test results of HIV, HBV, and SCD in a database, and securely encrypt the results on a Quick Response code embedded on a smartcard. We used a mobile app to read the contents on the smartcard without the need for Internet connectivity.ConclusionsOur findings indicate that it is possible to develop a patient-held smartcard and an mHealth platform that contains vital health information that can be read at the point of delivery using a mobile phone-based app without an Internet connection.Trial RegistrationClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE)
Highlights
Tremendous progress against AIDS over the last 15 years have inspired a global commitment to end the epidemic by 2030
Pre-exposure prophylaxis for population groups at higher risk of HIV infection. These pillars are reflected in the bold prevention targets for 2020 set by the United Nations General Assembly within the 2016 Political Declaration on HIV and AIDS to ensure that 90% of people at risk of HIV infection access comprehensive prevention services, including harm reduction; to reduce below 100 000 per year the number of adolescent girls and young women aged 15–24 years newly infected with HIV globally; to make 20 billion condoms available annually in lowand middle-income countries; to reach 25 million additional young men in high HIV incidence areas with voluntarily medical male circumcision and to provide three million people at higher risk of HIV infection with pre-exposure prophylaxis (PrEP)
The results suggest that alternative funding priorities for HIV prevention—including the promotion of condom use, voluntary medical male circumcision and treatment, combined with structural approaches—may yield greater health benefits
Summary
Tremendous progress against AIDS over the last 15 years have inspired a global commitment to end the epidemic by 2030. Pre-exposure prophylaxis for population groups at higher risk of HIV infection These pillars are reflected in the bold prevention targets for 2020 set by the United Nations General Assembly within the 2016 Political Declaration on HIV and AIDS to ensure that 90% of people at risk of HIV infection access comprehensive prevention services, including harm reduction; to reduce below 100 000 per year the number of adolescent girls and young women aged 15–24 years newly infected with HIV globally; to make 20 billion condoms available annually in lowand middle-income countries; to reach 25 million additional young men in high HIV incidence areas with voluntarily medical male circumcision and to provide three million people at higher risk of HIV infection with PrEP. Stakeholders need to analyse and understand their local prevention needs and mount an appropriate combination prevention response
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