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2.2     Implementation

            The application of the HITSystem was jointly conducted with the assistance of several partners including (but
            not limited to):
                   Global Health Innovations (developers of this system)
                   Kenya Medical Research Institute
                   OnTarget (internet marketing company)
                   Academic Researchers (from University of Kansas Medical Center and Children’s Mercy Hospital
                    Kansas City)
                   Walter Reed US Military HIV Research Program (training and implementation)

                   NASCOP.
            For the designated hospitals for the pilot project in Kenya, the HITSystem can be accessed on computers and
            laptops, using mobile broadband, which eases the implementation of this system even in remote areas (if
            required). The HITSystem has been built to generate regular alerts directed at health providers other EID
            stakeholders and lab technicians, when time sensitive interventions are required in a particular child’s case.
            These alerts are directed at tracking and identifying children who have omitted their treatments for a defined
            period of time. An inbuilt text messaging mechanism in the HITSystem sends messages to mobile phones of
            the parents when test results are ready or follow up visits for treatments are needed.

            In Kenya, especially Nairobi, the HITSystem was implemented from April 2011 to November 2013 at certain
                                                                                               38
            health facilities. The implementation and was conducted between April 2011 and May 2014.
            The health facilities chosen for the pilot were selected based on the logistical feasibility, absence of other EID
                                                                                            39
            related interventions for HIV and the approval from the respective hospital stakeholders.

            2.3     Outcomes
            This pilot project in Kenya has been carried out with remarkable ease and effectiveness. It was noted that
            relatively  limited  penetration of  ICTs,  telecommunications and  internet  connectivity  had  a very minimal
            negative impact on the continuance of the project. The sustained efforts stakeholders of the stakeholders
            facilitated the successful adoption, implementation and continuous maintenance of the HITSystem. With the
            monitoring mechanism in place, HITS was able to ensure that treatments were provided on time.
            The principles of the HITSystem were found to be in line with EID guidelines and the results of this pilot
            project surpassed the expectations and outcomes observed in national statistics. A feedback mechanism was
            also  incorporated  into  the  implementation  procedure  of  the  HITS  to  ensure  that  the  participants  were
            satisfied with the services received. This also helped improve the existing line of treatments and reduced
            response time for emergencies.

            It was noted that the HITSystem successfully reached nearly all mother–infant pairs, who were enrolled in
            EID services at the targeted health facilities. However, it was observed that nearly 40% of HIV-exposed infants
                                                                                 40
            in Kenya are never enrolled in EID, thereby not receiving the benefits of HITS.






            ____________________
            38   The  follow-up  periods  for  this  process  ranged  between  6  and  38  months  depending  on  month  of  initial
               implementation of the designated facility.
            39   Lessons  learned  from  implementing  the  HIV  infant  tracking  system  (HITSystem):  A  web-based  intervention  to
               improve early infant diagnosis in Kenya. 2015.
            40   Lessons  learned  from  implementing  the  HIV  infant  tracking  system  (HITSystem):  A  web-based  intervention  to
               improve early infant diagnosis in Kenya. 2015.

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