MICA:Development of new paradigm in differentiated care for HIV patients; Community pharmacy drug refill using the ARTAccess Mobile phone application.

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We have made great progress in getting life saving medication to people living with HIV all over the world. However, there are still around 15 million people worldwide who need treatment. This treatment is essential to stop people living with HIV from getting sick and dying, but it also helps to prevent new infections happening. As there are no vaccines for HIV at the moment and no cure, this is a very important form of preventing the spread of the infection. However, in many setting such as Uganda the cost of treating patients with HIV puts a great strain on the health services, and as more patients need treatment this will increase. Therefore, we need to find different ways of providing HIV treatment which will enable the health services to cope. This could include reducing the need for patients to see a doctor or nurse every time they go to clinic and so reduce the burden on staff, to reduce the paperwork involved, to make it easier for the patients to access their medication near to their homes, so that they do not lose working hours, and many more. Lots of people have now been on medication for a number of years and are doing very well. At the moment they still need to come frequently (every 1-3 months) to their local clinic to pick up medication which adds burden to both them and their clinic.We propose to use mobile phone technology to see if we can help to reduce this burden. Mobile phones are cheap and widely available in sub-Saharan Africa and very many people use them. In fact, many people use them to send money and do business, without the need for banks. We will use a mobile phone or tablet to link the patients records and their recent blood tests to community pharmacies, so that the patients can get their drugs from multiple sites, not just their clinic. As this approach is new we will need to see how the technology works, see what the patients, doctors and nurses, pharmacy staff and the government think about this system and to see what effect it is having on the delivery of services to the patients. We will also plan for a much larger research study which will link these technologies with other mobile phone based tools, such as daily reminders to take pills, and see how we can link up a whole geographical area and streamline the services for people living with HIV. If this works, it may be used for very many hundreds of thousands of people on HIV treatment, and in future may be used for other conditions such as high blood pressure or diabetes in Uganda and elsewhere in sub-Saharan Africa.