mHealth in the fight against HIV

Dec. 1 marked the 25th World AIDS Day, initially established in 1988 by the World Health Organization (WHO) for people globally to unite in the fight against HIV, the virus that causes AIDS. Much has been accomplished in the intervening years to increase global awareness around HIV, to aid its prevention, and to make advances in its treatment. In September, the Joint United Nations Programme on HIV/AIDS issued a new report revealing a 52 percent reduction in new HIV infections among children and a combined 33 percent reduction among adults and children since 2001.

However, currently an estimated 35 million people worldwide are living with HIV, which attacks the body's immune system. According to WHO, since 1981, almost 70 million people have been infected with the HIV virus and about 36 million people have died of AIDS-related illnesses, making it one of the most destructive global pandemics in history. Sub-Saharan Africa remains the hardest-hit region, which is home to just over 12 percent of the world's population but more than two-thirds of all people infected with HIV globally.

While there is no vaccine or cure for HIV, thanks to a powerful "cocktail" of antiretroviral medications life expectancy has improved dramatically for those infected with the virus. The combination of drugs prevents the virus from replicating, and in many cases can restore the patient's CD4 and T-cell counts, thus improving the quality and longevity of life.

It goes without saying that it is critical for HIV patients to take the drugs prescribed by their doctors in the dosages necessary to fight against the disease. A 2012 study on HIV antiretroviral medication adherence showed that weekly text messages can help patients better adhere to their often complicated drug regimens.

In addition, patients who received the weekly text reminders also had a lower viral load in their bloodstreams after one year, based on two trials conducted in Kenya. The study's lead author recommended that clinics and hospitals should consider using weekly text messaging as a way to ensure HIV patients stick to their antiretroviral therapy.

Similarly, in the area of prevention, a 2011 South African study conducted by Cell-Life, a nonprofit organization that provides technology-based solutions for the management of health in developing countries, revealed that sending 10 text message reminders to go for HIV testing and for counseling, spread out over every three days for a month, resulted in a 70 percent higher uptake of testing compared to a control group who did not receive any messages.  

Cell phone-based interventions leveraging voice or text-based SMS features are just the tip of the mHealth iceberg. Another area of tremendous growth is HIV prevention and care services via smartphones. According to GSMA, the mobile industry organization, there are 83 active mHealth products and services aimed at public health in South Africa, 43 of which address HIV. 

Yet, these apps are not without their challenges. Fewer than a third of South Africans own a smartphone that can download these kinds of HIV apps and therefore the majority of people in that country are limited to SMS technology given that apps can't be downloaded on basic cell phones which are the most prevalent.

Furthermore, a study published earlier this year found that although mobile apps increasingly are being used for the prevention and care of HIV and other sexually transmitted diseases, these available apps have failed to attract user attention and positive reviews. Researchers reviewed the Apple iTunes and Android Google Play stores for HIV/STD-related apps, concluding that "many of the very features that make apps such a promising platform for delivering HIV/STD prevention and care services appear to be lacking in the currently available HIV/STD-related apps."

Nevertheless, the world is making great strides in preventing and treating the virus, as well as helping patients rebuild and maintain their immune systems. HIV continues to be a major global public health issue but mobile technology is emerging as an enabling platform for better managing the disease and whose interventions have the potential for reversing this pandemic. As a result, the HIV/AIDS footprint worldwide could look very different on World AIDS Day another 25 years from now as the international community works toward achieving an AIDS-free generation. - Greg (@Slabodkin)