Challenge

For over 20 years, the University of North Carolina, Chapel Hill has collaborated with the Malawi Ministry of Health, supporting a range of clinical care and research in the areas of maternal health, STIs, malaria, cancer, and HIV/AIDs. 

However, accuracy and reliability of monitoring patients remains a challenge. Current EMR systems struggle to identify patients because of inconsistent names and misspelling, as well as an inability to link patients across different types of health services (e.g. ANC, HIV, malaria). Nearly 25% of women in Option B+ (a lifelong antiretroviral treatment program) are lost to follow up within 12 months of initiating ART, making long-term engagement in HIV care a barrier to successful outcomes (Bengtson et al., 2019).

Opportunity

This project explored the potential for biometric technology to assist with monitoring engagement in HIV care across HIV clinics in the Lilongwe district, among women enrolled in Option B+. Researchers evaluated how a technology-enhanced monitoring system compares to the current HIV monitoring system in recording HIV visits, identifying transfers between clinics, and identifying women who are lost to follow-up.

Results

Two peer-reviewed studies recently published by Brown University School of Public Health found that Simprints improved HIV care delivery and was wholly positive on the acceptability, usability, and feasibility of the technology. 

Specifically:

• Biometric fingerprint scanning out-performed the current EMR system in recording HIV visits among women in Option B+
• During the 3-month study period, nearly 50% of HIV visits captured in the biometric system were not recorded in the current EMR system used to monitor HIV visits
• The majority of participants felt the biometric fingerprint scanning system was easy to use (64%), required no additional assistance (69%) and met their expectations (76%)
• All enrolled participants (100%) successfully registered their fingerprint
• Women and healthcare workers reported few concerns about patient privacy or HIV status disclosure related to biometric fingerprint scanning. In fact, for some biometric fingerprint scanning was seen as providing improved privacy by enhancing anonymity
• Biometric fingerprint scanning emerged as the preferred strategy to monitor engagement in HIV care. Among healthcare workers, 70% felt biometrics were very feasible, while 48% thought text messaging and SIM card scanning were feasible
  

Please see linked the two papers published in AIDS and Behavior and in AIDS Care.

Looking ahead

This study ended in 2019, with the conclusion that biometric fingerprint scanning should be scaled-up and evaluated as an implementation strategy to support sustained engagement in HIV care for women during the perinatal period.