Use of mobile phones and text messaging to decrease the turnaround time for early infant HIV diagnosis and notification in rural Zambia: an observational study

Abstract

BackgroundEarly infant diagnosis of HIV infection is challenging in rural sub-Saharan Africa as blood samples are sent to central laboratories for HIV DNA testing, leading to delays in diagnosis and treatment initiation. Simple technologies to rapidly deliver results to clinics and notify mothers of test results would decrease many of these delays. The feasibility of using mobile phones to contact mothers was evaluated. In addition, the first two years of implementation of a national short message service (SMS) reporting system to deliver test results from the laboratory to the clinic were evaluated.MethodsThe study was conducted in Macha, Zambia from 2013 to 2015 among mothers of HIV-exposed infants. Mothers were interviewed about mobile phone use and willingness to be contacted directly or through their rural health center. Mothers were contacted according to their preferred method of communication when test results were available. Mothers of positive infants were asked to return to the clinic as soon as possible. Dates of sample collection, delivery of test results to the clinic and notification of mothers were documented in addition to test results.ResultsFour hundred nineteen mothers and infants were enrolled. Only 30% of mothers had ever used a mobile phone. 96% of mobile phone owners were reached by study staff and 98% of mothers without mobile phones were contacted through their rural health center. Turnaround times for mothers of positive infants were approximately 2 weeks shorter than for mothers of negative infants. Delivery of test results by the national SMS system improved from 2013 to 2014, with increases in the availability of texted results (38 vs. 91%) and arrival of the texted result prior to the hardcopy report (27 vs. 83%). Texted results arriving at the clinic before the hardcopy were received a median of 19 days earlier. Four discrepancies between texted and hardcopy results were identified out of 340 tests.ConclusionsMobile phone and text messaging technology has the potential to improve early infant diagnosis but challenges to widespread implementation need to be addressed, including low mobile phone ownership, use and coverage in rural areas.

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

“…Both aimed to have quicker infant ART initiation and both reported positive outcomes. (Finocchario-Kessler et al, 2014;Sutcliffe et al, 2017). The Kenyan study assessed the impact of faster laboratory result distribution through SMS technology to facilitate quicker result dissemination of HIVinfected infants to fast track their initiation on ART, and found that initiation had been reduced from 38 to 7 median days (Finocchario-Kessler et al, 2014).…”

“…The Kenyan study assessed the impact of faster laboratory result distribution through SMS technology to facilitate quicker result dissemination of HIVinfected infants to fast track their initiation on ART, and found that initiation had been reduced from 38 to 7 median days (Finocchario-Kessler et al, 2014). The other study in Zambia found that by offering mothers owning mobile phones the option of being contacted by study staff when their child's test results were available, infants in the intervention group were initiated on ART at a median of 66 days compared to the previous median of 101 days without the intervention (Sutcliffe et al, 2017).…”

Acceptability and feasibility of testing for HIV infection at birth and linkage to care in rural and urban Zambia: a cross-sectional study

“…Testing at sites in Macha and Choma represents the testing experience for clinics located far from the central laboratory. However, as testing at the central laboratory in Lusaka was performed as a study procedure and the process was managed by study staff, the turnaround times for this study were significantly shorter than those observed under routine conditions in this area [19][20][21]. In all study areas, the time to get results to the mother was longer than the 4 weeks recommended by WHO [3].…”

Text Messages Sent to Household Tuberculosis Contacts in Kampala, Uganda: Process Evaluation (Preprint)

“…SMS interventions have been evaluated across sub-Saharan Africa for their capacity to improve medication adherence [26], support the dissemination of lab results [27], and reduce missed clinic visits [28]. However, with few exceptions [29], the existing literature does not address how often SMS are received, understood, and retained by participants.…”

“…Median age among adult participants was 27 years of age (interquartile range (IQR) [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Step 2: SMS Received…”