Medical drones to support HIV differentiated service delivery in an island population in Uganda


BACKGROUND: Kalangala district, Uganda is comprised of 84 islands in Lake Victoria. These island-dwelling communities have the highest HIV prevalence (27%) and lost to follow up from HIV care (50%) in Uganda. Delivery of antiretroviral therapy (ART) is a challenge due to the geography and the nomadic nature of the community.
DESCRIPTION: Between July ' September 2019 we undertook a survey of medical supply chain gaps for HIV care at health facilities in two sub-counties Bufumira and Mazinga) in Kalangala district. At baseline 5.3% of PLHIV were accessing care from differentiated service delivery (DSD). Most ART refills were managed through outreach visits to remote boat landing sites. Between 50-90% health care worker time outreaches is spent on ART refills; the remaining spent on maternal and child health and non-communicable diseases. Annual cost of outreach activities by these facilities boat is approximately $90,000. Data were used to design a quasi-experimental pilot to evaluate the feasibility and acceptability of using medical drones for ART delivery to peer support groups.
LESSONS LEARNED: Since September 2021 two DJI Matrice 300 drones have flown from Bufumira health centre to five remote landing sites previously receiving ART through boat outreaches. In September 2021 the medical drone delivered three months of ART to 43 PLHIV in seven DSD groups on three landing sites. In December 2021 drones replaced boat deliveries to 64 PLHIV in 11 DSD groups across five landing sites. Average flight time was 9.3 minutes for medical drone compared to 35 minutes per boat trip. Average distance from Bufumira to landing site was 6.6km (max 10km). Six peer support workers have been sensitised on how to prepare the drone landing pad, secure the area, safely unload ART from the drone and load documentation for return to Bufumira.
CONCLUSIONS: The pilot will continue until June 2022, aiming to deliver to 100 PLHIV. The pilot will be evaluating (i). PLHIV: ART stock outs, lost to follow up, viral load and (ii) impact on health facility: number of DSD groups, number of outreaches and impact on outreach costs. Mazinga health centre and associated landing sites will be used as control comparison.