The goal of the proposed pilot project is to better understand how geographic information systems (GIS) integrated with SMS cell-phone technology can facilitate improvements in linkage to Prevention of Mother to Child Transmission of HIV (PMTCT) and reduce time between diagnosis and consistent treatment with antiretrovirals (ARV) in a rural setting in Tanzania. While promising improvements in PMTCT have occurred, there remains varied access to HIV counseling and testing and subsequent access to antiretroviral treatment for mothers testing positive for HIV. Research is emerging that underscores the potential for mobile phones to improve HIV diagnosis, prevention, and adherence to treatment throughout Sub-Saharan Africa and additional evidence illustrates the utility of using geographic information systems (GIS) in HIV care. Through combining these technologies, the interactive and dynamic system can be used to: facilitate real-time responses to delivery of care, to establish HIV VCT in areas with emergent infections, to increase referrals to the District Hospital, and to inform the distribution of additional medication and treatment for mothers and infants for facilitation of PMTCT. Guided by the Diffusion of Innovation (DI) Theory, the proposed pilot project will achieve a baseline for a subsequent randomized controlled trial that will test the efficacy of a culturally sensitive, technologically relevant PMTCT program for Misungwi, Tanzania. The pilot will develop and test a mobile phone-based record keeping system that will interface with existing GIS resource maps to facilitate and document delivery of PMTCT and VCT in Misungwi. The system will be implemented in the district over a 3-month period in order to establish how well the system works. The implementation phase will be followed by evaluation of the system with respect to the HIV treatment cascade, including whether an increased number of new HIV infections are identified, if the time is reduced between HIV diagnosis and start of treatment for women of childbearing age, and whether increased adherence to medication among female clients of HW using the mobile phone based tools occurs. We anticipate that this interactive and dynamic system will contribute to best practices in PMTCT by facilitating improved responses to delivery of care in these rural settings, assisting in locating additional HIV PMTCT programs in areas with emergent infections, and informing the distribution of additional medication and treatment for mothers. The explicit design of the study provides a model that could be scaled up in Tanzania and other East African settings. Additionally, if successful, the proposed approach holds great potential for replication to other priority populations for HIV and other health outcomes.
Even with significant progress in Prevention of Mother to Child Transmission of HIV (PMTCT) programs, varied access to HIV counseling and testing persists in rural settings. This study will combine two well-established technologies not commonly utilized in conjunction with one another for surveillance and health delivery, namely mapping and mobile phone text messaging. The pilot research will contribute to an improved understanding of how to develop and utilize technology to improve PMTCT care delivery in remote settings.