Needs and contents of a customized digital tool for retention in care and medication adherence among pregnant and breast-feeding women living with HIV in Kilimanjaro

Abstract

Background Retention in care and adherence to medication among pregnant and breastfeeding women living with HIV (PBWLH) are crucial for the prevention of mother-to-child transmission (PMTCT) of HIV. Wide coverage of mobile phones, digital tools, including the use of internet-enabled medication dispensers and short message service (SMS), have been recommended as potential interventions to improve adherence to medication by PBWLH. The main objective of the study was to understand the needs and contents for a customized digital tool for retention in care and medication adherence among PBWLH. Method A mixed-methods study was conducted from September 2021 to March 2022 at five health facilities in Kilimanjaro region. Pregnant and breastfeeding women receiving PMTCT services were included in a survey using a semi-structured questionnaire. Among the interviewed, twenty breastfeeding women were purposively selected and enrolled to use an internet-enabled Wisepill medication dispenser for one month. They received different types of SMS reminders for a period of one month and feedback on their adherence patterns was received after one month using adherence graph from the Wisepill digital tool. Later, exit interviews and in-depth interviews were conducted to explore the needs and contents for a future customized digital adherence tool. Descriptive analyses for quantitative data and thematic content analyses for qualitative data were also done. Results Among 142 women interviewed, 42(30%) were pregnant and 100 (70%) were breastfeeding. A majority of 136 (95%) had access to mobile phones and used SMS daily, while 90% were interested in receiving reminder messages. Qualitative findings revealed more insights on reminders’ content and educational SMS. Most people preferred neutral SMS which does not contain the word “medication”. Health educational SMS content was preferred to be on breastfeeding, opportunistic diseases, nutrition and entrepreneurship education. Overall, SMSs were regarded helpful to remind clients of medication time and the medication dispenser provided them with privacy and safe storage for their medication. Conclusions Findings from this study will help to construct useful content for future digital adherence tools to support the health of pregnant and breastfeeding women living with HIV.