SMS messaging to improve ART adherence: perspectives of pregnant HIV-infected women in Kenya on HIV-related message content

Abstract

There is growing evidence that mobile health (mHealth) approaches including short messaging service (SMS) can improve antiretroviral therapy (ART) adherence, but consensus is lacking regarding communication of HIV-related information. Most interventions to date have delivered SMS that do not overtly refer to HIV or ART in order to avoid risk of status disclosure. In formative work for an ongoing randomized controlled trial (RCT) evaluating one-way and two-way educational SMS for prevention of mother-to-child-transmission (PMTCT) adherence in Kenya, we conducted 10 focus group discussions (FGDs) with 87 HIV-infected peripartum women to determine desirability and preferred terminology of HIV-related content. SMS for the RCT were developed based on FGD findings. Roughly half of FGD participants supported receiving SMS containing overtly HIV-related terms, such as ‘HIV’ and ‘medication’, citing desire for detailed educational messages about ART and PMTCT. Those opposed to overt content expressed concerns about confidentiality. Many participants argued that acceptability of HIV-related content depended on the recipient’s disclosure status and others’ access to her phone. Based on these findings, both covert and overt SMS were developed for the RCT and participants who owned their phone or had disclosed their HIV status to anyone with access to their phone were able to choose one of three options: (1) covert SMS only, (2) overt SMS only in response to HIV-related questions from the participant, (3) overt SMS routinely, initiated by the study. Of the 825 participants in the RCT, 94% were eligible to receive overt SMS. Of these, 66% opted to receive routine overt SMS and 10% to receive participant-initiated overt SMS. These findings show there may be interest in overt HIV-related information by SMS when risk of status disclosure is low, and support use of messaging strategies that allows participant choice in HIV-related content while protecting against undesired disclosure.

Smartphone usage and preferences among postpartum HIV-positive women in South Africa

“…However, there were contrasts in sharing practices across studies. One study in Kenya reported significant phone sharing among women and their partners, while a more recent study in Kenya and another in South Africa revealed low rates of mobile phone sharing among women Ronen et al, 2018).…”

“…The six qualitative studies (Table 2) used structured in-depth interviews or focus group discussions (FGDs) to assess acceptability, feasibility as well as user's views on the use of mobile phone interventions to improve PMTCT uptake and maternal retention in care Ronen et al, 2018;van Heerden, Norris, Tollman, Richter, & Jane, 2013). Two mixed methods studies also reported qualitative components and are presented (Mushamiri, Luo, Iiams-Hauser, et al, 2015;.…”

“…Several studies evaluated acceptability of mHealth interventions, and overall reported high acceptability of the interventions by women in PMTCT as well as partners and health workers Ronen et al, 2018;van Heerden et al, 2013). High acceptability was reported for: 1) the mobile phoneassisted personal interview intervention for collecting maternal and child data along the PMTCT continuum; 2) case manager facilitated SMS and voice call motivational intervention among HIV-positive pregnant women; 3) direct SMS interventions to support women's ART adherence and retention in care Ronen et al, 2018;Sheree R Schwartz et al, 2015;Van Heerden, Norris, Tollman, Richter, & Jane, 2013) .…”

“…These studies also identified barriers to use of mobile phone interventions. Participants across several studies expressed concerns about unintended disclosure, lack of guaranteed confidentiality and privacy Ronen et al, 2018;van Heerden et al, 2013). Participants in a Kenyan study that was evaluating ART adherence were concerned that other people would find out about their HIV status, especially because some women had newly been diagnosed .…”

The Impact of a Maternal Education Program Through Text Messaging in Rural China: Cluster Randomized Controlled Trial (Preprint)

“…Attempts have also been made to use mobile phone text messaging to address issues related to maternal and child health including interventions to support post-abortion contraception (13), infertility treatment (14), lactation management (15), and infant feeding (16). While the overarching goal of mobile phone text messaging seeks to promote behavioural changes in both health care providers and the target population of interest, text messaging intervention evaluated to date have met with varying degrees of success (11,12).…”