Acceptability and Feasibility of a Mobile Phone-Based Case Management Intervention to Retain Mothers and Infants from an Option B+ Program in Postpartum HIV Care

Abstract

Objective To assess the acceptability and feasibility of a cell-phone based case manager intervention targeting HIV-infected pregnant women on highly-active antiretroviral therapy (HAART). Methods Pregnant women ≥36 weeks gestation attending antenatal care and receiving HAART through the Option B+ program at a primary care clinic in South Africa were enrolled into a prospective pilot intervention to receive text messages and telephone calls from a case manager through six weeks postpartum. Acceptability and feasibility of the intervention were assessed along with infant HIV testing rates and 10-week and 12-month postpartum maternal retention in care. Retention outcomes were compared to women of similar eligibility receiving care prior to the intervention. Results Fifty women were enrolled into the pilot from May-July 2013. Most (70%) were HAART-naive at time of conception and started HAART during antenatal care. During the intervention, the case manager sent 482 text messages and completed 202 telephone calls, for a median of 10 text messages and 4 calls/woman. Ninety-six percent completed the postpartum interview and 47/48 (98%) endorsed the utility of the intervention. Engagement in 10-week postpartum maternal HIV care was >90% in the pre-intervention (n=50) and intervention (n=50) periods; by 12-months retention fell to 72% and was the same across periods. More infants received HIV-testing by 10-weeks in the intervention period as compared to pre-intervention (90.0% vs. 63.3%, p<0.01). Conclusions Maternal support through a cell-phone based case manager approach was highly acceptable among South African HIV infected women on HAART and feasible, warranting further assessment of effectiveness.

A Rapid Review of eHealth Interventions Addressing the Continuum of HIV Care (2007–2017)

“…These cited theories include Information, Motivation and Behavioral (IMB) Skills Model [23–26], Theory of Planned Behavior [27], and Motivational Interviewing [28]. …”

“…Most of the theory-driven eHealth interventions (k = 19) were efficacious (74%, k = 14) for improving only medication adherence [32, 33, 35, 37, 38]; both medication adherence and virologic suppression [29, 30]; or care retention [26, 31]. Half (k = 7) of these efficacious, theory-based eHealth interventions were US-based [32] [33] [24, 30, 31, 34, 35].…”

“…Most (k = 11) of these efficacious, theory-based interventions implemented eHealth using electronic devices that were more technologically advanced (e.g., multimedia messaging) instead of or in conjunction with SMS texting. The theoretically-driven international-based interventions (k = 5) primarily used non-interactive (i.e., one-way communication) eHealth technology using either SMS texting [36] or electronic pill reminder alarm device [26, 37]. A few theory-driven interventions (k = 3) did not report the country setting in the report [38] [39, 40].…”

“…We discovered that most (56.5%, k = 13) of these studies focused only on improving medication adherence. Only one study [45] focused on linkage to care, three studies [26, 46, 47] focused on care retention, and another six studies [19–21, 30, 47, 48] focused on multiple outcomes related to CoC. All of the eHealth interventions using knowledge also employed other mechanisms of change except for four studies [46, 47, 49, 50].…”

Cell Phone-Based and Adherence Device Technologies for HIV Care and Treatment in Resource-Limited Settings: Recent Advances

“…Compared to control, each of the interventions significantly increased retention in follow-up, although there were no significant differences between interventions. A similar pilot study from South Africa evaluated an SMS-and phone call-based EID intervention from a case manager both before and after pregnant women delivered [22]. In this study, 50 prospectively identified women were compared with 50 retrospectively identified controls.…”