Implementation of an mHealth App to Promote Engagement During HIV Care and Viral Load Suppression in Johannesburg, South Africa (iThemba Life): Pilot Technical Feasibility and Acceptability Study

Lalla-Edward, Samanta Tresha; Mashabane, Nkuli; Steward-Isherwood, Lynsey; Scott, Lesley; Fyvie, Kyle; Duncan, Dana; Haile, Betiel; Chugh, Kamal; Zhou, Yiyong; Reimers, Jacob; Pan, Matt; Venketraman, Maya; Stevens, Wendy

doi:10.2196/26033

Cited by 12 publications

(5 citation statements)

References 20 publications

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“…Furthermore, in nearly all the cases where phone sharing occurred, the phone was being shared with a romantic partner or family member and the phone was with the owner for most of the day. These findings are consistent with the literature on phone sharing patterns in similar populations [ 35 - 37 ]. Limited phone sharing is encouraging for mHealth interventions because it minimizes periods of loss of engagement with the intervention, as well minimizing opportunities for privacy and confidentiality loss.…”

Section: Discussionsupporting

confidence: 93%

Smartphone Ownership and Usage Among Pregnant Women Living With HIV in South Africa: Secondary Analysis of CareConekta Trial Data

Noholoza¹,

Phillips²,

Madwayi³

et al. 2023

JMIR Form Res

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Background Mobile health (mHealth) initiatives are increasingly common in low-resource settings, but the appropriateness of smartphone interventions in health care settings is uncertain. More research is needed to establish the appropriateness and feasibility of integrating new mHealth modalities (novel apps and social media apps) in the South African context. Objective In this study, to inform future mHealth interventions, we describe smartphone ownership, preferences, and usage patterns among pregnant women living with HIV in Gugulethu, South Africa. Methods We screened pregnant women living with HIV from December 2019 to February 2021 for the CareConekta trial. To be enrolled in the trial, respondents were required to be 18 years of age or older, living with HIV, ≥28 weeks pregnant, and own a smartphone that met the technical requirements of the CareConekta app. In this secondary analysis, we describe mobile phone ownership and sociodemographic characteristics of all women screened for eligibility (n=639), and smartphone use patterns among those enrolled in the trial (n=193). Results Overall, median age was 31 (IQR 27-35) years. Of the 582 women who owned smartphones, 580 responded to the question about whether or not it was a smartphone, 2 did not. Among those with smartphones, 92% (421/458) of them used the Android operating system of version 5.0 or above, 98% (497/506) of phones had a GPS, and 96% (485/506) of individuals charged their phones less than twice a day. Among women who were enrolled in the trial, nearly all (99%, 190/193) owned the smartphone themselves; however, 14% (26/193) shared their smartphone with someone. In this case, 96% (25/26) reported possessing the phone most of the day. Median duration of ownership of the smartphone was 12 (IQR 5-24) months, median duration with current phone number use was 25 (IQR 12-60) months, and median number of cell phone numbers owned 2 years prior to enrollment in the trial was 2 (IQR 1-2). Receiving (192/193, 99.5%) and making (190/193, 99%) phone calls were among the most common smartphone uses. The least used features were GPS (106/193, 55%) and email (91/193, 47%). WhatsApp was most frequently reported as a favorite app (181/193, 94%). Conclusions Smartphone ownership is very common among pregnant women living with HIV in this low-resource, periurban setting. Phone sharing was uncommon, nearly all used the Android system, and phones retained sufficient battery life. These results are encouraging to the development of mHealth interventions. Existing messaging platforms—particularly WhatsApp—are exceedingly popular and could be leveraged for interventions. Findings of moderate smartphone ownership turnover and phone number turnover are considerations for mHealth interventions in similar settings. Trial Registration ClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625?term=NCT03836625

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Section: Discussionsupporting

confidence: 93%

Smartphone Ownership and Usage Among Pregnant Women Living With HIV in South Africa: Secondary Analysis of CareConekta Trial Data

Noholoza¹,

Phillips²,

Madwayi³

et al. 2023

JMIR Form Res

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“…The proportion of phone sharing reported at follow-up (15%) is consistent with that reported at the time of enrollment (14%). This frequency of sharing is similar to another recent mHealth study in South Africa that found 11% phone sharing [ 33 ]. The possibility of phone sharing and potential lack of confidentiality should be considered when designing future mHealth studies in this setting.…”

Section: Discussionsupporting

confidence: 89%

“…Screening for our study is described elsewhere [ 31 ] and did not encounter similar challenges, but the implementation of our study did encounter similar issues with the lack of data, and inadequate RAM may have caused the installation challenges we experienced, as apps and photos sometimes needed to be deleted to make space for the CareConekta app. A different South African study from 2019 found that 13% of the eligible participants were unable to download the study app on their Android-based phone, 6% were unable to scan a barcode, and 3% were unable to complete app registration [ 33 ]. During implementation, the authors noted reports of a lack of data access and lost or broken phones.…”

Section: Discussionmentioning

confidence: 99%

The Implementation of a GPS-Based Location-Tracking Smartphone App in South Africa to Improve Engagement in HIV Care: Randomized Controlled Trial

Clouse¹,

Noholoza²,

Madwayi³

et al. 2023

JMIR Mhealth Uhealth

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Background Mobile health interventions are common in public health settings in Africa, and our preliminary work showed that smartphones are increasing in South Africa. We developed a novel smartphone app—CareConekta—that used GPS location data to characterize personal mobility to improve engagement in HIV care among pregnant and postpartum women living with HIV in South Africa. The app also used the user’s location to map nearby clinics. Objective We aimed to describe the feasibility, acceptability, and initial efficacy of using the app in a real-world setting. Methods We conducted a prospective randomized controlled trial at a public sector clinic near Cape Town, South Africa. We enrolled 200 pregnant (third trimester) women living with HIV who owned a smartphone that met the required specifications. All participants installed the app, designed to collect 2 GPS heartbeats per day to geolocate the participant within a random 1-km fuzzy radius (for privacy). We randomized (1:1) participants to a control arm to receive the app with no additional support or an intervention arm to receive supportive phone calls, WhatsApp (Meta Platforms, Inc) messages, or both from the study team when traveling >50 km from the study area for >7 days. In addition to mobility data collected daily through the phone, participants completed questionnaires at enrollment and follow-up (approximately 6 months post partum). Results A total of 7 participants were withdrawn at enrollment or shortly after because of app installation failure (6/200, 3%) or changing to an unsuitable phone (1/200, 0.50%). During the study period, no participant’s smartphone recorded at least 1 heartbeat per day, which was our primary feasibility measure. Of the 171 participants who completed follow-up, only half (91/171, 53.2%) reported using the same phone as that used at enrollment, with the CareConekta app still installed on the phone and GPS usually enabled. The top reasons reported for the lack of heartbeat data were not having mobile data, uninstalling the app, and no longer having a smartphone. Acceptability measures were positive, but participants at follow-up demonstrated a lack of understanding of the app’s purpose and function. The clinic finder was a popular feature. Owing to the lack of consistent GPS heartbeats throughout the study, we were unable to assess the efficacy of the intervention. Conclusions Several key challenges impeded our study feasibility. Although the app was designed to reverse bill participants for any data use, the lack of mobile data was a substantial barrier to our study success. Participants reported purchasing WhatsApp data, which could not support the app. Problems with the web-based dashboard meant that we could not consistently monitor mobility. Our study provides important lessons about implementing an ambitious GPS-based study under real-world conditions in a limited-resource setting. Trial Registration ClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-020-4190-x

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“… 32 A good example is the iThemba Life application that showed that patients received HIV viral load results 10 times sooner than the standard of care. 33 Similarly, the miLINC suite of smartphone applications was designed to improve the time from diagnosis to treatment initiation for patients with rifampicin-resistant TB. 34 This study showed that the time from presentation to treatment initiation could be significantly improved by using an integrated approach.…”

Section: Discussionmentioning

confidence: 99%

Assessing the cost and utilization of SMS printers by primary health care facilities: lessons learned from South Africa

Cassim

Olsen

Stewart-Isherwood

et al. 2023

J. Public Health Afr.

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Background. Historically, paper-based laboratory reports were delivered by couriers to health facilities resulting in post-analytical delays. As a result, Short Message Service (SMS) printers were deployed to address this gap, the majority using the global data service platform (GDSP) to simplify deployment. In addition, these printers generate binary and quantitative information that can be used to assess utilization. Objectives. The objective of this study was to determine the costs and utilization of the SMS printer program in South Africa. Materials and Methods. A costing analysis for the 2020 calendar year was undertaken. We determined annual equivalent costs (AEC) for staffing, printers, fixed costs related to the national coordinator, consumables, travel costs, database support/hosting/dashboard development, printer repairs, and results transmission. The main outcome of interest was the cost per SMS printer result delivered. Data were extracted to assess utilization as follows: (i) months active (based on internet protocol data), (ii) signal, and (iii) battery strength. Results. There were 4,450,116 results delivered to printers that were situated at 2,232 primary healthcare facilities. An AEC of $687,727 was reported, with a cost per result delivered of $0.1618. The SMS printers contributed 73.52% to the total AEC. Overall, 90% of the printers were GDSP based, of which only 69.5% were determined to be active. The majority of active printers reported a signal strength ≥60% and a battery strength of ≥6 volts. Conclusions. Although the SMS printer program has the potential to reduce post-analytical delays, pathology services should migrate to an end-to-end electronic interface to improve patient care.

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Implementation of an mHealth App to Promote Engagement During HIV Care and Viral Load Suppression in Johannesburg, South Africa (iThemba Life): Pilot Technical Feasibility and Acceptability Study

Cited by 12 publications

References 20 publications

Smartphone Ownership and Usage Among Pregnant Women Living With HIV in South Africa: Secondary Analysis of CareConekta Trial Data

Smartphone Ownership and Usage Among Pregnant Women Living With HIV in South Africa: Secondary Analysis of CareConekta Trial Data

The Implementation of a GPS-Based Location-Tracking Smartphone App in South Africa to Improve Engagement in HIV Care: Randomized Controlled Trial

Assessing the cost and utilization of SMS printers by primary health care facilities: lessons learned from South Africa

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