UBC researcher applying virtual care platform to COVID-19

Dr. Richard Lester had just come back to his office from lunch on January 28 when he had an idea.

With COVID-19 beginning its spread across the world, Lester — an infectious disease physician and principal investigator at UBC — realized he could adapt the mobile health care platform he developed to improve the antiretroviral treatment of HIV in Kenya to help combat the new virus.

“I went out from my research office to lunch and I think I was reading the news about COVID again too and it just dawned on me that we had a tool that could be very useful for helping support patients during home isolation,” he said.

“[I] came back to the office and within an hour we had a version set up to monitor patient cases and contacts.”

Called WelTel, the platform aims to improve patient engagement and personal care by connecting physicians and their patients through text messages.

The technology was born during Lester’s infectious disease research fellowship in Kenya as both the prevalence of antiretroviral therapy and mobile phones were increasing. Amidst worry about people taking their medications when they needed to, Lester had the idea to create a platform to allow physicians to send SMS text check-ins to their patients.

In a randomized control trial carried out in both rural and urban areas in Kenya, Lester found that these text check-ins improved people’s adherence to their drug regimens by 24 per cent and improved treatment outcomes by 18 per cent.

“That was our first randomized trial to look at the effectiveness of this and it was the first one in the world, actually, to show that text messaging and contacting patients via their mobile phones could help increase health outcomes,” he said.

After the platform’s initial success in Kenya, Lester expanded its scope and scale by automating check-ins and giving care providers more features, although the core functionality of the technology has remained largely unchanged since its inception. It has since been used to aid care providers in treating HIV in several other African countries as well as HIV and tuberculosis in the Lower Mainland.

According to Lester, the effectiveness of the platform comes through its “show, don’t tell” approach to care, which makes patients feel more supported and connected during their treatment. It also allows care providers to give faster and more individualized follow-up.

“They feel that it actually helps build the relationship between the care provider and the patient and then builds on that trust,” he said. “If they have any issues, it’s actually the value of being connected to that health care provider who can help solve their problems.”

Due to its highly contagious nature, COVID-19 is much faster-moving than HIV, so Lester and his team modified the platform to provide daily check-ins for people in self-isolation as opposed to the weekly check-ins sent to HIV patients.

Lester sees the potential benefits of using WelTel to combat the spread of the virus as twofold: it can provide both public health support and provider connection for those in self-isolation. Providers using the technology will be able to more readily address people’s questions and concerns while in self-isolation, as well as being able to more easily triage patients who need additional assistance.

Lester estimates that using WelTel to manage patients in this way is 50-100 times faster than trying to reach them over the phone.

While he acknowledge it will be difficult to tease out exactly how much the technology aids in “flattening the curve” in places where it is utilized, Lester said that improved efficiency of care and the impacts on the lives of people in self-isolation will be much easier means to gauge the technology’s success.

The modified platform recently went live in Rwanda to aid in treating COVID-19 and the company is currently in negotiations over implementation with health authorities in the US, UK, Kenya and several Canadian provinces.

Despite the technology’s success to date, Lester cautioned that one of the important challenges that must be accounted for as virtual care becomes more prevalent is ensuring new technologies are evidence-based and thoughtfully implemented.

“I think it’s really important that we rely on prior knowledge in making our informed decisions as well as generating new scientific evidence so that as we go forward we have systematic ways to really inform best practices.”