Ensuring patients follow prescribed methods of care is a challenge for health care providers around the globe. In India, for example, 97% of HIV-infected pregnant women and their babies receive antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT). Poor outcomes persist, however, due to personal and socioeconomic factors — current estimates indicate that mother-to-infant transmission of HIV drops from 25% to less than 2% if HIV-infected women begin ART early in their pregnancy and maintain exclusive breastfeeding.

Researchers with the Johns Hopkins Center for Clinical Global Health Education (CCGHE) wanted to see if technology could assist uptake of PMTCT services. They supplied a group of HIV outreach workers (ORWs), who visited the homes of pregnant or breastfeeding women with specially designed videos — in the native language of the mothers — that were focused on (1) exclusive breastfeeding, (2) how to take ART medicines, (3) issues related to disclosure of HIV status and (4) ensuring HIV testing of babies. ORWs also collected information using smart forms on emocha Mobile Health’s platform and sent text alerts for upcoming and missed visits to mothers with HIV.

After two years, mothers and mothers-to-be who used technological aids showed significantly increased uptake of exclusive breastfeeding at two months as well as early infant diagnosis at six weeks compared to a control group, according to results published July 3, 2020, in the Journal of the International AIDS Society.

“Information given through videos in the local language to mothers with low health literacy in a standardized manner is a more effective way of communicating. Women in our study could relate to the women in the video stories,” says Nishi Suryavanshi, Ph.D., a CCGHE faculty member based in Pune, India, and the study’s lead author. “This kind of communication delivery is an easy and cost-effective method to encourage a positive change and improvement in patient behaviors, and to ensure consistent messaging is being delivered.”

While speaking with ORWs and their patients, the researchers found that the mobile health platform helped ORWs do their job more effectively, and that both ORWs and patients felt more confident and empowered to make decisions. The use of technology also can be scaled and optimized for all of India — or anywhere in the world — to change health-related behavior, according to Suryavanshi.

“An intervention could be adapted as per the cultural context of the setting,” she says. “For the United States, I think it could be adapted for lifestyle changes to reduce the risk of cardiovascular diseases, for example.”

The Johns Hopkins University has a financial interest in emocha, which was invented at the university. This financial interest includes equity in the company and entitlement to royalties. CCGHE founder Robert Bollinger Jr., M.D., M.P.H., a co-author of the paper, is an inventor of the technology who has equity and a royalty interest in emocha. He is a member of the emocha board of directors and a consultant for the company. These conflicts of interest are being managed by the university in accordance with its policies.