Center for Health Market Innovations (CHMI)

Programs

WelTel

last updated Apr 1, 2013

Overview

Year Launched: 
2008
Stage: 
Pilot/startup stage
Income Level of Target Population: 
Bottom 20%, 20-60% (lower to lower-middle)

Funding

Primary Source of Funding: 
Donor
Funders: 
International Development Research Centre's Africa Health Systems Initiative Support to African Research, President's Emergency Program For Anti Retrovirals (PEPFAR), Public Health Evaluation (PHE), US Centers for Disease Control and Prevention (CDC)

Technology

Technology Used: 
Phones › SMS/MMS (Text Message)
Technology Purpose: 
Facilitating Patient Communications › Encouraging Patient Compliance
Technology Partner(s): 
Vertical Labs, Dimagi
Summary: 

WelTel Kenya aims to improve health outcomes such as adherence and retention through automated SMS messages to support patients on ART, Preventing Mother-to-Child Transmission (PMTCT) of HIV and TB treatment.

Program goals/rationale: 

The widespread use and availability of mobile phones in Kenya and other developing countries provides a good opportunity to deploy mobile phone based solutions to improve health service delivery and health outcomes. Surveys conducted by Weltel at an AIDS clinic showed that more than 50% of patients owned their own mobile phones, despite their low income; when one took into account the number of patients who share phones, this percentage was even higher. Despite the prevalence of mobile phones, only 12% of patients reported ever calling the clinic or having had the clinic call them.

Key program components: 

The HAART cell phone adherence trial (WelTel Kenya1):
Between May 2007 and October 2008, WelTel operated a clinical trial in Kenya that measured the effectiveness of using SMS in improving patient adherence and response to highly-active antiretroviral therapy (HAART). It currently operates at two sites in Nairobi and a site in Kajiado District. In this trial, patients would receive a weekly check-in in the form of an SMS that said "Mambo?" ("How are you?"). Patients could then respond if they were fine or if they had a problem. Weltel decided to use weekly, rather than daily, texts because it was less expensive and helped overcome the problem that patients will sometimes temporarily leave their phones charging far away from them (e.g. in another larger town). In a randomized trial with 538 patients, Weltel's SMS system showed a 24% improvement in medication adherence and a 19% increase in patients with suppressed viral loads.

WelTel now plans to work with Kajiado District Hospital as a demonstration site on how WelTel can be implemented in Kenya and other resource limited settings. The purpose of implementing WelTel at a demonstration site in Kajiado is to monitor and evaluate the intervention in a programmatic versus trial setting. WelTel will also develop business models to be implemented in 5 other clinics.

Furthermore, WelTel has received a grant from the National Institute of Health to evaluate whether similar SMS messages are effective at retaining patients newly enrolled in HIV care (pre-ART) and whether it promotes initiation of therapy in accordance with current World Health Organization recommendations. WelTel is partnering with AMREF to conduct this study in their HIV Comprehensive Care Clinics in Kibera.

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