Cell Phone Availability and Usage for mHealth and Intervention Delivery to Persons Living With HIV in a Low-Resource Setting: Cross-sectional Study

Abstract

Background HIV/AIDS is now a manageable chronic illness owing to effective antiretroviral therapy (ART), which involves routine follow-up care, including regular physical visits to the clinic. In the recent past, and in wake of the COVID-19 pandemic, there has been increased need for virtual care and intervention delivery, a modality known as mobile health (mHealth), which includes cell phone–delivered services for medical and public health practice. Objective Here we describe cell phone use and its relationship with alcohol use in a cohort of persons living with HIV and latent tuberculosis (TB). Methods We performed a cross-sectional analysis of baseline data from a cohort of persons living with HIV and latent TB in HIV care in southwestern Uganda. We estimated proportions of cell phone and text message use and evaluated their associations with alcohol use—a common modifiable behavior among persons living with HIV. Cell phone use (primary outcome) was defined as owning a cell phone that is turned on at least half of the day. Any alcohol use was defined as any self-reported alcohol use in the prior 3 months or a phosphatidylethanol (an alcohol biomarker) level of ≥8 ng/mL. Results A total of 300 participants (median age 40 years; n=146, 48.7% male) were included in the analysis. Most (n=267, 89.0%) participants had access to a phone and of them, 26 (9.7%) shared the phone with someone else. In total, 262/300 (87.3%) of participants owned a cell phone that is turned on at least half of the time; the majority (n=269, 89.7%) rarely or never sent text messages, and over two-thirds (n=200, 66.9%) rarely or never received text messages. Most (n=214, 71.3%) had any alcohol use in the prior 3 months. In adjusted analyses, any alcohol use was not significantly associated with cell phone use (adjusted odds ratio [aOR] 0.48, 95% CI 0.18-1.25; P=.13) or sending (aOR 0.82, 95% CI 0.28-2.37; P=.71) or receiving (aOR 1.31, 95% CI 0.70-2.47; P=.40) text messages. Conclusions There is hope that mHealth interventions in this population can be carried out using cell phones owing to their popularity; however, the interventions may need to employ methods that do not rely on the sending and receiving of text messages only.

Men’s Willingness to Receive Text Messages and Talk with an HIV counselor from the National HIV Hotline in Tanzania for Support with Linkage to Care Following HIV self-testing

“…A vast majority of participants reported having access to mobile phones (98.0%), indicating potential feasibility for utilizing mobile health (mHealth) interventions such as text messaging for HIV-related communication. These findings align with and reinforce the insights gleaned from previous research conducted in resource-limited setting (23)(24)(25)(26)(27). The studies have consistently demonstrated the extensive use of mobile phones even in regions with limited access to traditional healthcare infrastructure.…”

“…mHealth) interventions such as text messaging for HIV-related communication. These findings align with and reinforce the insights gleaned from previous research conducted in resource-limited setting(23)(24)(25)(26)(27). The studies have consistently demonstrated the extensive use of mobile phones even in regions with limited access to traditional healthcare infrastructure.The ubiquity of mobile phones in such setting has been pivotal in reaching remote and underserved populations with healthcare information and services.Regarding the comfortability in engaging with HIV counseling services, participants who reported receiving HIV-related text messages in the past were more likely to feelcomfortable talking to a HIV counselor on the National HIV Hotline following HIVST.…”

Implementation of enhanced 99DOTS for TB treatment supervision in Uganda: An interrupted time series analysis

“…Access to mobile phones is expected to be lower among people with TB than in the general population (18% vs. 7.8% in Peru from 2007-2013) (12). Mobile phone access among populations affected by TB in Uganda has been reported to be high (89% among PLHIV with latent TB in a cohort in western Uganda (12) and 58% ownership with an additional 42% indirect access among household contacts of people with TB in urban Kampala (13). Nevertheless, an intervention that relies on cellphone access systematically excludes some of the most vulnerable.…”

“…Low enrollment has been a challenge in previous studies of 99DOTS and other cellphone-based DATs, raising concerns about equity and access to this mode of care. Access to mobile phones is expected to be lower among people with TB than in the general population (18% vs. 7.8% in Peru from 2007-2013) (12). Mobile phone access among populations affected by TB in Uganda has been reported to be high (89% among PLHIV with latent TB in a cohort in western Uganda (12) and 58% ownership with an additional 42% indirect access among household contacts of people with TB in urban Kampala (13).…”