The combination of mobile devices with diagnostic tools offers new possibilities to test, track and treat infectious diseases as well as improve health systems, according to a new review published today in Nature.
The review, led by a team of i-sense researchers from Imperial College London, University College London, Africa Health Research Institute (AHRI), University of KwaZulu-Natal and the London School of Hygiene and Tropical Medicine, discusses how mobile health (mHealth) solutions combined with connected diagnostics could increase access to testing and care for patients, and improve the ability of public health authorities to monitor outbreaks and intervene to stop them.
Smartphones are increasingly used in sub-Saharan Africa. By 2020, GSMA forecast that one in two mobile phone connections in the region will be via smartphone – a similar figure to worldwide smartphone adoption. “These highly accessible technologies have the potential to change the future of healthcare, particularly for infectious diseases,” says Professor Molly Stevens from Imperial College London.
By using the existing built-in sensors in mobile phones and exploiting their computational and connective power, diagnostic test results can be interpreted and securely sent to local clinics or healthcare workers, supporting virtual follow up appointments and rapid treatment in a simple, cost-effective way.
At Africa Health Research Institute, mobile phone-connected HIV tests, which link to online prevention and medical care, are being developed by a team collaborating with i-sense researchers for use in South African communities hardest hit by HIV. The m-Africa project aims to build low-cost and user-friendly mobile diagnostic tests for HIV, and explore the use of an app that allows a person to test, get their results and potentially access to HIV drugs from within their community.
Simple diagnostic devices are complemented by the processing power and connectivity of modern mobile phones to produce portable devices with the potential to match the performance of traditional expensive and cumbersome laboratory diagnostic equipment.
“When this new generation of diagnostic technologies is successfully implemented into care pathways, they will have the potential to lead to major health and economic benefits for millions of people all over the world,” says Rachel McKendry, Professor of Biomedical Nanotechnology at UCL and Director of i-sense.
The review outlines the benefits that such mHealth solutions could have for various groups.
- Individuals benefit from increased access to healthcare outside of traditional care settings, along with more rapid access to diagnoses and results, allowing them to better understand and manage their own health
- Healthcare workers benefit from improved efficiencies in service delivery, through automated decision trees and reduced paperwork, reducing workload and freeing up time
- Clinics benefit from improved data management, better stock control and more cost-effective, user-friendly services
- Public health systems benefit from the closer to real-time reporting of health data, allowing them more efficient surveillance of outbreaks, to implement control measures that can limit the spread of infection, and target public education
The implementations of such solutions, however, do not come without challenges. While rapid advances in technologies have the potential to widen access to testing, still more than 35% of the world’s population do not have access to a mobile phone. Concerns also arise in age and gender gaps in relation to the use of digital technologies as well as privacy and confidentiality of test results.
To demonstrate the challenges for mHealth solutions as a result of the digital divide, researchers used open source data to map out network coverage and distance to healthcare facilities in Uganda.
It was shown that one in five of the population there have no access to cellular networks. However, of the 22% that live more than 5 km from the nearest health centre, approximately two in three people are in range of a cell tower, meaning that they could benefit from mobile health interventions.
In addition to the digital divide, connectivity standards and regulatory science have not kept pace with technological advances, making it challenging for the adoption and implementation of mHealth solutions.
Regulatory challenges arising from the rapidly evolving types of mobile device and their associated hardware need to be overcome before we establish how these technologies will interface to clinical pathways and how they will allow escalation to face-to-face care and referral when needed.
“The future of this digital revolution brings promise for better connectivity and rapid changes in the way healthcare is delivered and received, for instance outside of clinics and hospitals,” says Deenan Pillay, Director of Africa Health Research Institute and i-sense Deputy Director.
“Indeed, such approaches are being rapidly scaled up in resource-limited settings.”
“There is a need for developers of connected mobile-health diagnostics to consider how these applications will co-exist in a coherent ecosystem (or ‘health app store’) where users can find the solutions they need and when used, applications can integrate with care pathways, exchanging data in a secure and standardised way to electronic health records,” says Kobus Herbst, AHRI’s Chief Information Officer and one of the co-authors of the paper.
This is an exciting opportunity for researchers and policy makers to develop new tools and systems that could drastically improve human health and wellbeing in the future.
- Taking connected mobile-health diagnostics of infectious diseases to the field – Nature Review
- Authors: Christopher S. Wood, Michael R. Thomas, Jobie Budd, Tivani P. Mashamba-Thompson, Kobus Herbst, Deenan Pillay, Rosanna W. Peeling, Anne M. Johnson, Rachel A. McKendry, & Molly M. Stevens
- Imperial College London
- University College London