HIV infections are a serious health issue in Mozambique and many other countries. The Clinton Foundation and the country’s Ministry of Health are now financing advanced ICT infrastructure to help speed up identification of the infection in pregnant women and thus reduce spreading of the disease. Finn Snyder spoke with Alexander Bufalino (›Fig. 1), Senior Vice President Global Marketing, Telit Wireless Solutions, about the technologies applied.
?: What is the situation regarding pregnant women and HIV in Mozambique?
Bufalino: Roughly half of HIV-positives in Mozambique are younger than 25 years. There is hardly a family spared of AIDS; nearly one in six Mozambicans between the ages of 15 and 49 years is HIV-positive, representing a total of 1.5 million people. More than 500,000 children have already lost their mothers or both parents to AIDS, and 35,000 babies are born HIV-positive every year. Nearly half of the babies born in Mozambique with HIV die in the first two years of their lives.
?: What has been the approach regarding transportation/communication in the context of tests and lab results up to now?
Bufalino: Essentially the tests and lab results were driven by human carriers to and from medical centers and labs. This was taking anywhere between 15 and 30 days while use of the new solution has reduced that to 2–3 days (›Fig. 2).
?: How did the idea of using modern technology originate, and who is organizing, and paying for, the implementation?
Bufalino: The Clinton Foundation, to be more precise The Clinton Health Access Initiative (CHAI) Mozambique, approached Sequoia Technology as cellular wireless data experts and Telit Wireless Solutions.
The request was to design a system to be able to get blood tests done and results sent back from central labs to remote clinics where there is no infrastructure (›Fig. 3) – quickly and in a scalable way. Mozambique has a GSM network. The Sequoia Innovative Expedited Results System (SERS) was able to send test lab data over the GPRS network accurately, without loss of data and able to see what had gone where and when, and for it to be scalable nationally. The project was funded by the Clinton Foundation and Mozambique’s Ministry of Health.
?: Please describe the design of the technology, and the workflow, in detail.
Bufalino: Clinics across Mozambique collect dried blood spot samples from mothers-to-be and transport them to the nearest reference lab, where lab technicians conduct the HIV tests. Sequoia developed a small, inexpensive printer incorporating SMS (short message service) wireless protocol used for mobile phone text messaging (›Fig. 4). Utilizing the GC864-Quad V2 wireless modules from Telit Wireless Solutions, the SMS printers are connected to a complex GSM cellular gateway that allows lab results to be wirelessly and securely sent to printers installed at the clinics.
Sequoia uses the local MCEL GSM phone network to transmit results back to the appropriate clinic. Details of the communications process are:

• User accesses the ‘website application server’ as provided by the end customer;
• The website application server gathers the user’s details from the ‘DB server’ and displays the user’s information as required on the user’s webpage interface, etc.;
• User requests the information be printed from the website application server and a print job is created. The server then updates the records and sends any relevant information (i.e. SMS messages, emails, screen updates) and then sends a HTTP POST (or GET) directly to the gateway server;
• The gateway server sends the print data to the relevant printer and manages the printing process and error handling of the print job;
• The printer prints the message and sends a confirmation back to the gateway server;
• The gateway server receives the acknowledgement from the printer and sends an XML confirmation quickly to the website application server which can then update the relevant information. It can also update the client with status of the communication – success, failure, or pending.

?: What are the challenges specific to Africa and the infrastructure there?
Bufalino: With very little infrastructure in Africa, most remote village clinics cannot be reached by car, they have no mail service and no landlines. The challenge for Sequoia and Telit was to use the only mode of communication you can reliably say is everywhere in Africa – the cellular network.
?: How is the solution working today?
Bufalino: In just the first six months of the launch, an estimated 20,000 babies have been saved from infection. This has allowed mothers with HIV-positive results to begin anti-retroviral drugs much earlier in their pregnancies, reducing the chances of transferring the virus to their newborns from 40 percent to less than 1 percent (›Fig. 5). Nearly 400 clinics in Mozambique are now outfitted with the printers.
?: Can this approach be ported to other regions, for further scenarios in healthcare?
Bufalino: A huge advantage of this project is that it can be applied to obtaining lab results for other diseases as well, such as malaria and tuberculosis, so life-saving treatments can begin much sooner. In addition, the advanced monitoring software included with the system can be a powerful tool for health ministers to track where illnesses are appearing and apply medical resources accordingly.