A chance phone call from the Clinton Foundation in Mozambique has changed ours and their lives dramatically. It shows the power of creating appropriate and well constructed websites describing a companys services and products.

What was the problem and then the solution:
Delayed test results have often meant that HIV patients in Mozambique have failed to get timely treatment, particularly for preventing Mother to Child transfer (MTCT) of HIV on birth. However, having introduced and developed our new SMS printer technology with the Clinton Foundation and the Mozambique Ministry of Health the need to send tests to far away laboratories has reduced and has dramatically speeded up test results and HIV treatment for Mothers, Mothers-to-be and their newly born. After a successful 2009 pilot Mozambique has nationally rolled out our SMS printer technology and gateway, with Clinton Foundations help. This GSM network based printer and gateway technology transmits the results of mother and infant HIV tests electronically from two central reference laboratories in Maputo and the northern provincial capital, Nampula, to more than 275 health centres across the country. Previously, test samples and results took, on average, three weeks and up to several months to be transported to and from clinics via various means in remote parts of the country.

How did Sequoia and Clinton Foundation meet?
Because of this serious delay in test results the Clinton Foundation in Mozambique looked around for a technology based solution. They ended up contacting us in Reading having seen our website and enquired about using our SMS printer technology for sending health test data over the GSM network to speed up the time taken. After hearing what the program was about and the disastrous pass through rate from Mother to child for HIV we, at Sequoia, could only say yes to help with the program. Two years of concentrated work with the Clinton Foundation on the hardware and the required gateway software produced a successful pilot program. Subsequent research conducted by the Ministry of Health of Mozambique and the Clinton Health Access Initiative (CHAI), after our SMS printer technology and gateway had been installed, showed that the time it took for clinics to receive test results from reference labs had dropped from an average of about three weeks to about three days after the printers were introduced. Research presented by the Ministry of Health and CHAI at the International AIDS Conference 2010 in Vienna, Austria, showed that this, in turn, reduced the time it took to start infants (and /or mothers to be) on antiretroviral (ARV) treatment by about 4 months. This is now part of the national prevention of mother-to-child (PMTCT) HIV transmission service within Mozambique. The number of infants starting treatment also increased by 60 percent.

How the SMS printer technology and gateway works:
Clinics across the country collect dried blood spot samples from infants and / or mothers to be and transport them to the nearest reference lab, where lab technicians conduct the HIV tests. Results are entered into the SMS printer database at the reference lab and then uploaded onto the Sequoia Technology online server (in Reading UK). The Sequoia gateway then uses the local MCEL GSM phone network to transmit results back to the appropriate clinic. Each clinic has a small thermal paper, GPRS enabled printer that receives the patient test data and prints out the HIV test results alongside a patient identification number. With interruptions in electricity and wireless network signal, the system has been designed to ensure 100 of the data is received by the appropriate printer completely intact – if printers are offline, results are safeguarded in an online gateway queue until the printer is available. The Sequoia Technology gateway shows the status of every printer whether on or not and the number of messages sent or in a queue waiting to be printed. The printer’s small size also makes storage easy in space-constrained clinics, which must also ensure that the printer is kept in a secure room to guarantee patient confidentiality.

Greater efficiency The introduction of SMS printers to clinics has not only meant that babies who test HIV-positive can be started on ARVs sooner – a potentially life-saving intervention – but has also reduced the numbers of new mothers who disappear from the clinics PMTCT program during the, previously, long wait times or after having spent time and money on multiple clinic visits to check for results. According to Mozambiques 2010 report to the UN General Assembly Special Session on HIV/AIDS (UNGASS), about 30 percent of babies born to HIV-positive mothers contract the virus, but only about 14 percent of these babies are tested for HIV before the age of 18 months. Without treatment one-third of HIV-positive babies will die in their first year of life, and almost half by the age of two. With our SMS printer technology in place now the clinics are being able to get to and test mothers-to-be ?for HIV and be able to prescribe AVR drugs in enough time to reduce the likelihood of mother to child transfer of HIV. Additionally further testing after childbirth can check the mothers viral load to ensure the right drugs are given when the mother is breastfeeding an additional way of MTCT of HIV. With our technology in place now, throughout Mozambique, the 30-40 or less if the pre and post birth testing and drug application takes place.

Our SMS printer technology and gateway is then a fast and accurate way of transmitting confidential health data to any remote location but crucially can be used for any disease Malaria, TB, HIV in fact anything that needs to be diagnosed in a lab. This technology forms a low cost and serious platform for countries to transmit diagnostic information quickly and accurately. Additionally, the gateway consolidates all information and therefore gives statistical data about disease spread and location and the quality of the health care across a complete country. Sequoia engineers took 2 years to perfect the gateway software with CHAI and MCEL to produce 100 full data quality and with printer / server buffering and handshaking to ensure the quality of data. Extensive testing took place in pilot phase of this project. Any authorized person can log on to the SMS2printer.co.uk website and retrieve the full data and visual map of where each printer is and the stats of how many messages have been sent / received / pending at each location.

Partnership – We continue to develop more capable GPRS enabled printers and are now working with CHAI in Kenya for potentially deploying a similar system in other African countries for the same health diagnostic transmission platform. Our association with the Clinton team in Mozambique continues and has become more of a partnership and further roll outs are planned as a result of the success so far.