1. 1 Using 3G Mobile Internet Technology to Enhance Early Initiation of Children on ART in Rural Settings of Lesotho O.OYEBANJI, A.TIAM, A.ISAVWA, L. BUHENDWA, A. AHIMBISIBWE, M. MOKONE, M. PUTSOANE, M. FOSO

2. Background HIV-related infant mortality is high in sub-Saharan Africa (260,000 children died from AIDS-related causes in 2009 1 due to delay in diagnosis and timely initiation ART) Infant mortality is high in Lesotho (91 deaths per 1,000 live births) 2 There is a high under-five mortality rate (117 per 1,000 live births) 1, especially among children living with HIV Children die while awaiting DNA PCR results, which can take up to 12 weeks to be returned to the health facility from the laboratory 2 There is difficulty not only accessing health care services in some remote locations, but also transporting laboratory results from facilities to laboratories and results back to facilities UNAID Report on the Global AIDS Epidemic, 2010 1 LHDS, 2011 2

3. Terrain in Lesotho

5. Description EGPAF-Lesotho supported the MOHSW to initiate innovative approach to promptly distribute DNA PCR results to health facilities by using 3G mobile internet In Q2 2010, laptops and 3G mobile internet were provided for EGPAF District Clinical Coordinators (DCCs), who are trained nurses based in all 10 supported districts All DCCs electronically signed a confidentiality form Through this approach, the EGPAF Director of Clinical Services (DCS) receives DNA PCR results from the South Africa National Institute of Health on a weekly basis and the DCS immediately sends results to the DCCs The DCCs compile the DNA PCR results of their districts and take them to the health facilities Results are printed and patients contacted through the use of Lesotho Network of AIDS Service Organization (LENASO) focal persons, mothers2mothers community members (both are EGPAF sub-grantees), and community volunteers in the districts

6. Assessment A two-year data review from January 2010 to December 2011, a total of 787 infants: 345 males (43.8%), 442 females (56.2%) with a mean age of six weeks had DBS PCR test performed at Berea Hospital and its feeder clinics, Butha Buthe and Maputsoe Through the use of 3G technology, average test result turnaround time was reduced from 12 weeks to 4 weeks The percentage of HIV-positive children initiated on ART at these facilities and its feeder clinics increased significantly from 2% (3 out of 127) in the 2nd quarter of 2010 to 22% (40 out of 181) in the 4th quarter of 2010, Now 100% (all 137 infants) in1st quarter and all 113 infants in 4 th quarter of 2011 were initiated on ART within.

7. ART Initiation of Eligible Children Before and After Introduction of 3G Technology Mortality: calculated by taking the of number of deaths among children initiated on ART within 3 months over the total number of children initiated on ART 3G Introduced

8. ART Initiation of Eligible Children from Jan. to Dec. 2011

9. Lessons Learned The use of 3G mobile internet technology is feasible in Lesotho and has enabled faster and easier transfer of DNA PCR results to rural health facilities Use of 3G mobile internet facilitates early initiation of children on ART by reducing the waiting time for test results This intervention can have a great impact on infant mortality among HIV-exposed infants in Lesotho

10. Next Steps Further research on the impact of this intervention on infant mortality among HIV-positive infants in Lesotho is underway

11. Thank you