Mobile health for early retention in HIV care: a qualitative study in Kenya (WelTel Retain)

Abstract

Many people newly diagnosed with HIV are lost to follow-up before timely initiation of antiretroviral therapy (ART). A randomised controlled trial (RCT), WelTel Kenya1, demonstrated the effectiveness of the WelTel text messaging intervention to improve clinical outcomes among patients initiating ART. In preparation for WelTel Retain, an RCT that will evaluate the effect of the intervention to retain patients in care immediately following HIV diagnosis, we conducted an informative qualitative study with people living with HIV (n = 15) and healthcare providers (HCP) (n = 5) in October 2012. Study objectives included exploring the experiences of people living with HIV who have attempted to engage in HIV care, the use of cell phones in everyday life, and perceptions of communicating via text message with HCP. Participants were recruited through convenience sampling. Semi-structured, qualitative interviews were conducted and recorded, transcribed verbatim and analysed using NVivo software. Analysis was guided by the Theory of Reasoned Action and the Technology Acceptance Model. Results indicate that while individuals have many motivators for engaging in care after diagnosis, structural and individual barriers including poverty, depression and fear of stigma prevent them from doing so. All participants had access to a mobile phone, and most were comfortable communicating through text messages, or were willing to learn. Both people living with HIV and HCP felt that increased communication via the text messaging intervention has the potential to enable early identification of problems, leading to timely problem solving that may improve retention and engagement in care during the first year after diagnosis.

Barriers and Facilitators to Interventions Improving Retention in HIV Care: A Qualitative Evidence Meta-Synthesis

“…A total of eleven studies were identified, including nine qualitative only studies [32–40] and two mixed method studies [41, 42] (Fig. 1).…”

“…Based on the CASP quality assessment tool for qualitative studies, seven studies [32–35, 37, 39, 40] were evaluated as having “minor” methodological limitations while the other four [36, 38, 41, 42] were evaluated as having “moderate” limitations (Table 3). …”

Mobile health applications for HIV prevention and care in Africa

“…Following the success of the WelTel trial for improving adherence to ART, another study in Kenya is seeking to evaluate the efficacy of SMS for patient retention in Nairobi [11]. Qualitative analysis has shown promise for enabling early identification of problems, leading to timely problem solving that may improve retention and engagement in care during the first year of diagnosis [12]. The MORE CARE trial in Cameroon tested the efficacy of reminders on follow-up in care among children exposed or infected with HIV [13 & ].…”

Is Involvement in Sex Work Associated with Engagement in HIV-Related Medical Care in Latin American Men Who Have Sex with Men? Results of a Large, Multinational Internet Survey

“…Programs should explore ways to engage these individuals in care at the time of testing, particularly by providing culturally competent case management and supportive services. 24,25 Results of this study must be considered in the context of several limitations. This study represents a convenience sample of members of a social/sexual networking website for MSM, and all measures were self-reported.…”