Designing and Implementing an Innovative SMS-Based Alert System (RapidSMS-MCH) to Monitor Pregnancy and Reduce Maternal and Child Deaths in Rwanda

Introduction: With the continuous growth of mobile network coverage and unprecedented penetration of mobile devices in the developing world, several mHealth initiatives are being implemented in developing countries. This paper aims to describe requirements for designing and implementing a mobile phone-based communication system aiming at monitoring pregnancy and reducing bottlenecks in communication associated with maternal and newborn deaths; and document challenges and lessons learned. Methods: An SMS-based system was developed to improve maternal and child health (MCH) using RapidSMS^®, a free and open-sourced software development framework. To achieve the expected results, the RapidSMS-MCH system was customized to allow interactive communication between a community health worker (CHW)following mother-infant pairs in their community, a national centralized database, the health facility and in case of an emergency alert, the ambulance driver. The RapidSMS-MCH system was piloted in Musanze district, Nothern province of Rwanda over a 12-month period. Results: A total of 432 CHW were trained and equipped with mobile phones. A total of 35,734 SMS were sent by 432 CHW from May 2010 to April 2011. A total of 11,502 pregnancies were monitored. A total of 362 SMS alerts for urgent and life threatening events were registered. We registered a 27% increase in facility based delivery from 72% twelve months before to 92% at the end of the twelve months pilot phase. Major challenges were telephone maintenance and replacement. Disctrict heath team capacity to manage and supervise the system was strengthened by the end of pilot phase. Highly committed CHWs and effective coordination by the District health team were critical enablers. Conclusion: We successully designed and implemented a mobile phone SMS-based system to track pregnancy and maternal and child outcomes in limited resources setting. Implementation of mobile-phone systems at community level could contribute to improving emergency obstetric and neonatal care, yet it requires a well-organized community health structure in limited resource settings

Association Between Time to Antiretroviral Therapy and Loss to Care Among Newly Diagnosed Rwandan People Living With Human Immunodeficiency Virus

Despite improved clinical outcomes of initiating antiretroviral therapy (ART) soon after diagnosis, conflicting evidence exists regarding the impact of same-day ART initiation on subsequent clinical outcomes. We aimed to characterize the associations of time to ART initiation with loss to care and viral suppression in a cohort of newly diagnosed people living with HIV (PLHIV) entering care after Rwanda implemented a national Treat All policy. We conducted a secondary analysis of routinely collected data of adult PLHIV enrolling in HIV care at 10 health facilities in Kigali, Rwanda. Time from enrollment to ART initiation was categorized as same day, 1-7 days, or \u3e7 days. We examined associations between time to ART and loss to care (\u3e120 days since last health facility visit) using Cox proportional hazards models, and between time to ART and viral suppression using logistic regression. Of 2,524 patients included in this analysis, 1,452 (57.5%) were women and the median age was 32 (interquartile range: 26-39). Loss to care was more frequent among patients who initiated ART on the same day (15.9%), compared with those initiating ART 1-7 days (12.3%) or \u3e7 days (10.1%),  \u3c .001. In multivariable analyses, same-day ART initiation was associated with a greater hazard of loss to care compared with initiating \u3e7 days after enrollment (adjusted hazard ratio 1.39, 95% confidence interval: 1.04-1.85). A total of 1,698 (67.3%) had available data on viral load measured within 455 days after enrollment. Of these, 1,476 (87%) were virally suppressed. A higher proportion of patients initiating ART on the same day were virally suppressed (89%) compared with those initiating 1-7 days (84%) or \u3e7 days (88%) after enrollment. This association was not statistically significant. Our findings suggest that ensuring adequate, early support for PLHIV initiating ART rapidly may be important to improve retention in care for newly diagnosed PLHIV in the era of Treat All

COVID-19 pandemic-related changes in clinic environment or operations at Central Africa IeDEA sites, 2020–2021.

COVID-19 pandemic-related changes in clinic environment or operations at Central Africa IeDEA sites, 2020–2021.</p

Effects of COVID-19 on HIV-related services and capacity at Central Africa IeDEA sites, by country, Round 2 (Oct 2020—Feb 2021).

ART: Antiretroviral therapy; IeDEA: International epidemiology Databases to Evaluate AIDS; PrEP: Pre-exposure prophylaxis. ** Sites where the service was not available prior to the COVID-19 pandemic excluded from denominator. (DOCX)</p

Changes in clinic environment or operations at Central Africa IeDEA sites, by country, Round 2 (October 2020—February 2021).

ART: Antiretroviral therapy; IeDEA: International epidemiology Databases to Evaluate AIDS; PrEP: Pre-exposure prophylaxis. ** Sites where the service was not available prior to the COVID-19 pandemic excluded from denominator. (DOCX)</p

Changes in clinic environment or operations at Central Africa IeDEA sites, by country, Round 1 (June—July 2020).

ART: Antiretroviral therapy; IeDEA: International epidemiology Databases to Evaluate AIDS. ** Sites where the service was not available prior to the COVID-19 pandemic excluded from denominator. (DOCX)</p

Changes in HIV-related services and capacity at Central Africa IeDEA sites, 2020–2021.

Changes in HIV-related services and capacity at Central Africa IeDEA sites, 2020–2021.</p

Characteristics of Central Africa IeDEA sites.

Characteristics of Central Africa IeDEA sites.</p

Effects of COVID-19 on HIV-related services and capacity at Central Africa IeDEA sites, by country, Round 1 (June—July 2020).

ART: Antiretroviral therapy; IeDEA: International epidemiology Databases to Evaluate AIDS; PrEP: Pre-exposure prophylaxis. ** Sites where the service was not available prior to the COVID-19 pandemic excluded from denominator. (DOCX)</p

S1 File - COVID-19 associated changes in HIV service delivery over time in Central Africa: Results from facility surveys during the first and second waves of the pandemic

(DOCX)</p