Posted by Nicole Moran on January 23, 2020 at 12:28 pm
At the Share-Net 8th Annual Student Meeting: Linking research, policy and practice, ISS ,The Hague
My name is Lucy Kaluvu. I am a healthcare provider from Kenya and currently a global health research intern at the Julius Center for Health Sciences and Primary Care, University Medical Center (UMC),Utrecht. Prior to starting my masters studies, I worked at a Level 4 district hospital in Kilifi, Kenya working closely with immunocompromised oral cancer patients.
My most memorable interaction was with a 55-year-old HIV positive patient, whose late diagnosis had resulted in late stage oral Kaposi Sarcoma. Kaposi Sarcoma is an AIDS-defining illness caused by the Human Herpes Virus-81.Her delayed HIV diagnosis and commencement of anti-retroviral therapy had increased the magnitude and spread of the cancer. This sparked my interest in the reasons behind delayed HIV diagnosis and treatment, especially for those living in low-resource setups.
During my master’s studies at the KIT Royal Tropical Institute, I decided to focus my thesis dissertation on the barriers to access of HIV prevention, care and treatment services and how digital technology can be used to eliminate these barriers. With the guidance of my thesis advisor, Mr. Hermen Ormel (Senior Advisor, Sexual and Reproductive Health and Rights, KIT Royal Tropical Institute) and my thesis academic tutor, Dr Lisanne Gerstel (Health and Education Advisor, Global Health, KIT Royal Tropical Institute), I embarked on a rollercoaster journey of lots of coffee, limited sleep and lots of hard work!
“Mhealth offers significant potential in positively changing the lives of people and with good health you have a great work force” Deputy head of DFID, Tony Gadner2.
Mhealth is the application of medical and public health through mobile communication devices3. Globally, there are more than 5 billion mobile phone subscribers. More than 80% of them reside in low- and middle-income countries (LMICs). In Kenya, the mobile phone penetration is at 93%3.
Mobile phones are portable, with ease of access and sharing capabilities, hence they can reach more people. In the context of HIV/AIDS, mhealth strategies can be used to create HIV awareness, promote HIV testing and improve the level of ART adherence among PLHIV. Moreover, such interventions can also be applied in
The main objective of my study was to identify the barriers of access to HIV services. I also wanted to understand why, despite the potential of mobile technology in health, mhealth interventions were not popular with governments and policy makers. Moreover, I wanted to explore the available mhealth evidence and the gaps in evidence evaluation.
I realized that although mobile health projects have been conducted in Low-middle income countries and in Kenya, they suffer from “mhealth pilotitis”4. The majority of mhealth projects remain in pilot phase and rarely reach full scalability. Also, I noticed significant gaps in mhealth intervention guidelines and limited published evidence on the effectiveness of mhealth interventions.
I applied the Levesque model of access to healthcare services to identify the main barriers to access of HIV services. I also used the Mhealth and ICT framework by Labrique et al to identify the different mhealth functions, as a guide into my literature search.
The World Health Organization (WHO) Digital Health Intervention guidelines 2019 played a major role in the categorization of mhealth studies based on quality and certainty of evidence6.
Figure 1: Mhealth and ICT framework7
“Until the ‘m’ is removed from mHealth and mobile becomes just another mainstream channel for delivering health services, it will continue to languish at the margins”, says Axel Nemetz, Head of mHealth Solutions, Vodafone Global Enterprise5.
NB: Digital, design and infrastructural limitations remain a major challenge in the efficiency and scalability of most mhealth interventions.
The Ministry of Health is keen to ensure an enabling regulatory environment to encourage innovation and use of mobile technology in improving the health of Kenyans. The other pillars are telemedicine, health information system, e-learning and information for citizens”, says Dr Izak Odongo, Ministry of Health Kenya2.
II Ministry of Health Kenya
III Area of research
Mhealth interventions have the potential to improve treatment adherence, facilitate remote supervision and training of healthcare workers, improve access to education material, promote behavior change and improve supply chain transparency. However, design and infrastructural challenges deter the promotion of mhealth interventions above other conventional methods. Also, more high-quality studies are required to produce high certainty of evidence needed to inform policy and integrate mhealth interventions into the healthcare system.
The research process and thesis writing was very rewarding for me. I was able to improve my skills in literature search, sentence construction and scientific writing. This was the beginning of my path towards pursuing a career in research. My advice to those embarking on their thesis journey is to enjoy every step. As always, the next research task will be harder, but you will have experience. I am grateful to Share-Net Netherlands for the opportunity to do my first poster presentation at the 8th Annual Student Meeting: Linking Research, Policy and Practice.
I am currently working on a systematic review on multimorbidity, communicable and non-communicable diseases with a great team. It is a new area of research and I am embracing the challenge. In March this year, I will be doing another poster presentation of this thesis at the Geneva Health Forum 2020.God speed!