Cell Phone Counseling Improves Retention of Mothers With HIV Infection in Care and Infant HIV Testing in Kisumu, Kenya: A Randomized Controlled Study

Abstract

Tailored, one-on-one counseling delivered via cell phone was very effective in retaining mothers with HIV in care and in promoting infant HIV testing and antenatal and postnatal care attendance. The highest risk of loss to follow-up among women with HIV accessing PMTCT services was prior to delivery and then after infant HIV testing at 6 weeks. Challenges include continued limited access to cell phones, difficulty with reaching participants on the phone, and poor adherence to antiretroviral therapy for a substantial percentage of the population.

“I Wish to Continue Receiving the Reminder Short Messaging Service”: A Mixed Methods Study on the Acceptability of Digital Adherence Tools Among Adults Living with HIV on Antiretroviral Treatment in Tanzania

“…Studies in Kenya, Uganda, India, Tanzania and Botswana reported that some participants were concerned about unwanted HIV disclosure, others reported anticipated stigma arising from SMS content, which may mention the words medication and HIV. 10 , 16 , 17 A systematic review showed that unreliable internet connections and high purchase and maintenance costs of smart phones resulted in unsuccessful mHealth interventions in resource-limited settings. 18 Others have also reported logistical challenges; including the fact that family members often share mobile phones, the unreliable access to electricity, and issues of mobile phones breaking.…”

A Qualitative Comparative Analysis of the Drivers of HIV Status Knowledge in Orphans and Vulnerable Children in Mozambique

“…This finding is also supported by literature that suggests case workers are more effective when they have access to all resources essential to basic care. 20 , 21 Adequate care resources and comprehensive care plans have also been shown to be important for treatment program effectiveness for people living with HIV. 11 , 20 , 41 Program funders could consider expanding HIV program budgets to account for activista reimbursement for transportation and airtime (i.e., cell phone service used for case management).…”

“…Literature highlights the importance of case worker connectedness to share challenges 5 , 6 , 14 , 15 and of connections to additional services to ensure that beneficiaries receive comprehensive, whole-person care. 9 , 18 , 20 , 21 , 42 The influence of care team networking and referral networks is an important area for future research. Similarly, since CBOs all followed similar protocols for case management, the influence of specific care methods could not be investigated.…”

“…For example, program performance may also be improved by increasing the mobility of care, such as using home-based rapid testing 22 , 42 or performing follow-up consultations by phone. 9 , 18 , 21 Future research that compares programs that employ different HIV testing methods and follow-ups and have different levels of care mobility could generate greater insight into program optimization.…”

“… 6 , 7 The limited number of studies that have examined specific case management attributes primarily consider a small number of factors in isolation and do not account for how factors may combine to have a collective impact on program outcomes. From previous studies, several case management program attributes have been hypothesized to positively influence case management effectiveness, such as case manager skills, 13 , 14 training, 9 , 15 – 17 caseload, 18 supportive supervision, 14 , 16 financial incentives, 19 – 21 resources, 19 – 21 networking, 5 , 6 , 14 , 15 and accessibility of care. 9 , 18 , 21 Although there are many factors posited to influence knowledge of HIV status, such as stigma, 19 , 20 demographics (e.g., beneficiary age, sex, income, education), 18 , 22 , 23 and social capital, 15 this study focused solely on the modifiable attributes of case management programs because these factors are in programs’ manageable control.…”