Digital Health Challenge (TB & HIV)

Context

PATH is a US-headquartered non-profit organisation whose mission is to advance health equity through innovation and partnerships. In relation to the project titled “Optimising data systems and digital health in South Africa,” PATH, is collaborating with Mobile Applications Laboratory (mLab), a technology innovation and skills accelerator, to manage two digital health, HIV/Tuberculosis-related innovation grants.

TB and HIV context in South Africa

The top 2 ailments in South Africa in terms of burden of disease are:  HIV/AIDS: South Africa has the highest prevalence of HIV/AIDS in the world, and the disease remains a major public health challenge, and Tuberculosis (TB): TB is the leading cause of death in South Africa, and the country has one of the highest TB incidence rates in the world.

Less than half the estimated 328,000 people with TB in 2021 were successfully treated. The World Health Organisation estimates that 55,000 people died from TB in South Africa in 2021 and it remains a leading cause of death in South Africa. The high prevalence of HIV, and socio-economic risk factors such as poor nutrition, over-crowding, and poor health-seeking behaviour all contribute. South Africa also has one of the highest HIV prevalence rates globally, with approximately 20% of adults living with HIV in the country. Despite progress in reducing new HIV infections, the number of new infections remains substantial. TB remains a leading case of death among people living with HIV.

South Africa has made significant strides in increasing access to antiretroviral treatment (ART). The country has one of the largest ART programmes in the world, with more than 5.5m patients on ART. Patients are able to pick up their HIV treatment at public primary health care clinics or other pick-up points available through the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme. The programme provides more convenient options for patients to pick up their medication thus improving access and reducing workload on staff at primary healthcare facilities. However, a high proportion of patients cycle in and out of care at multiple points, particularly in the first 6 months.

Despite these challenges, tremendous potential remains to grow and harness in-country technological and digital health expertise to innovatively solve for health obstacles in a sustainable and impactful manner.

Problem statements

Digital health and data-driven solutions that address the key problems listed below are being sought:

1. High Loss to Follow-up Rate for HIV and TB Patients: There is a significant initial linkage and loss to follow-up rate among patients diagnosed with HIV and TB. This issue is exacerbated by patients not receiving their test results promptly, which hampers the initiation of treatment. Additionally, a substantial portion of loss to follow-up cases is attributed to hospital-diagnosed patients who are referred to PHCs for receiving their treatment and are then lost to follow-up. Innovative solutions are needed to link patients to treatment and ensure their retention in care.
2. Undiagnosed TB Cases and Transmission Risk: Many TB patients are unaware of their condition, leading to unintentional transmission. Key challenges include patients avoiding testing and not receiving their test results promptly, delaying treatment initiation. Addressing this issue requires innovative approaches to increase TB awareness, testing, and early diagnosis, and improved patient agency.
3. Loss to Follow-up Among PLHIV in the First Six Months of Treatment: Patients living with HIV (PLHIV) often experience a high rate of loss to follow-up during the first six months of treatment. The lack of data integration between different healthcare systems and facilities makes patient monitoring challenging. Innovative solutions are needed to enhance patient tracking and ensure continuity of care for PLHIV.
4. Supporting TB and HIV integration – More than 50% PWTB are also PLHIV. A need exists to improve TB testing among HIV patients, and ensure that patients with these comorbidities receive patient centric care, and are able to receive integrated healthcare services (not needing two separate visits to the health facility, one for each condition), to reduce opportunity costs for both the patients and the health system.
5. Patient Mobility and Fragmented Healthcare Records: Patients are frequently referred across various healthcare facilities, including community-based services, primary healthcare facilities, and hospitals. Moreover, patients may move across administrative boundaries, making it challenging to track and provide consistent care. Current decentralised and siloed IT systems contribute to this issue. Proposals that speak to the proposed NHI framework are sought to improve patient identification and facilitate a patient-centric approach to healthcare, ensuring continuity of care for PLHIV and patients with TB.
6. Digital Tools for Treatment Adherence and Health System Navigation: There is a need for digital tools and resources to support patients in accessing the health system, adhering to their treatment regimens and navigating the healthcare system effectively. These tools should empower patients to take control of their health while facilitating their interaction with the healthcare system.

Call for Proposals

mLab is seeking proposals from emerging enterprises in the start-up phase, or enterprises whose proposed solutions are not older than 5 years, and that clearly address any of the problem statements outlined. The applicant must be a South African registered entity. Preference will be given to those solutions that are at an advanced development stage or close to market pilot/entry. However, novel early-stage solutions that have been clearly substantiated may also be considered. University teams are also encouraged to apply. Applicants must clearly articulate how the proposed solution will scale and achieve sustainability.

Two grant awards are available. The grant is geared towards enterprises that intend meeting one or more of the following milestones:

Demonstrate the feasibility of their solution in a real-world context

Conduct market validation or pilot their solution

Building a conceptual model, collect and develop a data-driven solution

Conduct market research or feasibility studies to demonstrate the socio-economic potential of their solutions.

Proposal outline:

The proposal must not be longer than 15 pages and must include the following sections:

1. The problem statement being addressed and why it was selected. Please give an indication of the health official or health facility that you are engaging with to support implementation of your solution, or indicate if this has not yet been initiated. Whose problem are you addressing (patient, health provider or health system)? How do you plan to address the problem?
2. Description of the use case, proposed solution, including a brief competitor analysis, highlighting what makes the proposed solution unique, how it will scale and its potential business model.
3. Given the limited timeframe of this project, clearly articulate the complete route and timelines to market what component of that will be achieved with the grant period, and how you intend completing the project beyond the end of the grant period.
4. 5-month project plan with specific work packages with key milestones, deliverables and timelines.
5. Detailed budget (what will the grant funding be used for).
6. Measures of success, outcomes and impact that could be achieved.
7. Description of key team members (please include concise CVs as an appendix).
8. Three references with contact details of clients or other partners who can speak to your experience in similar initiatives.
9. Project Risk Analysis and Mitigation.

Required Documents

The following documents must accompany your application:

1. CIPC registration document including shareholding structure (if applicable)
2. Company Profile
3. Identification document (ID) for the primary contact person
4. Tax Clearance Certificate
5. BBBEE certificate

Preference will be given to:

1. Enterprises with a BBBEE level between 1 and 4
2. Youth, female and/or black-owned enterprises

Duration

The project must be completed, and a final report submitted, by 25 June 2024.

Selection Criteria 

Technical merit, novelty , feasibility, and potential for scale? 45%

Quality of the proposal (clarity of goals, milestones and deliverables) 25%

Quality of the team and relevant expertise 20%

Transformation (youth, women, BBBEE rating) 10%

Value of the grant 

Two awards will be made to a maximum value of R1,2 million per grantee. This will be payable in tranches and against agreed milestones.

Queries can be emailed to: nicki@mlab.co.za