New NIH program awards $2.5 million to spur innovation in mobile health

A new NIH program is awarding nearly $2.5 million to spur innovation in mobile communication technologies and software applications used in biomedical research in low- and middle-income countries (LMICs). Fogarty has awarded the first round of grants from its Mobile Health: Technology and Outcomes in Low and Middle Income Countries (mHealth) program. Seven new awards will provide funding over two years to spearhead new mHealth initiatives in Kenya, Malaysia, Mali, Nigeria, Romania, South Africa and Vietnam. Additional awards are expected in fiscal year 2015, which begins Oct. 1.

The new program will support the development of groundbreaking mobile devices and apps focused on a wide range of public health concerns, including HIV/AIDS, child injury prevention, malaria, tuberculosis and improving training for community health workers.

"NIH and Fogarty have had a longstanding interest in the potential of cellphones, smartphones and mobile apps as powerful health intervention tools," said Fogarty Director Dr. Roger I. Glass. "These new mHealth awards will enhance efforts of researchers and clinicians in low-resource settings, while yielding crucial data on implementation, scale-up, and what works and what doesn't."

Microscopy experts from Beth Israel Deaconess Medical Center in Boston will work with researchers in Nigeria to develop and test an inexpensive and lightweight malaria screening tool. The disposable device will be based on the principles of magnetic levitation, using a set of magnets to separate infected red blood cells from uninfected ones. The prototype system the team developed requires less than a drop of blood and produces results that can be stored and analyzed using a standard cellphone camera. The device will be tested at the hematology lab at Redeemer's University in Nigeria, using blood samples from malaria-infected patients.

Researchers at the Aurum Institute in South Africa plan to improve TB diagnosis methods by designing an app that relays sputum tests from labs to health workers via a mobile device, as well as personalized text messages informing patients of their results. Tuberculosis control in South Africa is currently hampered by patients failing to follow up with treatment following diagnosis and the current paper-based system of recording TB data for health authorities. If successful, the new app will address this gap by speeding up communication between labs, health workers and patients.

Reducing child injuries at home will be the focus of an initiative being launched by Johns Hopkins University and Malaysia's Institute for Public Health. The research team will create a mobile phone-based app designed to assess household injury risks to Malaysian children under five, using scientific principles from other health intervention methods such as home visits. The designers will also develop a data registry as well as workshops and courses, with the goals of producing risk-reducing interventions and developing mHealth research capacity in Malaysia. After the app is evaluated, it will be modified into a preventive tool that can be used in other LMIC settings.

Another grant going to Johns Hopkins University will help streamline the household visits and outreach tools used by community health workers in Mali. Working with researchers from the University of Bamako, the team will create an mHealth system that prioritizes key contacts for interpersonal communications, shifts the burden of sending reminders to mobile phones, and helps health workers tailor the content of maternal and child health-related messages based on factors such as stages of pregnancy and ages of children.

Boston University will use its award to test a new mobile health training platform in Vietnam that uses text messaging to provide training to community health workers. In Vietnam and other countries, health workers provide a diverse range of services, maintaining their competence through continuing medical education, which is increasingly delivered via internet-based modules. The researchers' efforts will center on adapting the courses to standard cellphones, potentially expanding training opportunities to much larger number of health workers and offering poorer countries a cost-effective training option.

In Kenya, mHealth experts from the University of Washington will engineer a tablet-based app designed to facilitate safer conception methods among couples wherein one partner is HIV-infected and the other is not. The researchers will use data from text message surveys to identify peak fertility periods and develop an ovulation prediction tool and individualized safer conception text messages, assisting couples in practicing timed unprotected sex. The app and related tools will enhance an existing intervention that includes antiretroviral therapy for the infected partner and prophylaxis for the uninfected partner.

Finally, reducing the spread of HIV among gay, bisexual and other men who have sex with men (MSM) in Romania through a live chat intervention app will be the goal of a new project administered by Hunter College of the City University of New York. Currently Romanian MSM experience stigma that drives them away from HIV prevention services. The research team intends to circumvent this barrier by developing a smartphone platform that combines a live chat counseling program and mobile software that tracks risky behavior in real time. If effective, the app could be replicated in similar international communities where stigma and lack of resources contribute to HIV transmission among MSM.

Fogarty's mHealth program aims to contribute to the evidence base for the use of mobile technology to improve clinical outcomes and public health while building research capacity in LMICs and establishing mHealth research networks. The program promotes research on the use of mobile and wireless devices - such as cellphones, smartphones and tablets - to improve health outcomes, health care services and health research.

Applications for consideration in a second funding round are due Feb. 19, 2015.

2014 awards for Fogarty's Mobile Health program
Feasibility and Acceptability of a mHealth Intervention to Find and Link TB cases to Care
The Aurum Institute, Johannesburg, South Africa
Principal Investigator: Dr. Kerrigan McCarthy

Malaria screening in Resource-poor Settings Using a Simple, Power-free, Cellphone-friendly Device (Nigeria)
Beth Israel Deaconess Medical Center, Boston, Mass.
Principal Investigator: Dr. Ionita Ghiran

mCME: Delivering Continuing Medical Education to Community Health Workers Using Cellphones (Vietnam)
Boston University, Boston, Mass.
Principal Investigator: Dr. Christopher Gill

Building Mobile Health HIV-prevention Capacity for MSM in Romania
Hunter College of the City University of New York, New York, N.Y.
Principal Investigators: Dr. Corina Lelutiu-Weinberger and Dr. John Pachankis

JHU-IKU Mobile Health for Child Injury Prevention in Malaysia (M-CHILD)
Johns Hopkins University, Baltimore, Md.
Principal Investigators: Dr. Adnan Hyder and Dr. Abdulgafoor Bachani

Virtual Community Health Services - for Equity and Quality in Health Care in Mali
Johns Hopkins University, Baltimore, Md.
Principal Investigator: Dr. Peter Winch

Enhancing Safer Conception for HIV Serodiscordant Couples Through Mobile Technologies (Kenya)
University of Washington, Seattle, Wash.
Principal Investigator: Dr. Renee Heffron