Ushauri mHealth solution: Enhancing HIV Patient Care through timely appointment reminders

Regular attendance at medical appointments is essential for sustaining good health and well-being for PLHIV. These appointments provide important opportunity for patients to obtain personalized care, preventive screenings, and treatments suited to their specific health requirements. Aside from addressing existing medical difficulties, continuous attendance enables healthcare providers to track progress, change treatment plans as needed, and uncover prospective health risks before they worsen. Furthermore, prioritizing medical visits not only supports individual health goals, but also improves the general efficiency and efficacy of the healthcare system, resulting in improved health results for everyone.

In today’s fast-paced world, missed appointments poses significant challenge, leading to wasted resources, increased wait times, and compromised patient outcomes. Appointment reminders serve as a proactive solution to this challenge, offering patients timely notifications about upcoming appointments through their preferred communication channels, whether it’s via text messages or phone calls.

Evolution of Ushauri

Ushauri, a mobile and web-based platform initially developed by mHealth Kenya and currently managed by Palladium KeHMIS III under the Health Training and Research Kenya (HETARK), is a testament to the power of technology in healthcare. The project is funded by the Centers for Disease Control and Prevention (CDC),

 Ushauri was developed with an objective of improving the health outcomes of PLHIV by providing timely and reliable messages including appointment reminder messages, treatment adherence messages, and wellness messages. The system provides users with the option of either using short messaging services, applications on smartphones, or web-based access. The platform also provides the service provider with an electronic appointment diary at the facility level, making it possible to schedule and re-schedule appointments including tracing defaulters; thereby facilitating better management of clients on antiretroviral therapy (ART).

Key Features

Ushauri comprises of various modules namely: 1)Appointment Diary, which is an electronic diary that enables the health facilities to receive automated list of expected clients, missed clients & defaulted clients daily; 2) Defaulter Diary that is used for documenting tracing efforts, and outcomes; 3) Prevention of Mother to Child Transmission (PMTCT) Module which enables paired appointments for both mother & child; 4) Differentiated care model (DCM)module that facilitates longer appointment management making it possible to book two appointments for stable clients (at month 3 & month 6); and 5)  Dashboards at various levels for decision making.

Ushauri Application enhancements

Having been developed for the first time and rolled out in 2017, there was need to enhance the system to cater for the ever-increasing requirements by health care providers and patients. The recent enhanced in Ushauri include;

• Additional program indicators to support tracking Ushauri scale-up and use.
• Features that support transmission of data from non EMR sites to the national data warehouse (NDWH).
• Seamless integration with KenyaEMR system for efficient data exchange and ART directory for complete patient transfer and linkages across health facilities in the country.
• Features that support UPI verification to facilitate seamless client verification in paper-based sites (non-EMR sites).

 Uptake and Utility:

 Utilization of Ushauri is palpable with various service delivery partners utilizing the product. Out of 40 service delivery partners supporting HIV services in Kenya, 37(92.5%) are using Ushauri in their facilities to manage HIV patients on ART. The uptake across the 2250 health facilities that reported patients currents on ART in 2023 was significantly high at 79.1%. This translates to 52.4% of the 1,215,508 patients on ART at the time, being managed in Ushauri system in 2023.  (Table 1)

Table 1: Ushauri uptake by HIV sites being supported by PEPFAR (1 Year retrospective cohort as of December 2023)

Parameter	Status(Dec 2023)	Target	% achieved
Counties	40	44 PEPFAR supported	90.9%
Partners Active for Ushauri	37	40	92.5%
Active facilities	1,850	2,250	79.1%

 By December 2023, a total of 637,038 patients were actively using Ushauri application to track their appointment schedules and receive health messages. Of these, 74.8% consented to receive SMS reminders for their scheduled appointments (Fig 1).

Figure 1: Number of patients on ART that are active in Ushauri and their consenting for SMS status.

A patient who has a scheduled appointment and consented to receive an SMS reminder, is sent at least one SMS either, four weeks, three weeks, two weeks, one week, or a day before the appointment date. For all the 1,146,870 appointments scheduled in 2023, 67.1% had a consent for SMS reminder and 65.4% had at least one SMS reminder delivered to the patients successfully. A majority (71.3%) of these appointments, honored their appointments (Fig 2).

Figure 2: Appointments booked in 2023 and their Consent, SMS delivery and Honoring Status

Among the appointments that correspondently received an SMS, 74.1% were honored before or on the actual appointment date. Appointments that a patient honors any day after the appointment date to a maximum of 30 days are termed as prevented interruption in treatment (IIT). In 2023, IIT was prevented in 20.9% of the appointments that had successful SMS, while 4.9% returned to care (RTC) after 30 days (Fig 3).

Figure 3: Deviations in appointment honoring and prevented IIT

Summary:

Uptake: Ushauri has been widely adopted, with 79.1% of HIV sites and 52.4% of patients on antiretroviral therapy (ART) utilizing the platform.

SMS Reminders uptake: A significant majority (74.8%) of patients using Ushauri consented to receive SMS reminders. These reminders were crucial in helping patients remember their clinical review dates or medication refills, thereby promoting treatment adherence.

Success Rate of SMS reminders: Over half (65.4%) of SMS reminders sent for appointments were successfully delivered, ensuring that patients were alerted about their scheduled visits.

Appointment Honoring: Of all the appointments with consent and successful SMS reminders, 74.1% were honored. This indicates a positive impact on appointment attendance and continuity of care.

Prevention of Interruptions in Treatment (IIT): Through the use of Ushauri for SMS reminders, interruptions in treatment were prevented for 20.9% of scheduled appointments. This is crucial in maintaining consistent care for HIV patients and combating the challenges posed by missed appointments.

The Implementation and enhancement of Ushauri has enhanced efficiency and effectiveness of Appointment honoring through SMS reminders for HIV patients on ARVs .