1. Evidence based mHealth for patient engagement in care
WelTel International mHealth Society
Presenters: Bonface BetI &
Antony M. Khaemba

2. INTRODUCTION
WelTel SMS technology is an mHealth intervention that aims to improve health outcomes
WelTel is an evidence based intervention, based on evidence to improve HIV treatment adherence and viral suppression (Lancet, 2010)
WelTel Kenya 1 study carried out in three facilities in Kenya showed that patients who received SMS support had significantly improved ART adherence and viral load suppression
More clients that received WelTel SMS support in the RCT had improved rates of viral load suppression (156/273) as compared to 128/265) who received standard care
Mobile health/mHealth is a medical or public health practice supported by mobile devices, such as mobile phones, personal digital assistants and other wireless devices.

3. Clinic’s Tablet/ Phone
Client’s Phone
WelTel SMS Platform
Mambo? (How are you?)
Clinic’s Tablet/ Phone
Sawa (am fine)/shida (Not Fine)
If shida – clinician calls the patient
Point of care
WELTEL TECHNOLOGY SMS PROTOCOL

4. WELTEL KENYA 2 PROJECT
WelTel Kenya 2 project is a collaboration AMREF Aphia plus Imarisha, UBC, WelTel International mHealth society. The project is currently implementing the WelTel SMS technology service in various health facilities in NAL
Funded by GCC and USAID through Aphia plus Imarisha
The project aims
To introduce and optimize WelTel SMS service in the HIV CCC and MNCH clinics in northern arid land (NAL)
To evaluate the impact of the WelTel service on various HIV and MNCH health indicators in NAL
WelTel are involved in the implementation of the project while Aphia plus Imarisha and UBC are involved in the evaluation of the impact of the project

5. HEALTH CHALLENGES AND BASELINE STUDY IN NAL
Social cultural and geographic barriers in NAL limit access to health care
There was a low number of HIV CCC and MNCH clients who were retained in care which resulted to poor health outcomes
A baseline survey was carried out among MNCH participants in 6 government facilities in NAL and two neighbouring government facilities for comparison in 2014/2015
211(74%) of the participants owned a mobile phone and 39(53%) who did not own a phone shared access to phone
230(92%) of the partipants responded that they would like to receive a weekly SMS from health care provider to inquire about their health
Almost all counties in NAL have high maternal mortality rate (MMR)- e.g. Isiolo County has more than 700 MMR/ deliveries and Kenya has not yet achieved the set WHO MDG of 147/ by Some counties in NAL like Wajir have MMR of over 1100/100000

6. A MAP OF KENYA SHOWING NORTHERN ARID LAND
NAL occupies more than 60% in Kenya

7. REGISTRATION IN THE WELTEL PLATFORM
CCC HIV and MNCH clients are informed about the existence of the WelTel service during their visits in health care facilities, how the service functions and what the service aims to achieve
Clients are registered in the platform either using an offline mode- without internet or an online mode- using internet
A client who owns a phone or has access to a shared phone and is willing to participate in the project is registered in the WelTel SMS platform
WelTel Kenya 2 project is currently being implemented in Isiolo County Referral Hospital, Kinna Health Center and it will be launched in Maralal Referral Hospital in Samburu in June 2016

8. HEALTH EDUCATION AND REGISTRATION OF A CLIENT
A participant will sign a consent for him/her to participate in the project

9. PROTOCOL: SMS TEXT MESSAGING
Monday
If necessary
Health
Advice
<48h
SMS response

10. CLIENTS OFFLINE REGISTRATION
Send as a message
via SMS type: R clinic ID patient name
Most of the registration is done on offline mode because it is cheap, accessible and easily available

11. REGISTRATION USING ONLINE MODE
WelTel platform online mode is passcode protected
Passcode ensures that patients data is secure

12. REGISTRATION OF CLIENTS USING ONLINE MODE
After delivery the ANC clinic is changed to immunization clinic to help in transition from ANC care to postnatal care

13. SENDING REMINDERS MNCH
It is able to send appointment reminders, immunization reminders and reminders for psychosocial support group monthly meeting for HIV and MNCH clients

14. WELTEL MNCH PLATFORM
Immunization reminders at 6 weeks, 10 weeks, 14 weeks and 9 months

15. CHALLENGES EXPERIENCED DURING THE IMPLEMENTATION
The major challenge experienced in the implementation of the project is poor internet connections in NAL
However the WelTel technology is able to register a client on an offline mode and all the responses from the clients are visualized on the phone or tablet as a message
A patient registered on the offline mode will be automatically be registered on the online mode

16. ADVANTAGES OF WELTEL SMS TECHNOLOGY
It improves patient health service- it improves patient engagement in care with HCP through:
low cost, (basic SMS and voice), SMS bundles
discrete SMS (appropriate for HIV clients)
valued by patients: weekly “check-in” SMS makes a client feel better cared for
strong evidence base (multiple published studies)
WelTel Kenya 1 RCT done in three facilities (Editor’s choice, Lancet 2010) proved that WelTel weekly SMS check in model improved HIV treatment outcomes

17. CONTINUATION OF ADVANTAGES- WELTEL
Scalable: Has minimal training requirements, intuitive turnkey project, able to register clients without internet connection, central server (remote support)
Accessibility: minimal literacy and a basic phone is required, also sharing of phones is allowed- very appropriate for Manyatas where clients share phones
Adaptability: adapted and it is able to support various conditions HIV, MCH, TB, asthma and hypertension
Secure: highest international standards, health data not kept on devices
Secure server, password protected, encrypted, auditable
Stable: minimal down-time
Manyatas are common in NAL and most of the people staying in Manyatas share phones and there are community health care volunteer who respond to weekly SMS

18. IMPROVING ENGAGEMENT TO HIV CARE BY CCC CLIENTS IN ICRH USING WELTEL IN QUARTER 2 2016
Appointment status of non WelTel clients
Appointment status of WelTel clients
Jan
Feb
March
Met
174 (66.56%)
177 (53.25%)
165 (58.72%)
Previously missed
65 (25%)
131 (39. 39%)
88 (31.4%)
Missed
22 (8.44%)
25 (7.36%)
28 (9.88%)
Total
261
333
281
Jan
Feb
March
Met
160 (70.83%)
145 (64.29%)
163 (86.67%)
Previously missed
57 (25.22%)
80 (35.71%)
25 (13.33%)
Missed
9 (3.95%)
TOTAL
226
225
188
Met- patients who came for their appointment on the scheduled day, previously missed- patients who didn’t come for their appointment on the scheduled day but came within 7 days of their missed appointment and missed- do not appear in the clinic within seven days of their missed appointment

19. LOST TO FOLLOW CLIENTS IN CCC CLINIC ICRH IN 2014 and 2015
WelTel project was launched in the CCC clinic in April 2015, therefore it has helped to improve engagement and therefore more clients are retained in care and the number of clients who are lost to follow up have reduced

20. IMPACT IN THE MNCH CLINIC ICRH AS FROM APRIL 2015 to MARCH 2016
Four and more ANC visits usually lead to better maternal and neonatal outcomes

21. Scale up and sustainability
WelTel vision is to provide WelTel mHealth model to support clinical care setting and strive to include most vulnerable and remote population
The project aims to scale up to most facilities in Kenya and Africa to help meet Sub Saharan UNAIDS targets
It also aims to improve maternal child health and save lives in Africa- SDG number 3
WelTel will incorporate use of MAPS toolkit to facilitate successful scale of the WelTel mHealth model
mHealth Assessment and Planning for Scale- MAPS toolkit

22. Acknowledgements

23. THANK YOU