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ADOLE HIV Treatment/Management Literacy App
Strategies and Activities
Capacity building systems strengthening

  1. Increased patient knowledge about the responsible management of their HIV care
  2. Improved patient treatment adherence, retention, and active participation in HIV care management

OUTCOMES:
Short-Term Outcomes (1-2 years)
This outcome requires that patient access to online, phone, and other resources is increased as per
increased competencies of HCW providing HIV services. Thus, patients’ understanding of their own HIV
care management will also increase.

Intermediate Outcomes (3-4 years)
 Missed appointments and missed doses of medication
 Active and continued patient engagement in care and support systems (e.g. reminder systems,
support groups, online resources)

 

Current Situation
The rollout of antiretroviral therapy (ART) significantly reduced human immunodeficiency virus (HIV)-
related morbidity and mortality, but good clinical outcomes depend on access and adherence to
treatment. In resource-limited settings, where over 90% of the world’s HIV-infected population resides,
data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage
to and retention in HIV care systems, and suboptimal adherence rates to therapy. Data from
observational studies and randomized controlled trials support home-based, mobile and antenatal care
HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and
adherence support through education, counseling and mobile phone messaging services. While limited
in number, studies assessing interventions using mobile phones have shown positive results.

Two RCTs in Kenya investigated the use of mobile phone short message service (SMS) in improving
adherence. Pop-Eleches et al found that an intervention group receiving weekly SMS reminders to take
ART were significantly more likely to achieve >90% adherence rates (P = 0.03) and less likely to
experience treatment interruptions (P = 0.03) at 48 weeks’ follow-up compared to controls 1 . Lester et al
found significant improvements in adherence (P = 0.006) and viral suppression (P = 0.04) among an
intervention group that received weekly interactive SMS (inquiring about health and well-being), with
follow-up calls for nonrespondents after 48 hours

 

The mobile App retrieves information from the webserver that hosts the EMR database via PhP code
(hypertext preprocessor) files which are given in the web-server. The php files contain MySQL queries
that connect to the OpenEMR database and retrieves required information which is passed into a JSON
object (a format that is readable by the android application). The information returned from the JSON
object is then extracted in the java class by using HashMap ArrayLists and displayed to the mobile device
user. Each PhP file contains MySQL queries for a particular task. The location of the php file is called by
the App then it executes a line that opens connection to the OpenEMR database. It then closes the
connection after executed the query. Below is the PhP line to execute the database connection. con =
mysql connect(”localhost”,”username”,”password”); where con is the connection variable, localhost is

the server containing the database, and username and the password followed are credentials to the
database server.
The EMR database consists of more than 100 Tables that use MySQL database. We may only use four of
them for the scope of this project and from our previous experience. We will also add an extra database
Table called (SMS reminder log ) to record the time a medical practitioner sends out SMS appointment
reminders. A few minor alterations may also made to a some of the Tables. For instance, we may add an
extra column for patient password in order for a patient to log into the app. Also, another column will be
added in Appointments Table in order to indicate that the particular appointment has not occurred yet
and the value is updated after appointment has occurred. These amendments do not affect the
operations of the EMR in any way. The relationships (in terms of one-to-one and one-to-many) between
the tables utilized are depicted in Figure below.

In the App, when the button to send SMS messages to patients who made appointments for today is
clicked, it calls a PhP file that searches the Appointments table for appointments with date set to today’s
date. The Appointments Table contains a patient identification number (foreign key) for each
appointment record therefore uses that ID to search the Patient Table in order to retrieve mobile phone
number and patient full name which are necessary for generating tailored SMS messages to patients.
The data is returned and converted to a JSON object in the java class before it can be displayed to the
patient. Figure 11 gives a screen shot of the SMS feature that was sent to a patient specifying the
patient name, appointment time and the medical practitioner.