Cell-life project set to revolutionise management of anti-retroviral treatment

The cell phone solution also provides a data collection tool to establish drug effectiveness.

A COLLABORATION between UCT's Departments of Civil and Electrical Engineering and the Cape Technikon is set to revolutionise the way AIDS patients manage their anti-retroviral treatment, a rigid regime often involving the ingestion of up to 20 pills daily, many of which need to be taken at set times in order to be effective.

The project, called Cell-life, involves the use of cell phones programmed to record the medications details of AIDS patients. It brings together technology experts in IT, health and engineering to solve the management problem of HIV/AIDS. By merging cell phone technology with the Internet and database systems, a Medication Management System has been developed, one that provides a "virtual" infrastructure to support HIV positive patients on anti-retroviral treatment.

A pilot project has just been launched in Gugulethu involving a group of "therapeutic counsellors" (trained peer counsellors from the community who are also taking anti-retrovirals) who carefully record the health status of the patients in their care, including their adherence to medication schedules. These counsellors visit patients several times a week. During the visit cell phones, which have a wireless Internet gateway (WIG) application, are used to report on a patient's status. The information is sent via short messaging service (SMS) to a central database, which can be accessed by the patient's doctor or nurse. Should an emergency arise, the doctor will be automatically contacted via SMS and beeper.

Cell phone giant Vodacom has stepped in to provide sponsorship and support for the project, which will be showcased at the World Summit on Sustainable Development (WSSD) this week. The development signals a significant breakthrough in the provision of anti-retroviral treatment. Much of the focus on anti-retrovirals has centred on provision costs and toxicity levels. Little has been written about the sophisticated management involved in providing the therapy.

"Since the HIV virus mutates at a very high rate, the medication is only successful if taken as part of a complex time-and-diet regime. If the schedule is not adhered to with 95% compliance, the virus will start mutating and resistant strains to the specific drug will develop," explained project leader, Dr Ulrike Rivett from the Department of Civil Engineering.

"To support the patients in this life-long treatment, physical and psychological support has to be provided. As there are not enough doctors or nurses trained on the issues of HIV/AIDS, a short-term solution has been identified in the therapeutic counsellors who are supported by technology."

Cell-life, which has been pre-patented, brings together technology experts in IT, health and engineering to solve what is undoubtedly a logistical nightmare for patients and health professionals. The cell phone solution also provides a data collection tool to establish drug effectiveness and response time to side effects, such as lever-toxicity after using Nevirapine. It is envisaged that cell phones with GPS technology will be provided to the therapeutic counsellors, an important factor in rural areas.

The idea originated in July 1999. Rivett was giving a talk at the Cape Technikon's Mother and Daughter Day, explaining why women did not automatically turn to engineering as a career option. "Women are nurturers and carers and often turn to those careers where these characteristics will be fulfilled," she noted.

"During question and answer time a young woman asked what engineering was doing to prevent the spread HIV/AIDS. I was floored," she admitted. "I really had no answer. But it got me thinking. I came up with an idea for a pillbox that would send signals to a database." Rivett discussed the idea with many colleagues, from engineering to health sciences. "It was Professor Jon Tapson from Electrical Engineering who suggested we use existing technology to cut costs. Cell phones provided the perfect solution."

The spin-offs offered by this technology are significant as it can be used in the wider health arena. "We don't have the resources to build the roads, hospitals and clinics that engineers devote their energies to, but we can build a virtual infrastructures, with databases of patients, where one doctor can advise hundreds of patients all over the country," Rivett concluded.

Importantly for the EBE Faculty, the project has also moved the faculty into a "different era", said Rivett. Many of the students have been involved developing the systems for the project. "This is the first time our students have been directly involved in the fight against HIV/AIDS and where they have been able to see the direct impact of their work."

(Apart from Rivett and Tapson the team includes Dr Linda-Gail Bekker from the Boehringer Ingelheim Lung Institute and UCT alumnus Dr Jevon Davies from Electrical Engineering at the Cape Technikon.)