Premise recently wrapped up its project with the PEPFAR ‘DREAMS Innovation Challenge’ which supported medication adherence monitoring for HIV- positive adolescent girls and young women (15-24 years) in rural Kenya. Among adolescents, girls and young women account for 74 percent of new HIV infections in sub-Saharan Africa. The goal of the Innovation Challenge is to increase evidence-based approaches to the HIV epidemic and infuse additional innovative strategies and resources to better meet the urgent and complex needs of adolescent girls and young women in sub-Saharan Africa.
In order to combat the historically low rates of youth HIV medical adherence and clinical retention in sub-Saharan Africa, our project deployed a smartphone app-based adherence program in the Kenyan counties with the highest HIV prevalence: Homa Bay, Siaya and Kisumu. The Premise project focused on medical treatment adherence, since evidence shows that consistent medication intake is necessary to prevent antiretroviral treatment failure, sexual HIV transmission, opportunistic infections and premature death.
Selected participants downloaded the Premise App and received daily reminders to report on their adherence and clinic experience, receiving financial incentives for their submissions. Premise would then send the data to the local clinics to help providers better understand their patient’s behavior and improve the quality of their care.
The goal of this project was to understand and increase patient adherence while providing granular, actionable data visualizations to clinic staff and local government administrators. Our solution and user experience was specifically designed for a low tech literacy demographic and general ease for first-time smartphone users.
Throughout the course of the project, we witnessed several positive outcomes that impacted many of the participants. Some of these included:
- Improved Medication Adherence: Although incentives were not based on actually taking medications (only reporting behavior), the daily reminders did help users take their medications more regularly with reporting goals and incentives for 7-day streaks. Appointment reminders in the App also helped participants plan for and attend their clinic visits regularly.
Eunice* previously struggled to take her medication daily before but using the App has made the process much easier. “Premise has helped me to take my medicine daily, something I never used to do in the past.”
- Financial Empowerment: The money earned through the App has also had an impact on the lives of participants. Users reported putting the extra income toward supporting their families with food and other household necessities, paying for their education, and achieving a sense of financial independence.
Boke* reflected on how the income generated from the App has changed her life. “I no longer borrow money from friends or relatives in order to meet my needs like buying sanitary towels.”
- Sense of Community: The biggest impact was creating a sense of community for HIV-positive adolescents and young women who participated in the program. Stigma is still a major problem worldwide for people who are HIV-positive, often due to a lack of education on the disease. The supportive friendships and community created through the App helped to improve many participants resilience and sense of self-worth.
One user who previously faced harsh stigma for her HIV-positive status mentioned “Premise helped me acquire many friends. I did not expect someone like Ayo* to know my status and for me to know hers and to accept one another without discrimination. We talk to one another, support ourselves and even visit one another.”
Providing a safe space for young women in similar situations to share their experiences and support each other was extremely empowering.
Challenges continue for quantifying the impact of health programs due to a pervasive lack of measurement, learning and evaluation mechanisms within the international development field. However, digital tools can empower citizens on-the-ground to share information that prove highly effective for collecting the massive and wide-spread data needed to develop more effective and successful programming. As smartphone ownership becomes more pervasive, there remains promise for app-based projects to function as a powerful and effective tools in the fight against HIV, and other diseases.
As with other survey-based methodologies over-reporting and satisficing (reporting only what you think the interviewer wants to hear) presented major issues for data quality during this project. While we continue to think of ways to decrease bias in reporting and overcome data quality challenges, we will reflect on the lessons learned from the DREAMS ‘Innovation Challenge’ including the power of digital tools to foster community and enhance physical and financial wellbeing.
* Names have been changed to protect the anonymity of Contributors.