Two-way Texting Patient reminders and tracking (Zimbabwe)

iTech and Medic Mobile, Zimbabwe (January 2021)

Countries: Zimbabwe

Intervention Description

Two-way texting (2WT) between patients and providers with embedded alerts, referrals, and healthcare worker tasks improves patient retention and data quality. 2wT assists patients by sending personalized appointment reminders and missed appointment alerts, referring swiftly for tracing. 2wT also facilitates transfer reporting and proactive visit rescheduling, reducing unnecessary tracing and improving data quality.

Presenter: Caryl Feldacker, Phiona Marongwe (I-TECH and Medic)

Link to presentation.

Intervention Details

Data Elements	Appointment Date (history) Appointment Date (scheduled (prospective)) Confirmed visit Date Demographic details Phone contact details Tracing outcomes (Lost to Follow Up, dead, treatment interruption, etc.) Reason for Missed Appointment
Evidence	From related 2wT system with CHT: Babigumira, J. et al (2020). "Cost-effectiveness analysis of two-way texting for post-operative follow-up in Zimbabwe’s voluntary medical male circumcision program." PloS one 15(9): e0239915. Feldacker, C. et al (2020). "Usability and acceptability of a two-way texting intervention for post-operative follow-up for voluntary medical male circumcision in Zimbabwe." PLOS ONE 15(6): e0233234. Feldacker, C. et al (2020). "Reducing Provider Workload While Preserving Patient Safety: A Randomized Control Trial Using 2-Way Texting for Postoperative Follow-up in Zimbabwe's Voluntary Medical Male Circumcision Program." JAIDS Journal of Acquired Immune Deficiency Syndromes 83(1): 16-23.
Technology Requirements / Interoperability	Community Health Toolkit (CHT) app for 2wT: -Can be interoperable with EMR.EHR -Can run offline or online -Mobile tool optimized -Can run on PCs
Calculations / Algorithms	Patients are identified as high risk in 2wT when appointments are missed>14 days and referral task for tracing created
Factors to Scale	-Needs ART-context specific evidence generation (coming in 2022) -Availability of App on Play Store for widespread testing -2wT is not one size fits all; rather 2wT is part of the solution.
Implementation Considerations	-Ideal in larger clinical settings -Healthcare workers must be empowered to lead 2wT implementation -2wT will not work for all clients/contexts - caution to not present 2wT as sole solution -Works offline/low connectivity for low resource settings -FREE, open-source, no fee App -Any language
Governance Considerations	-Privacy & Security concerns addressed with 2FA and Medic PHI protections -Requires local server hosting if not AWS, etc -No additional consent needed if routine consenting for client tracing -MoH must be ready, motivated and able to assume ownership