The World Health Organization (WHO) classifies Tanzania within the top 20 high-burden countries for tuberculosis (TB) and for TB/HIV. Although HIV prevalence has fallen in Tanzania over the past decade, tens of thousands of people become infected with HIV every year. Stigma against HIV-positive people, the criminalization of key population groups, and human resource shortages are preventing a sustained reduction in new HIV infections. It is extremely important to improve rates of diagnosis and linkages to care, particularly among people from key affected areas.
The Tanzanian government has done well to keep the country on track to reaching all of the TB targets set within the Millennium Development Goal (MDG) frameworks. The government has prioritized the integration of TB services with HIV services to minimize the burden of these two co-morbidities. Ensuring that people living with HIV are on antiretroviral treatment means that they are in a better place to fight off TB infection. Integrating these two services will also ensure greater access to TB treatment.
Mobile Health Technology
Mobile health technology is revolutionizing healthcare service delivery for people living with HIV and TB in Tanzania. Mobile health technology is the provision of health services and information via mobile technologies such as mobile phones and personal digital assistants.
Among evidence-based efforts to halt the spread of these diseases, two cutting-edge mobile services were recently launched in Tanzania targeting various key populations including at-risk minors and the elderly. These mobile health (mHealth) services provide vital customized health information, educational messaging, reminders for patients on antiretroviral therapy (ART), and digital prompts for follow-up care.
FASTA
The first mobile service includes the Fast ART Self-Assessment & ARV Refill Mobile Service (FASTA), developed and implemented by the mHealth Tanzania Partnership team in collaboration with Henry Jackson Foundation Medical Research Institute. This is the first-ever mobile technology application for multi-month drug scripting targeting clients stable on ART.
FASTA aligns with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) multipronged service delivery strategy–a client-centered approach that simplifies and adapts HIV services across the HIV care continuum, in ways that both better serve the needs of people living with HIV and reduces unnecessary burdens on the health system. Previously, HIV, AIDS, and TB necessitated in-person check-ups with providers. The mobile application service allows eligible clients to answer a series of questions, similar to those a clinician would ask during a physical visit, before receiving authorization to pick up a three-month supply of ART. The text-message scheduling component is then used to deliver monthly self-assessments. The final step is sending semi-annual clinical visitation reminder messages to registered ART clients.This service application is the first comprehensive HIV mobile service to include treatment literacy messaging, index testing services, and clinical appointment reminders to target clients who are both stable and unstable on ART.
TB Self-Screening
The second mHealth service is the TB Self-Screening and Patient Treatment mHealth Application which was launched by the mHealth Tanzania Partnership under the leadership of MoHCDGEC’s National Tuberculosis and Leprosy Programme and partner KNCV Tuberculosis Foundation. This service leverages mobile technology to increase the identification of symptomatic TB patients in the general population, providing detailed tailored treatment literacy information to consenting TB and TB/HIV co-infected patients who have initiated TB treatment.
Since its launch in September 2018, over 164,018 people have completed the TB self-screening assessment with over 7,657 enrolled in the TB awareness messaging service. Additionally, 450 healthcare providers have been trained on the application allowing for dissection of data for self-screening with a breakdown of presumptive versus non-presumptive cases and multiple TB patient classifications to ensure clients receive the appropriate tailored content based upon the specifics of their medical condition.
The widespread expansion of mobile phone coverage in Africa and other resource-limited settings is offering opportunities to overcome some of the weaknesses that exist in health systems and to improve healthcare service delivery through mHealth technologies such as those in use in Tanzania. CDC and its partners continue to adapt and adopt new technology and evidence-based approaches to enhance service delivery, improve patient outcomes, and ultimately to achieve HIV epidemic control and bring an end to TB.
Written by Joanne Myers
