Evaluating mobile health interventions for HIV patients in Nigeria: Healthcare policy implications from a simulation study

Abstract

• The adoption of mHealth reduces F2F clinic visits, long queues, and waiting times. • mHealth apps allow continuous remote monitoring of patients who face stigmatisation. • The app reduces operational and economic burdens on HIV services while improving system efficiency. • The tool can improve patient health outcomes and reduce out-of-pocket expenses. • National stakeholders and policymakers should promote the use of mHealth apps for HIV/AIDS, especially in sub-Saharan Africa. People living with HIV/AIDS (PLWHA) benefit from mobile health (mHealth) technologies through self-managing and monitoring their disease with enhanced patient experience and health outcomes. However, the efficiency and cost-effectiveness of these interventions are yet to be studied. The study aims to assess the impact of mHealth on operational and cost metrics relevant to PLWHA and HIV service delivery. Data were a mixture of primary and secondary data from the hospital setting, experts’ opinions, reports, and the literature. Using a web-based simulation platform, SmartHIV Manager™, for the management of HIV services, we tested scenarios based on four possible reductions in the number of clinic visits and four groups of PLWHA who can be offered a mobile device free of charge (16 scenarios in total). The study was conducted in collaboration with Faith Alive Foundation Hospital (Nigeria) using a mHealth app (BSmart Chart). In the worst-case scenario, the hospital anticipates a 14% decrease in the number of visits from stable patients, nine fewer doctors to operate their service, and a 3% savings in total cost after accounting for mHealth intervention expenses and mobile phone acquisition. With the service currently running at 161% doctor capacity, this intervention alleviates staff pressure and ensures quality care. The study shows significant system efficiency gains, fewer visits, better health outcomes, economic benefits for stable patients, and increased capacity. These findings apply to most HIV services worldwide, especially in times of limited resources. Mobile health (mHealth) technologies support people living with HIV/AIDS by helping them manage their health and receive remote monitoring. This study examines the impact of mHealth apps on the costs and operations of HIV services. Conducted in a rural HIV setting in Nigeria, where many patients face financial challenges, the research used a simulation-based decision support tool (known as SmartHIV Manager) to test the scenario of providing free mobile devices and reducing clinic visits for stable patients. Results indicated that this approach could reduce patient visits and healthcare costs while easing the workload of overburdened doctors. Globally, introducing mHealth apps could be impactful, given the constraints of limited healthcare staff and budgets.