Txt Alert An Introduction m Health Working Group

Txt. Alert: An Introduction m. Health Working Group 20 April 2011

Praekelt Digital is a commercial company that develops digital & mobile solutions for emerging markets. Praekelt Foundation is the humanitarian, non-profit partner of Praekelt digital. We believe in building robust, scalable solutions that benefit people living in poverty. Our programmes have reached over 50 million people across 15 countries in sub-Saharan Africa. 



Gustav Praekelt Founder Marcha Neethling Operations Simon de Haan Chief Engineer David Maclay Engineer © 2010

An Introduction

What is txt. Alert? txt. Alert is an SMS communication tool which: Was developed by the Praekelt Foundation and launched in conjunction with Right to Care’s Themba Lethu Clinic at the Helen Joseph Hospital in 2007. Aims to increase appointment attendance of ARV-patients Notifies patients of their upcoming appointments (via SMS) and requests that they reschedule if they are unable to attend (via Please Call Me’s). Helps us understand the reasons for missed appointments in an attempt to reduce the number of patients who discontinue treatment.

txt. Alert Goals Short-Term Goals: Increase appointment attendance Decrease “Lost-to-follow-up” (LTFU) Long-Term Goal: Improve adherence to ARVs

How does it all work? Virtual Purple / Therapy Edge

Txt. Alert: Process Flow Patient Opts in Day after message 2 Weeks before message Day before message Patient attends clinic appointment and opts-in to the Txt. Alert service Thanks for attending your appointment. We will remind you of your next appointment closer to the time Your next appointment is on. . Opportunity to change appointment for free, by sending a Please Call Me to a Txt. Alert administrator See you at the clinic tomorrow Day after Appointment Day after message: Attendance Thanks for attending your appointment OR Day after message: Non. Attendance You missed your appointment. Send a Please Call Me to reschedule.

The power of “Please Call Me’s” Please Call 0834132002 Please Call Me’s are a free form of SMS which are extremely popular in South Africa. In both Txt. Alert reminder SMSs, (2 weeks before / 1 day before), a number is given to which a patient can send a Please Call Me if they want to: Confirm an appointment Reschedule a missed appointment A Txt. Alert administrator then receives the patient’s Please Call Me-message, (on a phone or web interface) and then phones the patient back to assist him/her to confirm or reschedule an appointment.

Txt. Alert’s Please Call Me Management System Praekelt Foundation has developed an on-line dashboard system for managing the incoming Please Call Me-messages sent by patients. This system enables the Txt. Alert administrator to: Track incoming Please Call Me’s of patients linked to their specific site. Choose the reason for the Please Call Me from a pre-configures drop-down menu Add unique patient / conversation notes to a notes field Categorize patients in high, medium, and low risk groups in terms of their propensity to miss their appointments Link the Please Call Me to the patient’s unique Therapy Edge/Virtual Purple number.

txt. Alert’s Please Call Me Management System

Addressing “Lost to follow up” at the Helen Joseph Hospital's and Temba Lethu Clinic Oct 04 Launched Apr - Jun 07 Mar 08

Txt. Alert Results “The success of Txt. Alert is telling: missed appointments have fallen from 30% to 4%. LTFU has declined from 27% to 4%” Dr Ian Sanne / CEO of Right to Care / 28 Nov 2009

Txt. Alert Next steps: 1) Txt. Alert-TB 2) Txt. Alert-PMTCT

1) Txt. Alert-TB Key Facts of the SA TB Crisis: SA has the highest burden of HIV-TB co-infection globally: 70% of TB patients are co-infected with HIV. SA has one of the lowest TB treatment completion and cure rates. TB is treatable and curable with a simple 6 -month course of treatment that is free, but treatment is only successful if completed. Patients are diagnosed late with TB (i. e. they are in advanced stages of the disease). Once on treatment, patients start to feel better, they stop taking drugs, and this causes almost untreatable drug resistant (MDR / XDR) TB that is 60 -85% fatal. TB remains the #1 killer here and in all of Africa

1) Txt. Alert-TB Targets the following aspects of the TB pandemic: Low TB treatment completion High TB mortality rates High rates of TB drug resistance (which is preventable if treatment is completed successfully) Applies a novel approach of engaging local and international celebrities to be virtual 'celebrity treatment buddies' for patients on TB Treatment.

Txt. Alert-TB At enrollment, patients can choose their celebrity treatment buddy and language and receive an ID card with the image/name of their buddy from whom they will receive personalized, automated monthly treatment reminders. Thanks for making me your Txt. Alert Treatment Buddy! I will help you to stick to your treatment via SMS reminders! Remember to continue to take your medication even if you are feeling better! LOVE: John Legend Annie Hi Thando, Annie Lennox here. Remember to go to the clinic tomorrow. You have 2 months left. keep it up! Annie xxx

Txt. Alert-TB At completion of the 6 -8 month treatment course, patients will get an airtime voucher donated directly to their mobile phone. Why incentives? TB treatment is a short course, that unlike ARVs, you can stop to take after course completion Drug resistant TB (MDR and XDR) is completely preventable, if treatment is successfully completed. An airtime prize will be a cost-effective incentive to all patients that complete successfully - a small price to pay to prevent the expensive treatment of MDR and XDR TB. Hi Thando, Annie Lennox here. congrats on completing your treatment! click here to download your airtime 1334455633123

Txt. Alert-PMTCT Program Goal Set up the first PMTCT appointment /treatment reminder system in South Africa. Remind mothers of their follow up visits to the doctor, so that treatment of mother and child can successfully be completed, and mother-to-child-transmission can be prevented. Program Partners Desired Outcomes Bring down the MTCT-rates of HIV in South Africa.

Conclusions Txt. Alert has had a positive effect on health care in South Africa. During a three year implementation phase, we have seen: increased patient appointment attendance rates an upward trend in the utilization of Please Call Me’s for rescheduling of appointments improved communication between patients and clinics improved logistics flow at large treatment sites

Contact Us Marcha@praekeltfoundation. org Phone: +27 83 413 2002 mailto: Marcha@praekeltfoundation. org twitter. com/praekeltfound