Mobile Phone Communication for Improving Uptake of Antiretroviral Therapy in HIV-infected Pregnant Women: Review

Abstract

Background: About 1.4 million pregnant women are living with HIV in low and middle-income countries with about 91% of these women residing in sub-Saharan Africa. HIV-infected pregnant women face several challenges that could decrease antiretroviral therapy adherence. Studies reported challenges such as poor mental health, lack of social support, fears of infecting children, medication side effects, cultural factors, economic instability, nausea and vomiting during pregnancy. This review investigated whether mobile phone text messaging could improve antiretroviral therapy in during and after pregnancy. Objectives : To assess the effectiveness mobile phone text messaging for improving adherence to antiretroviral therapy in HIV-infected pregnant women. To investigate whether mobile phone text messaging could improve follow-up in HIV-exposed infants. Search methods: We searched Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, MEDLINE via PubMed, Web of Science, CINAHL (EBSCO). Furthermore, we searched studies through HIV/AIDS conferences websites: International AIDS conferences, The European AIDS Clinical Society (EACS) conferences, International AIDS Society Conference on HIV Pathogenesis and Treatment (IAS). Two authors extracted data in the study eligibility form. Selection criteria: We selected randomized controlled trials (RCTs) assessing mobile phone text messaging as reminders for antiretroviral therapy uptake in HIV-infected pregnant women. Data collection and analysis: Two authors independently identified and assessed all studies that met inclusion criteria. Study design, characteristics of study populations, interventions and controls and study results were extracted by two review authors. Also, the risk of bias of included studies was assessed independently by two reviewers. We reported the results narratively as meta-analysis was not feasible because of differences in the study design. We reported the odds ratio with 95% confidence intervals for the different outcomes. Main results: We identified five eligible studies; three ongoing and two completed studies. Findings from the included studies showed that mobile phone text messaging did not increase antiretroviral therapy initiation (OR 1.79 95%CI 1.09 to 2.94, 307 participants, 1 study). However, there was an increase in maternal clinic attendance and HIV tested infants; (RR 1.66 95%CI 1.02 to 2.70, 381 participants, 1 study) and (OR 2.01 95%CI 1.03 to 3.92, 325 participants, 1 study), respectively. The overall quality of evidence was assessed as moderate. None of the included studies reported on adherence to antiretroviral therapy. Authors' Conclusions: The review revealed that mobile phone text messaging may improve maternal clinic attendance and number infants tested for HIV compared to the standard care. Mobile phone communication did not improve ART initiation compared to standard care. Further studies are needed to evaluate the value of mobile phone communication in promoting adherence to antiretroviral drugs among pregnan...

Mobile phone communication for improving uptake of antiretroviral therapy in HIV-infected pregnant women: updated systematic review and meta-analysis

“…Our review found that mobile phone had a minor impact on ANC visits among HIV-infected pregnant women (RR = 1.02, 95 percent CI: 0.95 -1.10, 1, 778 participants, 5 studies) [45,[48][49][50]52]. In comparison to our previous review, which found that mobile phone communication was ineffective in improving ANC visits (RR 1.66, 95%CI 1.02 to 2.70, 381 participants, 1 study) [33], this current review confirmed the previous findings on ANC visits. The pooled post-partum retention study, on the other hand, included four studies [46][47][48]52].…”

“…The study protocol was registered in Prospero: CRD42016032800. The previous review version was published [33]. We also conducted an electronic search for potentially eligible studies through conferences websites: International AIDS conferences, The European AIDS Clinical Society (EACS) conferences, International AIDS Society Conference on HIV Pathogenesis and Treatment (IAS).…”

“…Major reviews of adherence interventions, primarily conducted in developed countries, revealed that the most effective are typically patient-centered, behavioral interventions designed to increase patient knowledge and efficacy through practical medication management skills [29][30][31][32][33]. While some social and behavioral scientists have become heavily involved in developing adherence measures, studying explanatory factors, and developing programs to improve patient adherence, others [33][34][35][36] have argued, l'arbre qui cache la forêt' [33,36], meaning patient adherence is multidisciplinary and complex. Coomes et al proposed a conceptual model that integrates short message services (SMS) communication functionality with important psychosocial factors that could mediate the impact of SMS communication on health outcomes [33,37].…”

“…While some social and behavioral scientists have become heavily involved in developing adherence measures, studying explanatory factors, and developing programs to improve patient adherence, others [33][34][35][36] have argued, l'arbre qui cache la forêt' [33,36], meaning patient adherence is multidisciplinary and complex. Coomes et al proposed a conceptual model that integrates short message services (SMS) communication functionality with important psychosocial factors that could mediate the impact of SMS communication on health outcomes [33,37]. This model is based on limited but growing research that has used SMS to assist patients in self-management or adherence across a variety of disease conditions [33,37].…”

“…Coomes et al proposed a conceptual model that integrates short message services (SMS) communication functionality with important psychosocial factors that could mediate the impact of SMS communication on health outcomes [33,37]. This model is based on limited but growing research that has used SMS to assist patients in self-management or adherence across a variety of disease conditions [33,37]. The use of mobile phones to improve HIV-related health outcomes is being emphasized in most HIV-affected countries, as emerging evidence suggests that reminder SMS can increase adherence to ART and retention in care, decrease viral load and treatment interruptions, and improve communication with healthcare personnel [38].…”