Interactive voice response system (ARTmitra) - a lifeline to prevent treatment interruption during COVID-19 in Mumbai, India

BACKGROUND: In March 2020, India announced a nationwide lockdown due to the COVID-19 pandemic. People living with HIV (PLHIV) were at risk for treatment interruption. As the lockdown continued, the Mumbai District AIDS Control Society (MDACS) generated a list of 7,480 PLHIV due for a monthly refill. Over a period of 10 days, 14 program assistants, made phone calls and nearly 53% of clients were unreachable raising concern for impending ART interruption. To ensure treatment continuity, MDACS, I-TECH and AVGEN developed a new interactive voice response system (IVRS) ARTMitra' (Mitra meaning friend), to guide PLHIV to services based on their location during lockdown; distribute ART based on patient location; identify and operationalize new decentralized ART refill sites; ensure real-time stock update and reduce the burden of making phone calls.
METHODS: PLHIV who missed appointments received an SMS in vernacular from ARTMitra IVRS with a helpline number. The IVRS prompted PLHIV to respond on the availability of ART; current location and ability to reach the nearest ART center. Depending on the responses recorded in the IVRS, Program Assistants called PLHIV for further guidance and referral to the nearest ART refill site. The webform captured data at refill sites and allowed for real-time updates.
RESULTS: During April - July 2020 SMS notifications went out to over 13000 PLHIV and 1506 used IVRS and 1,314 (87%) collected ART. Based on the patient location data, an additional 13 decentralized dispensation sites were established. These sites led to the support of an additional 1,660 PLHIV who did not initially call the helpline mitigating a potential increase in treatment interruption. Due to the automated voice system, time spent by staff on making phone calls decreased by 57% allowing them to prioritize other critical duties. The webform was critical to move stocks around to keep centers replete.
CONCLUSIONS: Implementation of the ARTMitra platform averted a potential crisis of treatment interruption by optimizing technology to ensure treatment continuity during the pandemic. The user-friendly mobile web forms facilitated dispensation of the right and uninterrupted supply of ARV at the decentralized sites.