How real numbers can eliminate mother-to-child transmission of HIV

By Patricia Mechael 11 November 2015

New mothers gather at a clinic in South Africa linked to MomConnect. Photo by: Miriam Mannak

According to 2014 estimates from UNAIDS, between 3.4 million and 4.3 million women over 15 live with HIV in South Africa, while between 310,000 and 370,000 children in the country are HIV-positive.

In an age when countries can register nearly every mobile phone subscriber — and mobile phones are nearly ubiquitous — it is no longer acceptable, or ethical for that matter, for the public health community to work with HIV rate estimates that are “plus or minus” tens of thousands of people.

Real numbers can enable those who were previously invisible to become visible. By harnessing the power of digital technology to gather and send information, the public health community can use real numbers to more accurately measure incidence and prevalence of disease and provide more effective services to those who need them most. Milestones that have often seemed impossible — such as reaching an AIDS-free generation in countries that have struggled with the virus most — are now becoming possible.

Making pregnant women visible

South Africa is the only country in the world where more women die in childbirth today than did a decade ago. But with decent health infrastructure and mobile phone penetration rates over 117 percent, the country is also an excellent test case for assessing the power of real numbers to improve health outcomes.

In August 2014, South Africa’s Minister of Health Dr. Aaron Motsoaledi launched MomConnect, a service with the goal of registering every pregnant woman in South Africa, sending her relevant mobile messages about her pregnancy, and linking her to maternal and child health services through her mobile phone. Since its launch, MomConnect has registered more than half the estimated number of pregnant women in South Africa and has been adopted by over 90 percent of government-run health facilities.

While MomConnect aims to empower pregnant women with the information they need throughout their pregnancies, its services are particularly relevant for HIV-positive pregnant women. South Africa has made significant progress in reducing its mother-to-child HIV transmission rate (now at 2.6 percent), but more progress needs to be made if it hopes to become the second country — after Cuba — to completely eliminate mother-to-child transmission.

An SMS a pregnant woman receives from MomConnect. Photo by: Miriam Mannak

The simple act of registering pregnant women — and their newborn children — within the health system is providing the basis for South Africa to accurately pinpoint real cases of HIV in pregnant women. This helps ensure safe delivery, supported through appropriate medication, and tracks their infants to one year to eliminate mother-to-child transmission of HIV once and for all.

Getting faster to zero

Pregnancy and birth registries — coupled with active support for pregnant women — equip a health system to more effectively identify and support HIV-positive pregnant women. This process especially helps health systems provide more targeted support to women who are at greater risk of transmission — usually those who are young, pregnant for the first time, don’t visit the clinic early, or haven’t disclosed their HIV status.

Increasingly, studies are showing that mobile phone messages and information sharing can improve adherence to HIV treatment and ensure full coverage of targeted health services including immunizations.

To put this proof into practice and scale the impact of existing successful interventions like MomConnect, a new initiative called Faster to Zero will expressly use digital health tools to accelerate the end of mother-to-child HIV transmission — starting in South Africa and expanding to a second country in 2016.

Launched by HealthEnabled along with Knowledge for Health — the U.S. President’s Emergency Plan for AIDS Relief through USAID and Johnson & Johnson — Faster to Zero will use proven digital health tools to identify HIV-positive pregnant women, start treatment for those who test positive, and ensure their babies test HIV-negative at age 1. It is very promising to see that Faster to Zero will use real numbers to guide treatment, rather than estimates, so that data from these digital health tools will ensure women are receiving the right services at the right time to help the most at-risk populations become AIDS-free faster.

The path to an AIDS-free generation

Michel Sidibé, executive director of UNAIDS, has commented that an AIDS-free generation is not only feasible but also likely to come soon: “The world went from millions to billions and each dollar invested today is producing a $17 return,” he said. “If we frontload investments and fast-track our efforts over the next five years, we will end the AIDS epidemic by 2030.”

Overall, Faster to Zero and similar efforts are showing that such monumental achievements in public health are possible when the right cast of characters uses the right tools to treat real people, represented by real numbers. By collaborating across sectors and harnessing the latest digital technologies, we can sustain efforts in the long run and truly eliminate mother-to-child transmission of HIV.

To learn more about how digital health technologies can help end mother-to-child transmission of HIV, join Dr. Patricia Mechael, Dr. Peter Benjamin and other experts for an hour-long webinar at 9 a.m. EST / 4 p.m. CAT on Nov. 17. Register now.

This article is part of “Mainstreaming Digital Health: The New Normal,” a series exploring how digital health can strengthen health systems. The series is facilitated by HealthEnabled, an Africa-based not-for-profit that helps governments integrate life-saving digital health solutions into their health systems. 

To read additional content on global health, go to Focus On: Global Health in partnership with Johnson & Johnson.

About the author

Patricia Mechael

Dr. Patricia Mechael is principal and policy lead at HealthEnabled, an Africa-­based not-for-­profit that helps governments integrate lifesaving digital health solutions into their health systems. She also is the executive vice president for the Personal Connected Health Alliance and a visiting professor at Princeton University. @PattyMechael @HealthEnabled

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