Barcelona 2013 Barcelona, Catalonia, Spain 2013
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Abstract #2718  -  Fostering Unity for HIV Prevention Through Mobile/Social Media: Emerging Evidence From The Field
  Presenting Author:   Dr Sheana Bull - UC Denver
  Additional Authors:   
I propose a two-part call to action to utilize technology more efficiently and effectively.
  Method / Issue:
There has been substantial proliferation of mobile media related to health. Current estimates suggest there are over 20,000 mobile applications (apps) to help individuals accomplish a number of improvements in health behavior. We face two main challenges in this field~only a small proportion of the 20,000 plus applications have evidence of efficacy, and we have little evidence they can be scaled to realize their potential for impact on public health outcomes. For HIV prevention, important work by Lester et al., and Pop-Eleches et al., shows the efficacy of using infrequent text messages to facilitate adherence to ART, with reductions in HIV viral load. Ybarra et al., demonstrated the efficacy of using the Internet to deliver a comprehensive sexuality education program (CyberSenga) to Ugandan secondary school students, resulting in sustained abstinence and sex protected by condoms among those exposed. For each of these trials there are hundreds if not thousands of apps that make unsubstantiated claims of efficacy. Furthermore, we remain behind in assessment of whether taking these apps to scale will actually have the intended impact on critical public health outcomes such as HIV.
  Results / Comments:
First, we must standardize evaluations of eHealth/mHealth. Second, we must demonstrate that taking apps to scale will realize substantial public health benefit. The typical five to seven year timeline to conduct a well designed randomized controlled trial leaves most apps created today obsolete when evidence shows they work. When possible, we need to use technology more efficiently in conducting RCT?s with approaches such as online recruitment, panels of participants to facilitate enrollment and online data collection and management. We can also consider alternatives to RCT?s such as N-of-1 designs, interrupted time series, systems modeling and propensity scoring. Finally, we must integrate considerations related to scale in app development. Ultimately, small effects realized through efficacious eHealth/mHealth interventions can have substantial impact only if they are widely disseminated. This is possible?even probable?but not yet the reality.
This call to action can be applied to new and ongoing eHealth/mHealth apps in development at the individual level and health care delivery level alike. Taking text messaging for ART adherence and widely disseminating CyberSenga are two immediate individual level approaches that can and should be scaled. Meta-analyses and systematic reviews have established the utility of using text message reminders for appointments and to facilitate field based data collection of service delivery these too should be scaled to maximize quality of service delivery. Emerging initiatives for health care workers integrate geographic information systems into service delivery, further facilitating priorities for prevention of mother to child transmission in Tanzania. Rural health care workers are relying more consistently on using mobile phones to collect surveillance data, which in turn facilitates better data quality and reduces data entry costs. eHealth/mHealth should be regularly tested and widely disseminated to realize their potential for impact in HIV/AIDS.
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