The Aviro ART Treatment Mentor app is a decision support tool that enables HIV clinicians to accurately and easily administer antiretroviral treatment (ARV) to patients. Initially supported by MTN Foundation, to date the app has had over 2,500 downloads and there are over 500 active monthly users. Founder and Medical Director of Aviro, Dr Musaed Abrahams, weighs in on the upcoming WHO ‘Test and Treat’ guidelines and the importance of ARV adherence, and shares his insights into leveraging technology to support patients and nurses.
The National Department of Health (NDoH) has made significant strides in the fight against HIV/AIDS, from improving access to ARVs to adopting the WHO ‘Test and Treat’ guidelines. This latest achievement means everyone who tests positive for HIV will start ARV treatment regardless of their CD4 count.
Making Strides in HIV Care
Current guidelines recommend that patients should wait until their CD4 cell count falls to 500 or below before starting ARV treatment. The new game-changing guidelines will significantly impact how we manage the virus because when patients start ARVs earlier, there’s less destruction to their immune systems, the chances of developing other diseases such as TB are reduced, and importantly it will decrease the spread of the virus.
On a population management level, starting ARV treatment immediately and adhering to the treatment regimen means a patient’s viral load will reach a level where the disease is undetectable and the chances of that person passing on the virus to someone is very low.
However, ARV treatment requires a high level of adherence otherwise you run the risk of the patients developing drug resistance. This is a crucial aspect that many patients overlook. When they are sick and they take their ARVs, they get better and it is easy for them to understand the importance of taking the treatment. However, for healthy patients, the benefits of ARVs are less tangible and more difficult to observe. ARVs require a high level of adherence and patients need to understand that they can’t miss one tablet every other week. The new ‘Test and Treat’ guidelines will mean many more ‘healthy’ clients starting ARVs but this gives us the opportunity to drive the adherence message home.
Decision support for nurses
On the clinical side, the ‘Test and Treat’ strategy and the availability of a FDC for the first line regimen, will simplify the decision to initiate treatment and the regimen to be chosen. Our user-interviews with nurse-mentors and nurses indicate that the challenge now is to develop decision support to guide nurses on when to switch a patient on a failing regimen. The guidelines are quite simple, but the application of those guidelines is not being adhered to. For example, the data that we’ve collected from our collaborating partners shows a huge lag time between when the clinic flags that a patient should switch and when they actually do switch to the second line.
To provide more support for nurses, we’re working with the NGO Khethi’ Impilo to develop the Viral Failure module to the Nurse Mentor app, focussing specifically on decision support on 2nd and 3rd line switching.
The more people there are on ARVs, the more important adherence to those ARVs becomes. First line regimen involves taking one tablet once a day, but if patients are not adhering to that treatment, they have to go on to second line regimen which means taking around four to six tablets a day. We want to increase adherence and also ensure that nurses have adequate support to make the decision to switch patients and that this decision is carried out in a systematic manner. This new module will be launched at IAS.
Clinician and Patient education – Aviro Edu
HIV Care has improved largely through the efforts of civic society groups which, through an emphasis on patient education, turned patients into health activists. Our focus is currently on HIV patient education as most people learned about HIV at school during a Life Orientation class or in pamphlets they collected. Patients also get their information from a variety of other sources including other patients they meet at the clinic. It is important that patients can access credible sources of information to counter the misinformation that is currently out there. The use of technology as a knowledge translation medium can make accurate information more readily accessible to patients. Future government initiatives such as making Wi-Fi available at clinics means those patients can access more information on the diseases and conditions affecting them. They can then raise any issues with nurses to clarify their understanding and improving their care.
We have developed a set of videos in collaboration with the Desmond Tutu Foundation and MSF to train clinicians about the basics of ARVs, ARV adherence and resistance. We have also created a patient-oriented education video to explain this information as clearly as possible. Our aim is to make the information more vivid to improve their understanding of the disease and how it can be prevented and treated.
Start HIV education early – User-design for adolescents
We are also working on an interactive adolescent counselling syllabus with the Desmond Tutu Foundation to develop HIV counselling material specifically for adolescents. We are following a strict user-design process in which we are engaging with the experts and users to ensure that the message is customised toward adolescents – they then get the information they are looking for in a manner they want to receive it. By combining principles of pedagogy and storytelling we create video content that the user engages with and learns through, making the complete experience memorable and shareable.
We are using an interactive, tablet-based platform where participants can watch the video, after which they are asked questions about the information they have just seen. They will then be tested on the content they had viewed. This ability to receive feedback from users is critical in helping us understand gaps in the counselling process. We are doing this project to try and support and improve the current counselling process aiming to not only make the information more engaging, but also to standardise the process.