Ankita Kadakia, M.D., of UC San Diego Owen Clinic, presents "HIV Unplugged: Advances in Mobile Health" at AIDS Clinical Rounds
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The UC San Diego AntiViral Research Center sponsors weekly presentations by infectious disease clinicians, physicians and researchers. The goal of these presentations is to provide the most current research, clinical practices and trends in HIV, HBV, HCV, TB and other infectious diseases of global significance. The slides from the AIDS Clinical Rounds presentation that you are about to view are intended for the educational purposes of our audience. They may not be used for other purposes without the presenter’s express permission. AIDS CLINICAL ROUNDS
Transcript
The UC San Diego AntiViral Research Center sponsors weekly presentations by infectious disease clinicians, physicians and researchers. The goal of these presentations is to provide the most current research, clinical practices and trends in HIV, HBV, HCV, TB and other infectious diseases of global significance. The slides from the AIDS Clinical Rounds presentation that you are about to view are intended for the educational purposes of our audience. They may not be used for other purposes without the presenter’s express permission.
AIDS CLINICAL ROUNDS
HIV Unplugged: Advances in Mobile Health
Ankita Kadakia, MD Assistant Clinical Professor Owen Clinic
Objectives
Discuss mobile health (mHealth) technology specifically for resource limited settings
How mHealth technology can be used to bridge the health care delivery gap specifically for HIV/AIDS care
Using mHealth technology targeted towards the Ugandan healthcare system
Global Health Workforce and Burden of Disease by WHO Region
Crisp N, Chen L. N Engl J Med 2014;370:950-957
BURDEN OF DISEASE
HEALTH CARE WORKERS
The healthcare delivery gap
DIAGNOSIS TREATMENT
Harvard Department of Global Health and Social Medicine
“Despite unprecedented financial resources and medical advances care is prevented from consistently reaching the patients who need it.”
“The Know-Do gap , the often neglected work of getting effective therapies (the know) to the people who need them (the do)” -Paul Farmer, MD
What is the adherence rate to ARVS in sub-saharan Africa?
A) 10%
B) 33%
C) 55%
D) 77%
E) 95%
Mills Edward J. et al JAMA August 6,2009 Vol 290, No 679-690
What is the adherence rate to ARVS in sub-saharan Africa?
A) 10%
B) 33%
C) 55%
D) 77%
E) 95%
Mills Edward J. et al JAMA August 6,2009 Vol 290, No 679-690
Factors Affecting Adherence in Resource Limited Areas
Transportations issues Payment for services and
medications Illness and co-morbid
conditions Inability to obtain
consistent supplies of medication
Food insecurity Alcohol use Religious beliefs and
stigma Higher CD4 counts and
complacency Increased adherence with
cell phone users
Magutu D et al, Factors affecting first month adherence to antiretroviral therapy for HIV positive adults in South Africal; Afr J AIDS Res. 2010 Millis EJ et al, J Acquir Immune Defic Syndrome. 2013 May 1;63(1)e:23-7
Factors Affecting Adherence in Resource Limited Areas
Transportations issues Payment for services and
medications Illness and co-morbid
conditions Inability to obtain
consistent supplies of medication
Food insecurity Alcohol use Religious beliefs and
stigma Higher CD4 counts and
complacency Increased adherence with
cell phone users
Magutu D et al, Factors affecting first month adherence to antiretroviral therapy for HIV positive adults in South Africal; Afr J AIDS Res. 2010 Millis EJ et al, J Acquir Immune Defic Syndrome. 2013 May 1;63(1)e:23-7
2014 Winner of the World Press Photo Award: African migrants in Dijbouti
Convenient, Mobile, Cheap, Efficient and Fits in Your Pocket … Mobile Doctor
mHealth Point of Care Diagnostics
Why do POC diagnostics improve healthcare delivery in resource limited settings? Improve scalability: shifting health delivery to the local
level (healthcare community worker) Reduce cost Improve early detection: increasing the yield of disease
diagnosis Improve access to previously underserved populations Improve treatment rates
Bridging the Human Delivery Gap with mHealth in Health Care Delivery Systems of Resource Limited
Areas
Study Investigators and Collaborators Ankita Kadakia MD Sanjeev Bhavnani MD (The Scripps Research Institute) Rakhi Sharma MA (Disaster Relief, The World Bank) James Saturday BSc (Kabale Regional Medical Center) Elizabeth Ekirapa-Kiracho PhD (Makerere University School of Public Health) Peterson Kyebambe MD (Nagaru Hospital, Kampala Uganda)
Kabale Uganda 1 hospital system >600,000 people 200 beds 300 patient visits/day 13 doctors
Average time to CD4/VL
Flow Cytometry for CD4 count
CD4 count performed twice per year
Samples are grouped and processed at central facility distant from the collection site (9hours by bus once weekly)
Viral load results take 60-90 days
Galiwango RM et al. (2014) Field Evaluation of PIMA Point-of-Care CD4 Testing in Rakai, Uganda. PLoS ONE 9(3): e88928. doi:10.1371/journal.pone.0088928
Implementation of POC in Resource Limited Areas
1. Identify the major disease burdens in the community Choose a POC based on community based needs Specific factors leading to the delivery-care gap
2. Is the POC diagnostic suitable for use in rural areas? Diagnostic robustness, ease of use, accuracy and cost Is the POC an improvement over the current method of
diagnosis?
3. Organizational infrastructure Adequate medical, financial, human and technological
How can the Cellphone help with medication adherence?
mHealth HIV
Text messaging for medication adherence
Lab-on-a-Chip and Microfluidics
Mobile-Elisa (mElisa)
Future Directions
Lab-on-a-Chip
Lab on a Chip
•Clinical trial in Muhima Hospital, Kigali, Rwanda •Commercially available sera/ plasma samples of HIV /Syphilis tested in the mChip at Columbia University, HIV sensitivity 100%, specificity 95%, Syphilis 100%, 81% •Commercial ELISA HIV 100/98-100% and Syphilis ab 82-100/97-100% •70 specimens collected from known HIV positive men and women •1 out of 70 specimens tested was falsely negative, 98-100% sensitivity/88-100 specificity •67 samples for duplex HIV/Syphilis mChip yielded 100%/94% sensitivity and 100%/76% specificity
m-ELISA CD4 count
mHealth HIV
Text messaging for medication adherence
Lab-on-a-Chip and Microfluidics
Mobile-Elisa (mElisa)
Future Directions
•Tested 17 HIV/AIDS patients and 18 transplant patients on immunosuppression •Compared with Flow cytometry as gold standard •97% accuracy rate compared with flow cytometry
HIV Viral Load Pipeline
www.aslm.org
Simple Amplification Based Assay(SAMBA)
Lee, Helen et al, J Infect Dis. (2010) 201 (supplement 1): s65-s71
•HIV-1 viral nucleic acid based assay for dipstick, 2 hours for result •Sample prep for extraction of viral RNA, isothermal amplification of viral nucleic acid, rapid visual detection of amplification products by dipstick •Tests subtype B and Non-B strains •63 positive /6 negative samples from Royal College of London, 100% reproducible resultscompared with the same samples tested with Roche Taqman HIV-1 assay
