This program earned a Gold award.
South Africa has the highest number of HIV+ people in the world. Despite this, HIV-related stigma remains high; less than 25% of people have been tested; only 10% of those who qualify for ART are receiving the drugs; and only 60% of those on ART continue taking it for more than two years. Thus, there massive numbers of people who do not know their status, who are not accessing their ART, and who are dropping off their drug treatment programmes. Project Masiluleke was therefore developed to provide solutions that interact directly with end-users, ie. Those impacted by HIV/AIDS, on a large scale, by intervening at all stages of the HIV care continuum: promoting HIV testing, treatment, treatment adherence, and retention in care. To this end, three main programmes have been initiated: SocialTxt, to insert HIV/AIDS messages into the ubiquitous Please Call Me messages; TxtAlert, which sends patients messages reminding them about clinic visits, and allowing them to reschedule through SMS; and an HIV Self-Test Kit (STK), where people will be able to test themselves at home, thereby avoiding the stigma often associated with HIV-testing clinics. These tests would also include contact information for HIV/AIDS counselors via mobile services. Using mobile phones means that roughly 90% of the population can be reached by this initiative, as the use of mobile phones is widespread across the country, with both rich and poor people using them. These phones are also pervasive across the entire world, including most of Africa, where more traditional forms of media (eg. television, internet, radios) may not have much of a market. Thus, this programme has the potential to be rolled out on a massive scale. The overall aims are therefore to encourage people to get tested (through the SocialTxt messages); to give people a way to access testing in private (through the STKs); and to encourage treatment adherence (for both HIV and other long-term illnesses such as TB) through the TxtAlert messages.
Innovation: The innovation lies in finding a way to encourage people to access HIV testing, treatment, treatment adherence, and retention in care. Using mobile phones allows the project to access many more people than traditional advertising (on television, radio, the internet, or print). It also provides easily-accessible support services, again through mobile phone technology. Making direct contact with end-users (those impacted by HIV) also increases the likelihood of uptake of services; rather than focusing caregivers and healthcare workers.
Effectiveness: Since October 2008, 221, 577, 682 HIV-specific Please Call Me’s have been sent; and the volume of daily calls to the National AIDS Helpline has tripled. The TxtAlert system has been piloted at Right to Care’s Themba Lethu Clinic in Johannesburg, and will now be rolled out as part of the ART and TB programme at Edendale Hospital (with 8000 patients). The STKs have not yet been completed.
Poverty Impact: The impact of this programme lies in making HIV testing and treatment more accessible to many people, and in trying to reduce the heavy stigma attached to the virus. With the huge numbers of HIV+ people in the country, will hopefully have a positive impact. Although the full impact of the project is still being tested, a monitoring and evaluation programme is underway to research this.
Sustainability: The project is the result of a collaboration between a large number of stakeholders, mainly from South Africa and the United States. The main stakeholders (Pop!Tech Institute; iTEACH; Praekelt Foundation; and frog design) are all committed to the project in the long-term. Donations have mainly been received in-kind (eg. MTN donates 1 000 000 Please Call Me’s a day; LifeLine runs the National AIDS Helpline; National Geographic will document the project; Nokia Siemens Network is a funding partner; and Ghetto Ruff has committed to promoting Project Masiluleke through the voices of their musicians). Thus, it seems the sustainability of the project is ensured for the foreseeable future.
Replication: The use of mobile phone technology means that this kind of project can easily be replicated in almost any part of the world (as long as there is mobile phone coverage); and for almost any long-term health-related issue (eg. TB, birth-control). It could also be used for awareness-raising on almost any social problem (eg. pollution; crime etc). Replication would require substantial sources of funding, but the aim is for this project to be rolled out in as many places as possible. Thus, the project partners aim to replicate it themselves. Other mobile phone companies and service providers could work on similar initiatives.