HIV-positive patients in Botswana state that mobile teledermatology is an acceptable method for receiving dermatology care.

Introduction There is a severe shortage of dermatologists in sub-Saharan Africa, with many areas having no dermatologists at all.[1] Furthermore, there is an increased prevalence of skin disease in HIV patients, with many conditions being unique to this population or more severe than in immunocompetent patients.[2] The presence of many of these conditions may affect HIV management.[3,4] Store-and-forward teledermatology offers a method for increasing access to skin specialists. Although many areas have limited computer connectivity, mobile phone networks are more accessible.[5,9] Mobile teledermatology uses mobile phones to perform store-and-forward teledermatology consultations. Studies evaluating patient acceptability of conventional store-and-forward teledermatology have been conducted in various study populations.[6,7,8] However, it is unknown whether patients, particularly those infected with HIV in resource-limited settings such as southern Africa, find the use of mobile phones acceptable for collecting their health information and would be willing to receive skin care through this method. It is possible that patients with a socially stigmatizing condition such as HIV have additional privacy concerns or that they may feel concerned about transmission of sensitive information by mass telecommunication technologies. While several studies have evaluated patient acceptance of store-and-forward teledermatology in industrialized countries, we were unable to find any studies on patient acceptance in resource poor settings among patients with HIV.[8,9,10,11] We have investigated whether the use of mobile teledermatology technology in a resource-limited setting in Botswana was culturally acceptable to HIV positive patients. Survey We conducted a cross-sectional survey of adult patients with HIV and mucocutaneous complaints in Botswana. Survey questions were developed by physicians in Botswana and the US, and were vetted by dermatologists with clinical experience in Botswana for face and content validity. The survey questions were tested with HIV positive outpatients at the dermatology clinic at the Princess Marina Hospital in Gaborone, Botswana. The study was approved by the appropriate ethics committees and the Botswana Ministry of Health. The study was conducted in consecutively recruited HIV positive patients in Botswana. The patients were at least 18 years old and presented with a skin or mucosal complaint that had not been previously evaluated by a dermatologist. The patients were recruited from the medical and oncology wards, the dermatology clinic, and the Infectious Disease Care Centre at the Princess Marina Hospital; from the Independence Surgery Center, a private primary care clinic in Gaborone; and from the outpatient clinics and medical wards at Athlone Hospital in Lobatse over a 5-week …