A Digital Solution to Support our COVID19 Response

The Solution: While the COVID-19 pandemic spread across Africa and experts warned that the virus was a “ticking time bomb” for the continent, given the likely impact on already stretched health systems, mothers2mothers (m2m) was intensely focused on the health and wellbeing of the nearly 1,800 women living with HIV we employ as Mentor Mothers, and the hundreds of thousands of individuals they support to access vital health services, stay in care, and adhere to treatment regimens. We knew then that Mentor Mothers could continue to provide these life-saving services while maintaining personal safety and reduce the impact of COVID-19 in their communities. Our solutions were driven by their needs and that of the clients and communities we serve. We rapidly developed and launched our electronic service (eService) delivery range starting with two solutions:

Virtual Mentor Mother Platform (VMMP): m2m developed the VMMP to provide interactive WhatsApp-based social and behavioral change messages across key health and wellbeing topics. The platform was rolled out initially with messages about COVID-19 screening, prevention, and control, and later added messages about safe motherhood, healthy childhood, teen health, living with HIV, chronic disease, and family health. The COVID-19 content, based on the WHO’s guidelines, was rolled out in July 2020 and translated into the 31 languages spoken in m2m’s 10 operating countries (Angola, Ghana, Kenya, Lesotho, Malawi, Mozambique, South Africa, Uganda, and Zambia). The solution is currently being implemented in 31 provinces, 54 districts, and 293 health facilities; this is about 94% of m2m health facilities and their surrounding communities.

As of November 2020, m2m has translated and made available to clients 80 percent of its content, including messaging on reproductive, maternal, newborn, child, and adolescent (RMNCH), HIV care & treatment, prevention of mother-to-child transmission (PMTCT) of HIV, adolescent health (AH), and early childhood development (ECD) to all of our operating countries. The remaining content for the VMMP, will be translated and rolled out by end of December 2020.

Peer via Phone services: m2m designed and implemented Peer via Phone services, providing routine, continued to follow up and support for m2m’s clients. The prior relationships Mentor Mothers had with clients and their families were pivotal to this solution. Several clients newly diagnosed with HIV also enrolled in the program during the COVID-19 lockdown period; these clients received Mentor Mother facility-based services upon their diagnosis and were educated about the Peer via Phone services face-to-face. This enabled them to easily sign up for the services.

Lessons Learned: We have had several early learnings coming out of our implementing countries which are shaping the ongoing improvements in our solution.

• Staff in our countries speak diverse languages, as do the clients our Mentor Mothers serve. We have

learned that the translation of content for the VMMP client and team lines is a huge and challenging task, but necessary to ensure that users understand the content.

• Rollout of eServices has been the low proportion of clients with access to mobile phones, especially in countries like Malawi and Mozambique. To address this, Mentor Mothers have worked with clients to identify a family member or friend’s phone who they can use. Being able to reach a cohort of clients via phone enables Mentor Mothers to prioritize those with no phone access for face to face follow up as country regulations allow.

• Our efforts have focused on developing the VMMP content and platform; an important aspect of the success will be promoting the VMMP to clients. Over the coming months, m2m will be developing materials and messages to market the VMMP, and support country staff in presenting the value proposition for the platform.

QA/QI initiative ‘Bring it On’ (BIO) We measure the performance of m2m sites and eServices against key indicators: antiretroviral therapy (ART) initiation; ART pick-ups according to schedule; Viral load test and result according to schedule; Early Infant Diagnosis; final test outcomes for HIV exposed infants; and treatment initiation among those who unfortunately became HIV positive.

Graph 1 shows the BIO results available for 2020. While this includes face to face as well as Service delivery, it shows that our performance remained steady despite COVID-19 lockdowns and restrictions, demonstrating the importance of eServices in maintaining clients' access to and retention of vital health services.

Graph 2 illustrates excellent uptake of eServices among m2m clients with mobile phones from May to September 2020 in five early adopting countries (Angola, Lesotho, South Africa, Mozambique, and Zambia). The same graph compares timely antiretroviral therapy (ART) refills/pick-ups according to schedule. We continue to see excellent results across the implementation period which are consistent or sometimes better than previously observed before the rollout of m2m’s eServices

Graph 3 compares the final test outcomes of HIV-exposed infants born to their mothers. Initially, Ministries of Health and clinical partners, including m2m, focused on multi-month drug distribution among clients with HIV, without accounting for the needs of the HIV-exposed infants. m2m recognized this early and worked with Mentor Mothers to strengthen education and support on infant testing during Peer via Phone calls. As a result, we registered great improvements in infant testing across the months.

While m2m uses routine data for performance monitoring, our Evaluation and Operations Research team will be conducting an evaluation using both qualitative and quantitative methodologies to provide empirical data and evidence for m2m to review our solution and improve it accordingly. This will include evaluating the experiences and acceptability of this new approach from the perspective of the clients receiving the intervention, as well as our Mentor Mothers delivering it. Also, we will collect and use data to assist in informing the optimal eService intervention dosage (duration, frequency, and amount). Finally, we will continue to monitor the impact of the introduction of this new approach on key indicators and outcomes. This data will inform amendments to optimize our approach, as well as augment current global research on the potential of eServices for health and their contribution towards achieving universal health coverage.