Impact of SMS and peer navigation on retention in HIV care among adults in South Africa: results of a three‐arm cluster randomized controlled trial

Abstract

Introduction Few interventions have demonstrated improved retention in care for people living with HIV (PLHIV) in sub‐Saharan Africa. We tested the efficacy of two personal support interventions – one using text messaging (SMS‐only) and the second pairing SMS with peer navigation (SMS+PN) – to improve HIV care retention over one year. Methods In a cluster randomized control trial (NCT# 02417233) in North West Province, South Africa, we randomized 17 government clinics to three conditions: SMS‐only (6), SMS+PN (7) or standard of care (SOC; 4). Participants at SMS‐only clinics received appointment reminders, biweekly healthy living messages and twice monthly SMS check‐ins. Participants at SMS+PN clinics received SMS appointment reminders and healthy living messages and spoke at least twice monthly with peer navigators (PLHIV receiving care) to address barriers to care. Outcomes were collected through biweekly clinical record extraction and surveys at baseline, six and 12 months. Retention in HIV care over one year was defined as clinic visits every three months for participants on antiretroviral therapy (ART) and CD4 screening every six months for pre‐ART participants. We used generalized estimating equations, adjusting for clustering by clinic, to test for differences across conditions. Results Between October 2014 and April 2015, we enrolled 752 adult clients recently diagnosed with HIV (SOC: 167; SMS‐only: 289; SMS+PN: 296). Individuals in the SMS+PN arm had approximately two more clinic visits over a year than those in other arms (p < 0.01) and were more likely to be retained in care over one year than those in SOC clinics (54% vs. 38%; OR: 1.77, CI: 1.02, 3.10). Differences between SMS+PN and SOC conditions remained significant when restricting analyses to the 628 participants on ART (61% vs. 45% retained; OR: 1.78, CI: 1.08, 2.93). The SMS‐only intervention did not improve retention relative to SOC (40% vs. 38%, OR: 1.12, CI: 0.63, 1.98). Conclusions A combination of SMS appointment reminders with personalized, peer‐delivered support proved effective at enhancing retention in HIV care over one year. While some clients may only require appointment reminders, the SMS+PN approach offers increased flexibility and tailored, one‐on‐one support for patients struggling with more substantive challenges.

Evaluation of a Text Messaging Intervention to Promote Preconception Micronutrient Supplement Use: Feasibility Study Nested in the Healthy Life Trajectories Initiative Study in South Africa

“…However, systematic reviews from low-to middle-income countries have found mixed or inconclusive evidence of the impact of SMS text messaging interventions, which are often not explicitly designed using behavior change theory [20][21][22]. In South Africa, SMS text messaging interventions have shown highly promising results for HIV care adherence, support, and education [23][24][25], as well as for pregnant and postpartum women, through the National MomConnect SMS text message health messaging program [26,27]. Data from high-income settings suggest that a 2-way SMS text messaging intervention can support nutritional behavior change, resulting in weight loss and maintenance in the postpartum period [28], and that a mobile app can effectively improve preconception nutrition [29].…”

Peer Navigation to Support Transgender Women’s Engagement in HIV Care: Findings from the Trans Amigas Pilot Trial in São Paulo, Brazil

“…While the pilot was not powered to detect significant differences between the two arms, the point estimates of effect are intended to provide preliminary evidence of impact as well as early indicators of the sample size needed to power a future trial. Based on findings in our previous navigation trial [ 33 , 34 ], we would have needed 328 participants to have sufficient power to detect an equivalent effect (OR 1.78) of the intervention on retention.…”

“…To address this, we developed a trans-specific peer-based patient navigation (PN) intervention for the Brazilian context to address social, structural, and personal barriers to care. The intervention utilized elements of a successful peer-based program with trans women in the US [ 30 , 31 ] and a PN study conducted in South Africa [ 32 ] with cisgender adults that improved retention in care [ 33 , 34 ]. We examine feasibility and acceptability of the “Trans Amigas” intervention and explore initial efficacy among 113 TWH in São Paulo, Brazil who participated in a randomized controlled pilot trial to increase engagement in HIV care.…”

Prevalence, motivation, and outcomes of clinic transfer in a clinical cohort of people living with HIV in North West Province, South Africa

“…This secondary analysis is based on the I-Care study, conducted in the Bojanala Platinum District of North West Province, South Africa [ 21 , 22 ]. The district is home to 1.5 million people; mining and agriculture are the major sources of revenue, with 40% of economically active adults unemployed [ 23 ].…”

“…Study enrollment occurred from October 2014 to April 2015 and follow-up continued through May 2016. At the time of the study, 1 in 5 adults in the province and nearly 1 in 3 pregnant women were living with HIV [ 22 , 26 , 27 ]. Bojanala District was not part of the 2014-2016 national pilot program for differentiated care interventions: HIV care was provided centrally within Department of Health primary care facilities [ 28 ].…”