Founder and Medical Director of Aviro, Dr Musaed Abrahams, used his extensive experience as an HIV Training Coordinator for Doctors Without Borders to devise a solution that suitably fills the gap in HIV training and on-the-job experience for nurses.
“I’ve always had an interest in technology, so three years ago I started to think how best to apply mobile technology to my speciality of HIV. The problem is that due to the complexity of HIV treatment many nurses don’t have an in-depth knowledge of the procedures involved in the assessment and administration of ARV medication,” said Abrahams.
Abrahams explained that the app forms part of his vision towards integrated care. “Nurse training in SA is often executed in stand-alone or “vertical programmes” that focus on specific conditions, which often aren’t comprehensive enough to suitably equip a nurse when they enter the workforce,” said Abrahams who went on to identify a lack of mentorship for nurses after they qualify as part of the problem.
“I wanted to develop an app that would provide theoretical and practical training and mentorship to enable nurses to treat HIV patients that have other underlying conditions as well, such as TB or women who are pregnant, because the treatment plans become more complicated when combined with other conditions,” said Abrahams.
In 2012 Abrahams assembled a team consisting of a technician, a designer and programmer to start developing his idea into an app. “The key to the app’s success will be that it was developed in conjunction with nurses from the beginning. By interviewing them and observing their workflows we were able to use their input to determine exactly what aspects of HIV treatment they found the most challenging, such as administering the ARV injection, and develop the guide as the highly useful tool that fits into their typical workflow,” said Abrahams. He went on to emphasise that they are continually refining the app based on nurse feedback and most recently included valuable information about drug resistance to the app.
The app was specifically designed to improve efficiency by giving nurses a practical guide when treating a patient that can be completed in less than ten minutes. Abrahams explained that the app can be used by any nurse in a primary care setting to determine a patient’s eligibility for ARV treatment, what drugs to use and when to start, etc.
“One of the features of the app is that it can be used as a checklist when carrying out the examination as well as to check facts and calculate medicine dosage from lab results and assess their kidney function to determine their eligibility for ARVs. All that’s required is for the nurse to enter the patient’s age, sex, physical characteristics, if they are pregnant or breast feeding, and other healthcare conditions such as TB or meningitis and any other medication they are currently on,” said Abrahams.
Based on the patient data the nurse inputs, the app returns a guide for what drugs to administer and how to adjust the dosages appropriately. According to Abrahams, the app also goes one step further by providing access to a referral system and the HIV hotline, which isn’t utilised to its full potential due to many being unaware of its existence. The app is also updated in line with the HIV guidelines, which is subject to rapid changes and updates.
According to Abrahams, the app has received positive feedback since being released in October despite it not being widely used due to its recent launch. Abrahams explained that they are working with the SA HIV Clinicians Society to carry out user tests which we hope will lead to the NDoH adopting it for roll out in all public primary care facilities,” said Abrahams.
Aviro, who is sponsored by the MTN Foundation, is also currently working with Anova Health in Gauteng to provide theoretical and practical training to nurses in Soweto. “We’ve seen downloads from doctors and nurses at Khayelitsha Hospital,” said Abrahams.
Aviro’s next step is to release an iOS version of the app that will include short forms that will feed into a database that can potentially provide valuable insights into the effectiveness and extent of HIV infection and treatment. “We’re assessing the safety and usability of the data generated; we first want to build the capability of the nurses and then create a database that is interoperable with other systems, such as Tier.Net and eKapa, which would be useful to the NDoH,” said Abrahams.
Abrahams is optimistic about the uptake of the app and envisions a further roll out in other countries, which would harness the app’s flexibility to be adapted to other languages and local guidelines. “The bottom line is that Aviro wants to improve the quality of healthcare; our app provides expert guidance where there is no expert,” said Abrahams.
While continuing to have a strong focus on the end user, Aviro plans to develop more drug interaction apps focusing on other disease groups. “We want to provide the appropriate solution for the problem, which doesn’t only mean building apps. We take a consultative, holistic approach to improving healthcare by combining the appropriate training with technology for real-world application. We use technology to create practical solutions, not just for the love of technology,” concluded Abrahams.