Care from distance, yet closer together: How an SMS intervention enhanced care engagement for prevention of mother-to-child HIV transmission care in Western Kenya

Angeles, Katrine Judith Chamorro De; Oware, Phoene Mesa; Were, Edwin; Ekström, Anna Mia; Skovdal, Morten; Kågesten, Anna

doi:10.1016/j.ssmqr.2022.100195

Cited by 2 publications

(5 citation statements)

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“…This likely contributed to the increased use of telecommunication as part of standard care in Kenyan HIV and PMTCT care and at our study sites during the trial. In qualitative interviews with healthcare workers and participants during our trial, we found that informal phone communication between healthcare workers and patients took place in both groups 35 . This included healthcare workers using their private phones and contacting patients outside of the clinic’s operating hours 35 .…”

Section: Discussionmentioning

confidence: 91%

“…In qualitative interviews with healthcare workers and participants during our trial, we found that informal phone communication between healthcare workers and patients took place in both groups 35 . This included healthcare workers using their private phones and contacting patients outside of the clinic’s operating hours 35 . In addition, increased use of telephone calls and text-messaging to deliver laboratory test results, appointment reminders, and to guide and refer patients with questions or problems were part of programmatic strategies implemented for all women in PMTCT care.…”

Section: Discussionmentioning

confidence: 91%

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The effect of an interactive weekly text-messaging intervention on retention in prevention of mother-to-child transmission of HIV care: a randomised controlled trial (WelTel PMTCT)

Nordberg

Kop

Mwangi

et al. 2023

Sci Rep

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Retention in prevention of mother-to-child transmission (PMTCT) care is critical to prevent vertical HIV transmission and reduce morbidity and mortality of mother-infant pairs. We investigated whether weekly, interactive text-messaging improved 18-month postpartum retention in PMTCT care. This randomised, two-armed, parallel trial was conducted at six PMTCT clinics in western Kenya. Pregnant women with HIV at least 18 years of age with access to a mobile phone, able to text-message, or had somebody who could text on their behalf, were eligible. Participants were randomly assigned at a 1:1 ratio in block sizes of four to the intervention or control group. The intervention group received weekly text messages asking “How are you?” (“Mambo?” in Swahili) and were requested to respond within 48 h. Healthcare workers called women who indicated a problem or did not respond. The intervention was administered up to 24 months after delivery. Both groups received standard care. The primary outcome was retention in care at 18 months postpartum (i.e., clinic attendance 16–24 months after delivery based on data from patient files, patient registers and Kenya’s National AIDS and STI Control Programme database), which was analysed by intention-to-treat. Researchers and data collectors were masked to group assignment, while healthcare workers were not. Between June 25th, 2015, and July 5th, 2016, we randomly assigned 299 women to the intervention and 301 to standard care only. Follow-up concluded on July 26th, 2019. The proportion of women retained in PMTCT care at 18 months postpartum was not significantly different between the intervention (n = 210/299) and control groups (n = 207/301) (risk ratio 1.02, 95% confidence interval 0.92–1.14, p = 0.697). No adverse events related to the mobile phone intervention were reported. Weekly, interactive text-messaging was not associated with improved retention in PMTCT care at 18 months postpartum or linkage to care up to 30 months postpartum in this setting. (ISRCTN No. 98818734).

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 91%

The effect of an interactive weekly text-messaging intervention on retention in prevention of mother-to-child transmission of HIV care: a randomised controlled trial (WelTel PMTCT)

Nordberg

Kop

Mwangi

et al. 2023

Sci Rep

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“…The greatest perceived benefit of the intervention was that it enabled access to and contact with healthcare workers. In qualitative in-depth interviews, women enrolled in the WelTel PMTCT trial have reported that they felt safe having the option to text “problem” 24 h per day, 7 days per week, which was considered to be an important feature of the intervention [ 37 ]. Another benefit was that participants felt that the healthcare workers cared for them, which also is in line with qualitative assessments from our trial [ 37 ] and a study of the same intervention among people in general HIV care [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…In qualitative in-depth interviews, women enrolled in the WelTel PMTCT trial have reported that they felt safe having the option to text “problem” 24 h per day, 7 days per week, which was considered to be an important feature of the intervention [ 37 ]. Another benefit was that participants felt that the healthcare workers cared for them, which also is in line with qualitative assessments from our trial [ 37 ] and a study of the same intervention among people in general HIV care [ 13 ]. In addition, the WelTel intervention has previously been observed to improve ART adherence [ 11 ], HIV viral suppression [ 11 ], self-perceived health-related quality of life [ 12 ], and study participants in previous WelTel studies have reported that the text-messaging reminded them to take ART and to attend clinic appointments [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The study also had several limitations. According to qualitative data collected in our trial, there were extensive informal non-intervention phone communication between some healthcare workers and participants alongside the intervention [ 37 ]. This may have impacted participants' response to text messages and their use of the intervention for assistance with potential problems.…”

Section: Discussionmentioning

confidence: 99%

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The use, adherence, and evaluation of interactive text-messaging among women admitted to prevention of mother-to-child transmission of HIV care in Kenya (WelTel PMTCT)

Nordberg,

Kaguiri,

Chamorro de Angeles

et al. 2024

BMC Pregnancy Childbirth

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Background To improve future mobile health (mHealth) interventions in resource-limited settings, knowledge of participants’ adherence to interactive interventions is needed, but previous studies are limited. We aimed to investigate how women in prevention of mother-to-child transmission of HIV (PMTCT) care in Kenya used, adhered to, and evaluated an interactive text-messaging intervention. Methods We conducted a cohort study nested within the WelTel PMTCT trial among 299 pregnant women living with HIV aged ≥ 18 years. They received weekly text messages from their first antenatal care visit until 24 months postpartum asking “How are you?”. They were instructed to text within 48 h stating that they were “okay” or had a “problem”. Healthcare workers phoned non-responders and problem-responders to manage any issue. We used multivariable-adjusted logistic and negative binomial regression to estimate adjusted odds ratios (aORs), rate ratios (aRRs) and 95% confidence intervals (CIs) to assess associations between baseline characteristics and text responses. Perceptions of the intervention were evaluated through interviewer-administered follow-up questionnaires at 24 months postpartum. Results The 299 participants sent 15,183 (48%) okay-responses and 438 (1%) problem-responses. There were 16,017 (51%) instances of non-response. The proportion of non-responses increased with time and exceeded 50% around 14 months from enrolment. Most reported problems were health related (84%). Having secondary education was associated with reporting a problem (aOR:1.88; 95%CI: 1.08–3.27) compared to having primary education or less. Younger age (18–24 years) was associated with responding to < 50% of messages (aOR:2.20; 95%CI: 1.03–4.72), compared to being 35–44 years. Women with higher than secondary education were less likely (aOR:0.28; 95%CI: 0.13–0.64), to respond to < 50% of messages compared to women with primary education or less. Women who had disclosed their HIV status had a lower rate of non-response (aRR:0.77; 95%CI: 0.60–0.97). In interviews with 176 women, 167 (95%) agreed or strongly agreed that the intervention had been helpful, mainly by improving access to and communication with their healthcare providers (43%). Conclusion In this observational study, women of younger age, lower education, and who had not disclosed their HIV status were less likely to adhere to interactive text-messaging. The majority of those still enrolled at the end of the intervention reported that text-messaging had been helpful, mainly by improving access to healthcare providers. Future mHealth interventions aiming to improve PMTCT care need to be targeted to attract the attention of women with lower education and younger age.

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Care from distance, yet closer together: How an SMS intervention enhanced care engagement for prevention of mother-to-child HIV transmission care in Western Kenya

Cited by 2 publications

References 32 publications

The effect of an interactive weekly text-messaging intervention on retention in prevention of mother-to-child transmission of HIV care: a randomised controlled trial (WelTel PMTCT)

The effect of an interactive weekly text-messaging intervention on retention in prevention of mother-to-child transmission of HIV care: a randomised controlled trial (WelTel PMTCT)

The use, adherence, and evaluation of interactive text-messaging among women admitted to prevention of mother-to-child transmission of HIV care in Kenya (WelTel PMTCT)

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