Cluster-Randomized Controlled Study of SMS Text Messages for Prevention of Mother-to-Child Transmission of HIV in Rural Kenya

Abstract

Background. Antiretroviral medications are key for prevention of mother-to-child transmission (PMTCT) of HIV, and transmission mitigation is affected by service delivery, adherence, and retention. Methods. We conducted a cluster-randomized controlled study in 26 facilities in Nyanza, Kenya, to determine the efficacy of SMS text messages on PMTCT outcomes. The relative risk and confidence intervals were estimated at the facility level using STATA. Results. 550 women were enrolled, from June 2012 to July 2013. The median age was 25.6 years, and 85.3% received ARVs. Maternal ARV use was similar between the intervention and control arms: 254/261 (97.3%) versus 241/242 (99.6%) at 34–36 weeks of gestation and 234/247 (94.7%) versus 229/229 (100%) at delivery. Among infants, 199/246 (80.9%) and 209/232 (90.1%) received ARVs (RR: 0.91; 95% CI: 0.77–1.14); 88% versus 88.6% were tested for HIV at 6 weeks, with 1/243 (0.4%) and 3/217 (1.4%) positive results in the intervention and control arms, respectively. Communication increased in both the intervention and control arms, with the mean number of 7.5 (SD: 5.70) compared with 6 (SD: 9.96), p < 0.0001. Conclusions. We identified high ARV uptake and infant HIV testing, with very low HIV transmission. Increased communication may influence health-seeking behaviors irrespective of technology. The long-term effectiveness of facilitated communication on PMTCT outcomes needs to be tested. The study has been registered on ClinicalTrials.gov under the identifier NCT01645865.

Smartphone usage and preferences among postpartum HIV-positive women in South Africa

“…The final study, also conducted in Kenya, offered 3-6 weekly, semi-automated stage-based SMSs, together with airtime, to women to facilitate an increased communication with PMTCT trained CHWs until their final 6-8 postpartum visit. They found no significant difference in either infant HIV testing rates or infant HIV transmission rates with this intervention (Kassaye et al, 2016).…”

“…The other study from Kenya assessed the effect of a combining gestation-based PMTCT SMS and increased communication between women and community health workers (CHW) on ART initiation in ANC as well as ART adherence at 34-36 weeks of gestation and delivery. The authors reported no significant difference in either ART initiation or adherence between the intervention arm and the control arm who were allowed to directly communicate with the CHW whenever they needed but did not receive any PMTCT SMSs (Kassaye et al, 2016).…”

“…Five studies evaluated the effect of using mHealth interventions on infant HIV testing and infant HIV transmission rate. Most reported improved outcomes with the mHealth intervention Kassaye et al, 2016;Mushamiri, Luo, Iiams-Hauser, et al, 2015;. The study that offered Kenyan women a combination of tailored gestation-based SMS and weekly calls found higher rates of early infant HIV testing in the SMS group compared to the control group .…”

“…Two studies using mobile phone interventions to improve maternal ART initiation amongst HIV-positive pregnant women found a non-significant effect compared to control (Dryden-Peterson et al, 2015;Kassaye et al, 2016). One study conducted in Botswana compared the effects of an SMS-based CD4 result distribution system to a standard CD4 distribution procedure to health centers and found that, though the intervention significantly reduced the turnaround time to patient receipt of results, the intervention did not increase ART initiation in eligible pregnant women (Dryden-Peterson et al, 2015).…”

Maximizing adherence and retention for women living with HIV and their infants in Kenya (MOTIVATE! study): study protocol for a randomized controlled trial

“…While access to a mobile phone is significantly associated with postpartum retention in PMTCT [42–44], there are few studies evaluating the long-term impact of mobile phone technologies on improving long-term retention and adherence in the context of Option B+. One cluster randomized trial of text messages to support PMTCT care in Kenya did not demonstrate increased uptake of PMTCT services such as ART uptake, facility delivery, or infant testing, but it did not study the effects long term [45]. Another recent randomized trial in Kenya used behavior-based text messaging to improve uptake of early infant diagnosis and postnatal retention [23].…”