Digital Virtual Support During COVID-19
Background: The global outbreak of the novel coronavirus (COVID-19) beginning in Wuhan, China and spreading to numerous countries, including Canada, is the latest example of a rapidly spreading infectious outbreak with global impact on people and economies(1). Capacity to support emerging cases and rapidly test contacts using countries’ response mechanisms pose serious risks to regions with limited healthcare resources. Isolation at home is often employed for confirmed cases and contacts. However, public healthcare personnel need ways to monitor such individuals, who may feel stranded or otherwise unsupported. WelTel, is an integrated virtual care and patient engagement digital health service that acts as a hub for healthcare workers to communicate with patients. It emerged as an innovation to support the global HIV pandemic through a Canadian-Kenyan partnership funded by the US PEPFAR program(2). By integrating basic text messaging via short message service (SMS) to ‘check-in’ on patients automatically, patients can respond at any time, and reach a health care provider (HCP). In turn, HCPs can respond via a dashboard using text, phone or video, among other patient support and data collection features.
Key Objectives: Through this international collaborative project, we will: 1) Deploy and co-optimize the WelTel virtual care service for multiple countries to assist in home monitoring and support of COVID-19 cases and contacts (Canada, Rwanda, & Kenya); and 2) Evaluate communication and other metadata captured by the system for public health quality improvement to better understand and reduce barriers (incl. implementation & stigma)
Hypothesis: The support of cases and contacts of COVID-19 requiring home isolation will benefit from digital virtual care tools such as WelTel by streamlining the work of care providers by providing better data management to inform public health best practices for communicable disease responses compared to current telephone and in-person based approaches alone.
Preliminary Data: WelTel was first used in Kenya to support patients staring HIV treatment and was shown to improve treatment adherence and viral suppression in a landmark randomized clinical trial (2). It was adapted for use in Canada where improved HIV suppression was seen among vulnerable populations and has been expanded for use in chronic disease management (e.g. asthma) and rural and remote primary care (3). Internet access remains below 50% in many parts of Africa and in a January 2020 survey of acute medical patients at Vancouver general hospital, 30% of those with phones did not have smartphones (4,5). Most recently, Rwanda’s national government has officially adopted the WelTel program as its primary IT solution for home-based care of COVID-19 patients and their contacts in all districts based on its success in the first wave. In accordance with our third objective, BC Children’s Hospital cardiology program rapidly expanded WelTel service to >500 pediatric patients with heart transplants and other conditions who require enhanced virtual support. Additionally, Samburu County in Kenya is continuing to deploy WelTel for pregnant mothers to access antenatal care and for COVID monitoring in rural Kenya.
Methods: We are partnering with 3 priority countries (Canada, Kenya, and Rwanda) to test a novel public health purpose-based configuration of WelTel for public health monitoring (WelTel PHM). Initial countries were chosen since they already use WelTel services or are familiar with it, have cases or are preparing for COVID-19, and have high level interest in urgent research collaboration to inform virtual care into the response. We will use system data, field notes, surveys, linkages to other public health data, and structured focus groups to assess the impact and usefulness of the virtual health tool to support immediate public health efforts and to develop novel tools for rapid assessments to inform public health efforts and challenges going forward.
Impact and Future Directions: There is an urgent need for novel approaches to support cases and contacts of COVID-19 in global settings, especially if the outbreak expands internationally. Using virtual care may be a cost-effective and efficient way to provide the necessary public health monitoring and support for the current epidemic and to develop evidence-based preparedness for future emerging or re-emerging communicable pathogens in both higher- and lower-income countries.
1. Government of Canada. Coronavirus disease (COVID-19): Outbreak update [Internet]. Diseases and Conditions. 2020 [cited 2020 Feb 17]. Available from: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html
2. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. The Lancet. 2010 Nov;376(9755):1838–45.
3. Lester RT. Ask, Don’t Tell — Mobile Phones to Improve HIV Care. N Engl J Med. 2013 Nov 7;369(19):1867–8.
4. Africa [Internet]. Internet World Stats: Usage and Population Statisitcs. [cited 2020 Feb 17]. Available from: https://www.internetworldstats.com/africa.htm
5. Kazi AM, Carmichael J-L, Hapanna GW, Wangoo PG, Karanja S, Wanyama D, et al. Assessing Mobile Phone Access and Perceptions for Texting-Based mHealth Interventions Among Expectant Mothers and Child Caregivers in Remote Regions of Northern Kenya: A Survey-Based Descriptive Study. JMIR Public Health Surveill. 2017 Jan 30;3(1):e5.