Barriers such as knowledge, cost, time, and access to services, prevent women and their partners from adopting and continuing use of contraceptive methods. Nivi’s highly scalable AI-powered conversational chat service is working to change that by providing users with personalized and culturally appropriate SRH information, contraceptive recommendations, and referrals to clinics and pharmacies where they can access methods from condoms and over-the-counter pills to IUDs and implants. The digital service complements existing health education campaigns and health services, while also providing a new pathway to expanded contraceptive adoption through self-care. In 2019 alone, Nivi engaged over 900,000 people in India and Kenya through popular digital channels including Facebook Messenger and SMS. Looking ahead to 2020, engagement will only pick up further when WhatsApp is added as a channel. Through these digital interactions we capture market-level insights on user demographics and needs, their barriers, method preferences, and readiness to act. Nivi works with provider networks, pharmacies, and voucher programs to improve access to services and enable self-care.

The retention of HIV patients on antiretroviral therapy (ART) is critical in achieving the global UNAIDS 95-95-95 targets. Given the critical role of retention in care and adherence to antiretroviral therapy, the USAID Boresha Afya Southern Zone program introduced a mobile-based reminder system that automatically sends text messages for improving adherence three days before and on the day of the appointment. A study involving 1,820 patients from 135 HIV care and treatment centers (CTC) who received text reminders and 5,126 patients from 176 CTSs who didn’t receive text reminders was conducted in Tanzania’s five regions (Iringa, Lindi, Morogoro, Mtwara, Njombe) to understand the role of text reminders in improving retention. Retention-related data was collected for 12 months (April/2018 – March/2019). The mobile numbers of consenting clients on ART in the CTC database were registered on SMS reminder system. To protect confidentiality, the system extracted only patient ID and telephone numbers. Enrolled clients received two types of adherence SMS reminders on their mobile phones: three days in advance and the second on appointment day. The study showed that the average retention among clients receiving text reminders was 92.6% (Iringa 94.3%, Lindi 94.5%, Morogoro 91%, Mtwara 92.8%, Njombe 92%) while average retention among clients who didn’t receive reminders was 56.8% (Iringa 57.4%, Lindi 58.4%, Morogoro 52.8%, Mtwara 52.6%, Njombe 63%). The study showed that scheduled mobile text reminders have demonstrated significant improvement retention. A client who received at least 1 successful SMS reminder was 9 times more likely to be retained compared with those who didn't receive (p< 0.001). Patients changing their phone number over time was a challenge and to overcome this, the initiative required each patient to update their contact information at every visit. Zero-rated USSD is considered in lieu of SMS to reduce transmission costs.

Nigeria, the most populous country in sub-Saharan Africa with a population of 190 million is currently experiencing an epidemiological health transition with growing rates of Non Communicable Diseases (NCDs). NCDs, especially diabetes mellitus, hypertension and stroke, have emerged as a major public health challenge in Nigeria specifically with 20% of the population aged 30-70 dying prematurely from these diseases largely due to limited access to quality care provision, under supply of primary care providers and specialists and a minimal health care coordination. Digital health technologies are increasingly being used to support management of NCDs. Here, we will outline the digital solutions deployed in Lagos, Nigeria as part of our pilot implementation of an integrated NCD self-management program and describes the integration of quality improvement methodologies to drive engagement and ensure patients are receiving the right care at the right time. Methods: A total of 66 participants with Hypertension and/or Diabetes Mellitus Type 1/2 were enrolled into the activation and maintenance phases of the CompleteHealth™ program from December 2018 to May 2019. Each participant was assigned to a virtual coach-led multi-disciplinary team who co-creates health goals based on their risk factors. Digital health tools were co-created with patients such as patient health portal, glucose and blood pressure diary tracking and medication reminders. Members with basic phones were provided SMS-based support. Health providers from the facilities where patients went for treatment have also been trained in diabetes and hypertension care and use of the platform. Results: Early results demonstrate improvements in blood pressure or blood glucose in over 60% of participants and 78% of participants were more confident in themselves in managing their health condition. Full detailed data analysis of outcomes and patient experience will be available at the time of the conference.