Using Digital Technologies to End Mother to Child Transmission of HIV

Faster to Zero is an initiative that will use digital health tools to accelerate the end of mother-to-child transmission of HIV in South Africa and in one other country to be determined. As a public-private partnership, Faster to Zero uses proven digital health tools to strengthen programmes to identify HIV-positive pregnant women, start treatment for those who test positive, and ensure their babies test HIV-negative at age one. By using real numbers to guide treatment, rather than estimates, data from these digital health tools will ensure women are receiving the right services at the right time -- altogether helping the most at-risk populations become AIDS-free faster.

Many countries have made significant progress in reducing the number of new infections, but to truly eliminate the epidemic, they must register and track those who are HIV-positive to provide specific services at the right time -- a feat which technological advancements has made possible. Faster to Zero aims to bring together the necessary partners and experts -- from promising digital health tools to funders and governments -- to sustain these efforts in the long run and ensure this continuum of care can truly make that AIDS-free generation a reality.

Through the initial funding from PEPFAR and J&J, Faster to Zero has started in South Africa in 2015 and about to roll out in Uganda in 2016.

The Approach

Through a process of stakeholder engagement, the initiative seeks to ensure that the specific strategies developed are relevant and customized to each context and align with the priorities of the Ministries of Health in each country.

Then proven digital health solutions are identified to help address the specific need and are strengthened to ensure that they can be scaled and integrated with other key systems before being rolled out with partners.

In order to ensure good user acceptance and proper use, as well as sustainability, training and capacity building for health workers, health managers and partner organisations forms an ongoing component of the work.

Similarly it is necessary to identify the in-country experts to provide ongoing local, contextually-sensitive support.

A focus of the programme is to ensure that the solutions implemented support and assist health workers and health managers in their work and that systems don't add to workloads or create unnecessary overheads. The 9 Principles of Digital Development are used as a guide to help ensure the effectiveness, user-acceptance, scalability and sustainability of the various elements of the programme.

Faster to Zero in South Africa

While significant progress has been made in South Africa to reduce the country’s mother-to-child HIV transmission rate down to 2.6%, more progress can be made. Faster to Zero is working closely with South Africa’s National Department of Health to harness digital technologies to effectively eliminate HIV transmission from mothers to babies, aiming to prevent over 7 800 new infections each year.

The initiative is connecting directly with MomConnect, an initiative of the South African government seeking to register all pregnant women, send them stage-based messages supporting their own and their baby's health, and providing an opportunity for them to comment on health services and facilities.

Faster to Zero will strengthen the EMTCT focus of MomConnect, expanding the messages to include more specific messages for HIV+ women, as well as extending the registration process to enable high risk mothers to be quickly identified and provided with additional support and services, including calls from the PMTCT MomConnect Helpdesk. Drawing on existing proven digital health solutions, and based on the needs identified through detailed needs analyses and discussions with the department, the programme will seek to create linkages between MomConnect and the National Health Laboratory Service and other computerised services in the department. 

The five pilot districts for Faster to Zero in South Africa are:

  • Gauteng: Ekurhuleni and City of Johannesburg districts
  • Kwazulu-Natal: Ethekwini and Umgungundlovu districts
  • Western Cape: City of Cape Town District

All pregnant women registered for MomConnect in the pilot districts are the target for MomConnect messaging. For Faster to Zero, there are two categories being targeted: Pregnant women living with HIV and High-risk pregnant women living with HIV. These two categories are targeted and specific services are offered, as described below:

(1) Pregnant women & mothers living with HIV

The women who opt in to this service are receiving the additional set of SMS messages designed for pregnant women living with HIV. There are around 45 SMSs which are free to the patient. These SMSs are in addition to the usual MomConnect messages, scheduled appropriately, including for women starting at different stages of the pregnancy. The messages encourage ARV adherence, encourage women to share their status and get support, use condoms, call the AIDS helpline, breastfeed exclusively, prevent TB, prevent infection, be aware of danger signs, bring the baby in for checkup, and make sure to get all the PCR tests. The SMSs are be based on the current PMTCT guideline and are updated to reflect any guideline changes. 

(2) High-risk pregnant women & mothers living with HIV

Pregnant women identified as being at high risk of mother to child transmission (MTCT) of HIV are provided with additional services. There are two types of services offered to high risk women:

  1. National services via helpdesk  - answering questions (which is advertised via SMS) and at least one call out to the high-risk women promoting adherence and the linkage to care; and
  2. Promotion of district-level services for PMTCT (facility & community based) where they exist.  The interventions are SMS messaging and helpdesk support (pregnant women text in and helpdesk calls back where appropriate).

Faster to Zero in Uganda

Uganda has made significant progress in reducing mother-to-child transmission of HIV, cutting the number of new infections from about 25,500 in 2010 to about 3,500 in 2015. The country’s implementation of the World Health Organization prevention of mother-to-child transmission (PMTCT) Option B+ strategy, which aims to provide antiretroviral therapy (ART) to all HIV-positive pregnant women for life, has contributed to the success. Most women are now tested for HIV in antenatal care and are encouraged to initiate ART if they are infected. However, keeping women and their children in care throughout their pregnancy and until the child is 18 months old remains a challenge. 

HealthEnabled and the Knowledge for Health Project (K4Health) are partnering with the Elizabeth Glaser Pediatric AIDS Foundation and the Ministry of Health in Uganda to address these challenges using practical digital health solutions. After a thorough technology assessment process, in which the team met with key in-country stakeholders and conducted a literature review to understand the PMTCT and digital health landscapes, stakeholders participated in a prioritization workshop to review the assessment findings and identify the most appropriate solutions. 

Through these activities, the Faster to Zero initiative will contribute to the development of a national digital health strategy for the elimination of mother-to-child transmission of HIV (EMTCT) and strengthen the local capacity to design, implement, and evaluate digital health solutions in line with national standards and priorities. 

Faster to Zero is supported through a public-private partnership between PEPFAR and Johnson & Johnson and implemented by HealthEnabled and the USAID-funded Knowledge for Health Project to support the strategic use of digital technologies to end mother-to-child transmission of HIV. Faster to Zero is currently working in South Africa and Uganda.

For more information on Faster to Zero in Uganda, please contact Nadi Nina Kaonga, Deputy Director, HealthEnabled (This email address is being protected from spambots. You need JavaScript enabled to view it.), Cassandra Mickish Gross, Program Officer II, Knowledge for Health Project (This email address is being protected from spambots. You need JavaScript enabled to view it.), or Edward Bitarakwate, Country Director, Elizabeth Glaser Pediatric AIDS Foundation (This email address is being protected from spambots. You need JavaScript enabled to view it.). 

The Partners Behind Faster to Zero

Faster to Zero is being launched by HealthEnabled, Knowledge for Health, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID, and Johnson & Johnson.

For Information about Faster to Zero, contact:

Peter Benjamin, This email address is being protected from spambots. You need JavaScript enabled to view it. (Overall)

Idon-Nkhenso Sibuyi, This email address is being protected from spambots. You need JavaScript enabled to view it. (South Africa specific)