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Innovative Mobile Health Initiatives Poised to Transform Tanzania’s Tuberculosis and HIV Response
Mobile Health (mHealth) technology—which, simply put, is the provision of health services and information via mobile technologies such as mobile phones and personal digital assistants—is revolutionizing healthcare service delivery for people living with HIV (PLHIV) and tuberculosis (TB) in Tanzania, thanks to strong support from the Government of Tanzania, U.S. government agencies such as the Centers for Disease Control and Prevention (CDC) and USAID, as well as implementing partners. Tanzania ranks sixth among countries in Africa bearing the highest TB burden and 22nd among countries globally. Additionally, TB continues to be among the top 10 causes of mortality and hospital admissions for patients ages five years and above in the country. HIV and TB are overlapping epidemics, and PLHIV face an increased likelihood of developing TB. Among evidence-based efforts to halt the spread of these diseases, two cutting-edge mobile services were recently launched in Tanzania targeting at-risk minors, the elderly, and various key populations. These mHealth services provide much needed customized health information, educational messaging, reminders for patients on antiretroviral therapy (ART), and prompts for follow-up care.
The first mobile service includes the Fast ART Self-Assessment & ARV Refill Mobile Service (FASTA), developed and implemented by the mHealth Tanzania Partnership team in collaboration with Henry Jackson Foundation Medical Research Institute, under the leadership of the National AIDS Control Program of the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) – and the President’s Office for Regional Administration and Local Government. It is the first-ever mobile technology application for multi-month drug scripting targeting clients stable on ART.
FASTA aligns with the U.S. President’s Emergency Plan for AIDS Relief’s (PEPFAR) multipronged service delivery strategy, a client-centered approach that simplifies and adapts HIV services across the HIV care continuum (cascade), in ways that both better serve the needs of PLHIV and reduce unnecessary burdens on the health system. The mobile application service allows eligible clients to answer a series of questions, similar to those a clinician would ask during a physical visit, before receiving authorization to pick-up a three-month supply of ART. The text-message scheduling component is then used to deliver monthly self-assessments, without the in-person check-ups with providers that were previously required. The final step is sending semi-annual clinical visitation reminder messages to registered ART clients.
FASTA has been launched in August 2018 in 15 high-volume sites in Ruvuma, an administrative region in southern Tanzania and has thus far enrolled 1,634 HIV-stable clients. To date, 113 care and treatment center healthcare staff have been trained on assisting HIV-stable clients with registration and 28 pharmacists have been oriented on how to dispense ART to FASTA clients. This service application is the first comprehensive HIV mobile service to include treatment literacy messaging, index testing services, and clinical appointment reminders to target clients who are both stable and unstable on ART.
The second mHealth service is the TB Self-Screening and Patient Treatment mHealth Application,
launched by the mHealth Tanzania Partnership under the leadership of MoHCDGEC’s National Tuberculosis and Leprosy Programme and partner KNCV Tuberculosis Foundation. This service leverages mobile technology to increase the identification of symptomatic TB patients in the general population, providing detailed tailored treatment literacy information to consenting TB and TB/HIV co-infected patients who have initiated TB treatment.
Since its launch in September 2018, over 164,018 people have completed the TB self-screening assessment with over 7,657 enrolled in the TB awareness messaging service. Additionally, 450 healthcare providers have been trained on the application allowing for data disaggregation for self-screening with a breakdown of presumptive versus non-presumptive cases and multiple TB patient classifications to ensure clients receive the appropriate tailored content based upon the specifics of their medical condition.
The widespread expansion of mobile phone coverage in Africa and other resource-limited settings offers opportunities to overcome weaknesses in health systems and to improve healthcare service delivery through mHealth technologies such as these in use in Tanzania. CDC and its partners continue to adapt and adopt new technology and evidence-based approaches to enhance service delivery, improve patient outcomes, and, ultimately, achieve HIV epidemic control and bring an end to TB.