Use of Unmanned Aerial vehicles (Medical Drones) to Support Differentiated Service Delivery Models for Elimination of HIV in Uganda

Context of Aims & Objectives:

Fishing populations living on islands struggle to get their HIV medication and other medications, they have to travel long distances by boat to the closest health facility. Small unmanned aircraft (medical drones) are being tested in Africa for delivering medication and other medical supplies in areas where there are long distances to health centres or limited road transport.

This research study hopes to compare the use of small unmanned aircraft (medical drones) to deliver medicines to people living with HIV in an island district in Uganda (Kalangala) that consists of 84 islands. We aim to see if delivering medicines by this method helps people to better manage their HIV. This will be measured by looking at the level of HIV in their blood (viral load) which gives an indication if they are taking their medicine, reacting well to their medicine. If we cannot detect HIV in their blood it is a good indication that they will suffer minimal health problems related to their HIV, and cannot pass it on to their sexual partners. We will also look to see whether people living with HIV are attending appointments for their HIV. We will also conduct research to see if people living with HIV and health workers are comfortable with using medical drones and what other medical uses, they think the drone could be helpful for. In addition, we will compare the financial costs of using drones versus boats.

We will also look at different types of drones, including ones that look like the photography drones widely used by the public, to a large one that looks more like a small plane. We will also try a recyclable drone made mainly of cardboard. We will look at the carbon use of drones (which use batteries) compared to boats with petrol motors.

b) Potential applications and benefits
One may be tempted to ask why this study is needed. Aren't drones just transport vehicles like cars or boats? As long as they can travel the distance, why do we need to study them in a direct comparison? Drones are new and not widely used to carry medical goods. A key barrier to wider adoption has been the lack of rigorous data examining the impact of drones and their costs. The reason is that the real-life implementation of any intervention is almost always different than predicted. This has been the case for all kinds of medical and social interventions and is likely to be the case for medical drones. This study using rigorous methods, will allow us to document the real-world impact of drones beyond the estimations that people have used to justify medical drones so far.

Over the last 12 months, we established a small medical drones pilot project in the Kalangala District. For three years before that, we collected data on patients' challenges getting to health centres and any problems in getting medication when they get there. Based on our observations of significant barriers to patients getting steady medicine supplies, we sought permission from the Ministry of Health and other authorities, including Civil Aviation Authority and the Ministry of Defence, to do a small medical drones project. To test to assess whether this kind of project is possible in this setting, we have managed to deliver HIV drugs to 99 people living with HIV by medical drone. Of these, we completed 12 months of delivery to 63 people using medical drones in September 2022. We have reached 5 islands and delivered to 17 peer support groups whose leaders have trained on safe drone drug delivery.
It is now time for a more robust study. If this study shows that patients are comfortable receiving their medication by drone, or saves money, or helps the environment by using less petrol than boats, then we believe that medical drones could be used in many places around the world where it is difficult for people to get their medication. We would first try to extend the medical drones in East Africa and then move to other sites in Africa for further work.

The medical drones will support a health system activity - differentiated service delivery of ART, delivering ART to people living with HIV near to where they live and reducing delays in ART refills. Convenient ART delivery improves satisfaction with care and ultimately reduces PLHIV attrition from care. In this island population, DSD uses a large amount of health worker time and boat travel and is very expensive. Despite DSD being part of the Ugandan national HIV strategy, our preliminary work shows that few PLHIV are benefitting from DSD in this population. Furthermore, our work so far has shown it is feasible to use medical drones to implement DSD avoiding the need for expensive, dangerous and time costly boat travel. Therefore, we hypothesise that the medical drone will improve the efficiency of the health system to deliver ART and have benefits across the whole health services for the island by reducing the resources needed for ART refills and increasing the time available for other critical health service activities.

Additionally, whilst drones are a form of transport, real-life implementation of any intervention is almost always different than predicted. Drones carrying a payload are still very new, and a key impediment to wider adoption has been the lack of rigorous data examining the impact of drones and their costs. This RCT design will allow us to document the real-world impact of drones beyond conjecture and posturing. We aim to undertake carbon use and comparison of different types of drone (including recyclable) as a sub-study.

Our pilot work has shown that drone work is technically complex, with extensive regulatory hurdles and community engagement needed. We have put together a multi-disciplinary Ugandan team of social scientist, quantitative researchers and statisticians, health economists, environmental and drone experts to undertake this work, to ensure we have the highest chance of future impact