A team of Mass General doctors is helping colleagues at Mbarara Hospital in Uganda develop better systems to treat children with HIV/AIDS, malaria and other diseases.
Mbarara Hospital: A Ugandan Success Story

Mbarara Hospital in southwest Uganda reflects many of the medical challenges that exist elsewhere In Africa, where children die of diseases fully preventable and treatable in the developed countries. They vary from the simplest-to-treat conditions like diarrhea and bacterial pneumonia, to the most severe, like malnutrition, tuberculosis and HIV/AIDS.

A team of doctors from Massachusetts General Hospital is helping to treat at least one group of these childrenat Mbarara Hospital, where David Bangsberg, MD, MPH, director of Mass General’s Center for Global Health, has a long-standing working relationship. To date, Dr. Bangsberg and his Mass General and Ugandan colleagues have had some major successes in saving the lives of children.

A recent $17,500 donation from the Rotary Club of Scottsdale, Ariz., for instance, helped MGH internist Jessica Haberer, MD, MS, coordinate the shipment and dissemination of basic medications like penicillin to about 5,000 sick children at Mbarara Hospital.

“We estimate that as a result of these medications, we were able to treat and save about 1,000 children who probably would have otherwise died,” says Dr. Haberer.

Mbarara Hospital treats children with the gamut of diseases and conditions, including three of the biggest childhood killers in sub-Saharan Africa: malaria, HIV/AIDS and tuberculosis.

Mbarara Hospital treats children with the gamut of diseases and conditions, including three of the biggest childhood killers in sub-Saharan Africa: malaria, HIV/AIDS and tuberculosis.

Taking on Some of Africa’s Toughest Medical Challenges

But Mbarara Hospital alone isn’t able to cure one of the toughest challenges in healing sick children in Africa, says Dr. Haberer.  That involves ensuring adherence to treatment for chronic therapies, like HIV medicines. “Even if we can get the medicines to the patients, treatment will only be effective if the patients stick to their regimen once they leave the hospital,” she says. “Many of these kids are AIDS orphans and are being transferred from one caretaker to the other, which makes adherence really tricky.”

Her solution? In collaboration with Dr. Bangsberg and their African colleagues on the ground in Uganda, Dr. Haberer is helping fine-tune the use of two types of technologies to monitor treatment adherence. In the first instance, she is monitoring a subset of patients via cell phones, using interactive voice response and short message service (SMS) texting to see when they are missing doses. Large swaths of Uganda have cell phone reception, which makes this method feasible.

But Dr. Haberer thinks a wireless monitor made by a private company named Wisepill Technologies Adherence Management Solutions in South Africa may hold even greater promise. The device, also called Wisepill and the size of a wallet, transmits signals via cellular networks when a patient opens it to take a pill. The information is fed back to Dr. Haberer and her colleagues who can then see — in real-time and tracked in archived charts — when the patient has likely taken his or her medication. If a patient misses more than two days of medicine in a row, a member of Dr. Haberer’s team contacts the patient to see why.

The goal is to integrate this technology into clinical practice, where adherence reminders could be sent via cell phones, or community health workers could be alerted to go to the patient’s home to provide more in depth assistance.

Innovative Technology to Help HIV/AIDS Patients

“This is extremely innovative and important technology, particularly for HIV/AIDS patients because if a patient misses just a few doses in a row, the patient may begin to develop drug resistance and within a few weeks could lose treatment efficacy,” says Dr. Haberer. “‘Second line’ therapy is much more expensive to treat and the resistant virus can then begin circulating in the population.”

In addition, for poor patients in rural areas who can’t easily travel to faraway health clinics—and given the paucity of physicians in many African countries—the technology could be a major boon, she says. The device also may allow for targeted use of ‘viral load’ in HIV/AIDS patients, which is a resource-intensive measure of the severity of the infection. This test could potentially be reserved for those patients with adherence problems. Drs. Bangsberg and Haberer are planning additional research in this area.

And for those children frequently shuttled between caretakers, Wisepill could help mitigate the possibility of variable adherence between caretakers.

Dr. Haberer is still working out some of the challenges with both of these remote adherence systems, but Wisepill and improved cell phone methods could potentially be replicated throughout the world, both in developing countries and in the West, for a variety of patients, including the elderly.