TeleHealth for Mother and Child Pairs.

Access to health services is a challenge in limited resource settings due to frequent stock-outs of essential supplies, as well as a shortage of skilled health providers. As a result, many remote and underserved communities are served by a single Clinician poorly equipped to manage HIV positive mother and HIV exposed children with complex and chronic illnesses. Telemedicine play a but role in strengthening health systems and promoting universal health coverage for mother and baby pairs. By using an innovative telemedicine platform designed by Collegium Telemedicus, CADFIN connects a network of volunteer Clinician to physicians around the world  to bring specialty care to the people.  Clinicians access to telemedicine system through an app on their mobile device, collect all vital signs and connect the client to a network of online Physicians to provide the most effective and appropriate care to patients and ensure they are adhering to recommendations. 

Cameroon updated its National ART Guidelines in 2016, expanding the implementation of Test and Start for all HIV-positive individuals including pregnant women and HIV exposed children. 2017 data show that an estimated 845,048 pregnant women attended ANC, and about 34,028 HIV positive pregnant women are in need of PMTCT services with HIV positivity rate of 4.0%. Cameroon’s mother to child HIV transmission rate is 5.6 % at six weeks (MOH, 2015) and 25% by 18 months, contributing roughly 7,300 of 9,500 newly infected children annually. 

Many PMTCT programs cite weak linkages between health facilities and the communities they serve as a barrier to program performance. Other problems are a lack of dissemination, a lack of affordable and effective medical solutions , inadequately trained personnel, and operational bottlenecks. There is also lack of opportunity and motivation to access timely health care or adopt healthy behaviors before, during, and after pregnancy. 

Telehealth has therefore adopted a client-centered approach that provides all of the necessary support that mother-infant pairs require to successfully enter the  PMTCT program and adhere to lifelong ART through linkages with Physicians.  The interventions are organized according to how they support the mother-infant pair along the continuum of care. 

The Solution utilizes asynchronous telemedicine technology to connect local Clinicians with a network of volunteer physicians specialized in a wide range of areas such as dermatology, pediatrics, radiology, family medicine, oncology, infectious disease, and cardiology. The Solution incorporates the use of information and communication technologies (ICT), such as computers and cell phones, to exchange pre-recorded Mother and Child data between the Clinician and Physician at different times. The platform is designed to work in low-connectivity and remote areas, allowing Clinicians to deliver specialty medical care to mother and baby pairs living with HIV in a timely and cost-effective manner. The platform also empower clinicians through distance learning and clinical mentorship. Each physician consultation through the telemedicine brings Clinicians up to date medical recommendations, the expertise required for early diagnosis and treatment plan development, clinical mentoring, and personalized collaboration with specialists right from a smartphone.

 Clinicians will use the telemedicine platform to submit patient consultations, determine the most appropriate ART treatment regime, and provide long-term expert level care. Because the platform allows the Clinician to communicate with volunteer physicians regularly, patients receive continuous care from expert providers while the ultimate responsibility of patient care falls in the hands of the Clinicians.

The solution specifically target HIV positive mothers and HIV exposed children. The Telehealth Solution therefore addresses this challenge by adopting a client-centered approach that provides all of the necessary support that mother-infant pairs require to successfully enter the  PMTCT program and adhere to lifelong ART.  The interventions are organized according to how they support the mother-infant pair along the continuum of care, increase demand for and access to primary health interventions for women and newborns and substantially improve the quality of care and sustains healthy behaviors, attitudes, and practices. The Solution impact lives in the follow ways;

1) Empower clients through individual client support and participatory medical support by assigning a Peer Health Workers and Physicians to provide education, counseling and psychosocial support to individual HIV positive clients. This two way messaging allows clinicians and physicians to ask and answer inquiries and receive guidance on best practices, treatment plans, and individual patient cases. Such support is associated with increased PMTCT, adherence and retention to treatment and improved health outcomes.

2) The solution establish and enforce an appointment and tracking system that follows the mother-infant pair together from ANC through cessation of breastfeeding and retention on ART for HIV positive cases. 

The Telehealth innovation fits into the existing health care structure of Cameroon as the government has adopted the policy of free access to ART at the point of delivery with focus on pregnant, breastfeeding mothers and HIV exposed infants  children. 

The Solution also fits into the global plans on Accelerating Children’s HIV/AIDS Treatment Initiative with priorities of preventing mother-to-child transmission of HIV, scaling-up access to care and treatment, health systems strengthening with a focus on improving health information systems, and strengthening the continuum of care and treatment and ensuring linkages in the delivery of HIV prevention, care, and treatment services.