Best Practices, Experiences and Lessons learnt on using mobile phones to impact HIV/AIDS Behavioral ChangeAIDS2012July 2012

Eunice Namirembeenamirembe@texttochange.com

+256 776833855

Developing countries have more mobile phones than “developed”

countries

Developing countries have more mobile phones than “developed”

countries

6 billion Mobile Phone subscriptions Globally (ITU,2011)

433 million in Africa (GSMA 2011)

53% have access to mobile phones in Africa (ITU)

95% of messages is read within 4min

6 billion Mobile Phone subscriptions Globally (ITU,2011)

433 million in Africa (GSMA 2011)

53% have access to mobile phones in Africa (ITU)

95% of messages is read within 4min

Over 14 million mobile subscribers in Uganda as at June 2011

At least 50% of Ugandans can access a mobile phone

5 Major Mobile Operators

Over 14 million mobile subscribers in Uganda as at June 2011

At least 50% of Ugandans can access a mobile phone

5 Major Mobile Operators

At least 1.2 million people infected in Uganda in 2011

At least 130,000 new infections every year

More women than men infected

Ref: Global AIDS Response Progress Report: Uganda Jan 2010-Dec 2012

At least 1.2 million people infected in Uganda in 2011

At least 130,000 new infections every year

More women than men infected

Ref: Global AIDS Response Progress Report: Uganda Jan 2010-Dec 2012

Uganda: Mobile & HIV/AIDS StatisticsUganda: Mobile & HIV/AIDS Statistics

NGO founded in 2007 in Amsterdam

Social Mobile Service & Content provider

TTC develops Interactive and Incentive based mobile programs

Pioneer in mHealth in Africa – 1st Mhealth programme in Africa in 2008

Mobile Tools for Health, Education & Social Impact: SMS, Voice, Data

NGO founded in 2007 in Amsterdam

Social Mobile Service & Content provider

TTC develops Interactive and Incentive based mobile programs

Pioneer in mHealth in Africa – 1st Mhealth programme in Africa in 2008

Mobile Tools for Health, Education & Social Impact: SMS, Voice, Data

Text to Change has active programs in 8 countries (red) and upcoming programs in 7 more (yellow)

Family planning/re

p health

PMTCT

Medicineadherence

Mobilisation health services

Drug stock outs

HIV/AIDS

TB

Data collection

Antentatel care

mHealth

First TTC program in Mbarara ( 2008) Target: 15.000 Celtel subscribers HIV/AIDS Quiz Results: 20 % response rate Uptake in HCT of +40% at AIC Built our own platform + toll free short

code

First TTC program in Mbarara ( 2008) Target: 15.000 Celtel subscribers HIV/AIDS Quiz Results: 20 % response rate Uptake in HCT of +40% at AIC Built our own platform + toll free short

code

Do you think a healthy looking person can have HIV?1. Yes2. NoTo reply send: QUIZ<space><answer nr> to 8181

Do you think a healthy looking person can have HIV?1. Yes2. NoTo reply send: QUIZ<space><answer nr> to 8181

Users participate in free Health quizzes

Users participate in free Health quizzes

Well done! Someone who looks healthy may be HIV positive and could infect others. To know your own and your partners’ status, you should test for HIV together 

Well done! Someone who looks healthy may be HIV positive and could infect others. To know your own and your partners’ status, you should test for HIV together 

Lira District 2010

After 3 hours radio show 4000 people opt-in7000 people reached

Health Quiz

Response rate: 53%

SMS mobilization HCT

Duration: 3 months

Program costs: 6000 USD

Costs per person: < 1,- USD

SMS mobilizationSMS mobilization

Increased uptake for VCT after SMS message

Increased uptake for VCT after SMS message

Week in which message was sent

Tomorrow there is FREE HIV testing at the clinic in Lira. Please come and bring your partner! Tell your friends and family to come also!

Tomorrow there is FREE HIV testing at the clinic in Lira. Please come and bring your partner! Tell your friends and family to come also!

• Started in April 2010 -112 clients – 104 clients (93% ) were active on the program

• Sending reminders to clients to take ARVs

• Increased adherence after SMS use :87% adherence above 95% @ project start and 93% after 3 months

• Testimonial from partner ‘A greatly successful project as seen in the results below, the clients adherence increased, their viral load reduced and their CD4 also went up’

• Started in April 2010 -112 clients – 104 clients (93% ) were active on the program

• Sending reminders to clients to take ARVs

• Increased adherence after SMS use :87% adherence above 95% @ project start and 93% after 3 months

• Testimonial from partner ‘A greatly successful project as seen in the results below, the clients adherence increased, their viral load reduced and their CD4 also went up’

+

Providing Comprehensive Holistic Care to Clients with TB, HIV/AIDS and Cancer

Providing Comprehensive Holistic Care to Clients with TB, HIV/AIDS and Cancer

Adherence Below 95% Above 95%

Baseline 13% 87%

3monts 7% 93%

End of project 8% 92%

PEPFAR SMALL GRANTS

RemindersRemindersMedicineMedicine

InformationInformation

HIV changes your life, but don't panic. If you live healthy and

take medication when you need to, you can live a good, long life.

HIV changes your life, but don't panic. If you live healthy and

take medication when you need to, you can live a good, long life.

Greetings! Please do not forget to take your medicine. Please call 0784121381 if you have any problems.

Greetings! Please do not forget to take your medicine. Please call 0784121381 if you have any problems.

Combining strengths: Public Private Partnerships

Combining strengths: Public Private Partnerships

• Reach people at workplace• Quizzes on HIV/AIDS• HCT Mobilization

• Time and cost effective• 4 companies joined• Scientific research (in

progress)

• Reach people at workplace• Quizzes on HIV/AIDS• HCT Mobilization

• Time and cost effective• 4 companies joined• Scientific research (in

progress)

Text at work and stay healthy!

Health & company messages

Participants 1500 /company

Health SMS Quiz 40 questions

Response rate over 50%

VCT mobilization 3

Company messages

10

Total / company 80000 messages

Duration: 12 months

++

TestimonialSarah Mukuru, Community member Kinyara“I never knew that one can get health messages from a phone. It is very interesting except that I am not sure I will get airtime. I am planning to just read the message on condom use to my husband so that we start a serious discussion. For a longtime I have wanted to talk about these things but as you know our men here, it is not easy”

TestimonialSarah Mukuru, Community member Kinyara“I never knew that one can get health messages from a phone. It is very interesting except that I am not sure I will get airtime. I am planning to just read the message on condom use to my husband so that we start a serious discussion. For a longtime I have wanted to talk about these things but as you know our men here, it is not easy”

Cure for HIV/AIDS?Cure for HIV/AIDS?

EPMTCT/ Mother Reminder program in rural Uganda

EPMTCT/ Mother Reminder program in rural Uganda

Increase number of ANC visits to a minimum of 4.

Increase PMTCT uptake & adherence for HIV positive pregnant women

Increase number of women delivering at the health clinic

Provide postnatal support; examples: info about nutrition and hygiene.

Increase number of ANC visits to a minimum of 4.

Increase PMTCT uptake & adherence for HIV positive pregnant women

Increase number of women delivering at the health clinic

Provide postnatal support; examples: info about nutrition and hygiene.

• To enquire on sites offering MC services send: WAPI to 1504

• To enquire on sites offering MC services send: WAPI to 1504

Promotion of Medical Male Circumcision via SMS

Promotion of Medical Male Circumcision via SMS

• High uptake of SMS inquiries suggests that use of mobile phone technology has ability to increase access to MMC for HIV prevention services

• High uptake of SMS inquiries suggests that use of mobile phone technology has ability to increase access to MMC for HIV prevention services

• To receive post MMC health messages send: BAADA to 15014

• To receive post MMC health messages send: BAADA to 15014

• To learn about Male circumcision and its advantages send: TOHARA to 1504

• To learn about Male circumcision and its advantages send: TOHARA to 1504

Response

How do you get users to participate?

Social incentivesSocial incentives Scalable Sustainable Scalable Sustainable

Incentives with monetary valueIncentives with monetary value

Examples:

• Airtime• Merchandise• Health products

Examples:

• Airtime• Merchandise• Health products

Mosquito netMosquito net

Barcelona shirtBarcelona shirt

AirtimeAirtime

Our ImpactOur Impact

• Increased uptake in people going for health services after receiving the messages from

TTC

• Health awareness is promoted

via the interactive and incentive-based messaging

• Adherence improvement (Improved Health seeking

behavior)

• Increased uptake in people going for health services after receiving the messages from

TTC

• Health awareness is promoted

via the interactive and incentive-based messaging

• Adherence improvement (Improved Health seeking

behavior)

Mhealth is Cheap, Mhealth is expensiveMhealth is Cheap, Mhealth is expensive

Text Vs Voice

Text: cheap, can be retrieved any time,

Voice: closes illiteracy gap, expensive,

Text Vs Voice

Text: cheap, can be retrieved any time,

Voice: closes illiteracy gap, expensive,

Combining with other media:

Radio

Television

Newspapers

Posters

Combining with other media:

Radio

Television

Newspapers

Posters

Lessons learnt•CONTENT • Sustainability/ Pilot disease;• Create a win-win situation, Business Model?;• Not always demand for M&E;• Phone Sharing – Advantage and Disadvantage;• Male cell phone ownership;• Local partnerships: relevance and responsiveness to

local needs and conditions;• Timing of SMS messages• Data inaccuracy is always an issue when collecting

data

Lessons learnt•CONTENT • Sustainability/ Pilot disease;• Create a win-win situation, Business Model?;• Not always demand for M&E;• Phone Sharing – Advantage and Disadvantage;• Male cell phone ownership;• Local partnerships: relevance and responsiveness to

local needs and conditions;• Timing of SMS messages• Data inaccuracy is always an issue when collecting

data

Text to Change: Why does it work?

Simple in Concept powerful in Result;

Multimedia approach ;

Partnerships with mobile operators, telecom industry, NGO‘s, private sector and governments;

Software that works in Africa;

Toll free services;

Demand driven programs;

Local content;

Focus on the end-user

Flexible SMS system

Text to Change: Why does it work?

Simple in Concept powerful in Result;

Multimedia approach ;

Partnerships with mobile operators, telecom industry, NGO‘s, private sector and governments;

Software that works in Africa;

Toll free services;

Demand driven programs;

Local content;

Focus on the end-user

Flexible SMS system

@texttochange @texttochange

www. www.texttochange.com

Eunice Gnay Namirembeenamirembe@texttochange.com

www.texttochange.com