1. Using Mobile Technology to Strengthen HIV/AIDS Management in Remote Areas Authors: (1)Kunda, Mwape; (2)Pereko, Dawn; (2)Sumbi, Victor; (2)Mwinga, Samson; (1)Blom, Abram; (2) Mabirizi, David Affiliations: 1 Ministry of Health and Social Services (MoHSS) Namibia, 2 Strengthening Pharmaceutical Systems (SPS) Presenter Victor Sumbi Management Sciences for Health Date : Tuesday, 15 Nov 2011 Time: 3:15pm - 4:15pm Location: Septeryan B1-B3

2. Background Namibia is the second most sparsely inhabited country in the world. Vast distances have to be travelled to district hospitals which can greatly compromise quality of care and services resulting in patients being non-adherent in attending clinic appointments and medicine collection. To improve access to antiretroviral therapy (ART) services, the MoHSS has decentralized ART services to clinics and health centers in remote areas of Namibia. Data capturing and management at outreach sites was a challenge resulting in duplication of work. The staff at the outreach site had to use paper records and then use those records to update the Electronic Dispensing Tool (EDT) upon return to the main antiretroviral treatment (ART) site. Furthermore, data for outreach sites would often be missing or incomplete and therefore monitoring patients and quantifying medicines presented challenges. Intervention SPS supported the MoHSS in developing the EDT mobile using a hand held scanner. The device has the same functionalities of the EDT in that it enables dispensing, monitoring adherence through pill counts, setting patient appointments and managing stock. Data from the EDT is uploaded onto the scanner at the main site before an outreach visit is done. The scanner is then used to dispense medicines at the outreach site, and upon return to the main site, the primary EDT is updated with information from the scanner. At this stage, patient and stock records are updated. Results (1) 14 % (12,320) of all ART patients are serviced at outreach sites through the EDT-mobile. (2) Speed and accuracy of dispensing at outreach sites increased as dispensing is automated and labels printed. The need for double recording was eliminated thus freeing staff to perform other critical tasks. (3) Improved stock control at outreach sites due to accurate data on quantities of each antiretroviral (ARV) dispensed at the outreach site. (4) Improved patient and data management at outreach sites allowed for patient monitoring, stock management, and quantification of ARVs. (5) The need to computerize smaller outreach sites as had been envisaged was eliminated thus saving on costs and (6) Pill counts could be recorded which helps to objectively assess patient adherence as well as the facility average adherence. Conclusion The EDT mobile scanner is a fast, cost effective and efficient way to manage ART records in remote settings. Because it uses batteries, the scanner can be employed in areas where there is no electricity. The record holding capacity of the scanner enables use for multiple outreach sites and eliminates the need to update the EDT daily (updates can be done monthly or quarterly). EDT mobile is effective to use where record management is essential, but installation of a desktop computer is not feasible. This novel concept is recommended for data management in sparsely populated and resource limited countries like Namibia. Funding Source United States Agency for International Development/ Namibia

3. Introduction & Background (1) Namibia is the second most sparsely inhabited country in the world. Vast distances have to be travelled to district hospitals which can greatly compromise quality of care and services resulting in patients being non-adherent to attending clinic appointments and medicine collection. In order to improve access to antiretroviral therapy (ART) services, the MoHSS has decentralized ART services to clinics and health centers in remote areas of Namibia.

4. Introduction & Background (2) Challenge: Data capturing and management at outreach sites was a challenge. Pharmacy staff had to fill in paper records at the outreach site and then type in the same data into the Electronic Dispensing Tool (EDT) computer on returning to the main site resulting in duplication of work. Furthermore, data for outreach sites would often be missing or incomplete and therefore monitoring patients and quantifying medicines presented challenges.

5. Intervention MoHSS with support from MSH/SPS developed the EDT mobile using a hand held scanner. The device has the same functionalities of the EDT in that it enables dispensing, monitoring adherence through pill counts, setting patient appointments and managing stock

6. Picture of the EDT Mobile

7. EDT Mobile Specifications NB: This slide is hidden Mobile EDT (Handheld scanner) Cost per unit: N$ 6,325-00 (US$800) Item: CASIO DT930 Data Terminal Bluetooth functionality. Software: - Developed by supplier and charged as a one-off cost

8. Intervention (cont.) Data from the EDT is uploaded onto the scanner at the main site before an outreach visit is done. The scanner is then used to dispense medicines at the outreach site. Upon return to the main site, the primary EDT is updated with information from the scanner. At this stage, patient and stock records are updated.

9. Results As at October 2010, 16.5% (15,900) of all ART patients were serviced at outreach sites through the EDT-mobile Speed and accuracy of dispensing at outreach sites increased as dispensing is automated and labels printed The need for double recording was eliminated thus freeing staff to perform other critical tasks Improved stock control at outreach sites due to accurate data on quantities of each ARV dispensed at the outreach site.

10. Results (cont.) Improved patient and data management at outreach sites allowed for patient monitoring, stock management and quantification of ARVs The need to computerize smaller outreach sites as had been envisaged was eliminated thus saving on costs Pill counts could be recorded which helps to objectively assess patient adherence as well as the facility average adherence

11. Implications & Conclusions The EDT mobile scanner is a fast, cost effective and efficient way to manage ART records in remote settings. Because it is battery-powered, the scanner can be employed in areas where there is no electricity. The record holding capacity of the scanner enables use for multiple outreach sites and eliminates the need to update the EDT daily (updates can be done monthly or quarterly). EDT mobile is effective to use where record management is essential, but installation of a desktop computer is not feasible. This novel concept is recommended for data management in sparsely populated and resource limited countries like Namibia.

12. EDT Mobile in Use at a Health Facility A pharmacist's assistant scans medicines to enter into the EDT Mobile

13. Thank You