218. Implementation of the PIERS on the Move mobile health app in the Community Level Interventions for Pre-eclampsia trials

Abstract

Background The PIERS on the Move (POM) app was implemented as part of a complex health system intervention in the CLIP (Community Level Interventions for Pre-eclampsia; NCT01911494) Trials in India, Pakistan and Mozambique. POM guides community health workers through an antenatal/postnatal assessment and provides recommendations for referral to a nearby facility with immediate treatment with MgSO4 and methyldopa when hypertension is detected, based on disease severity. Objective To evaluate the implementation of the POM app based on population coverage, compliance and recommendation acceptance. Methods As per the protocol, coverage was measured as the proportion of women receiving one or more POM home visit out of all pregnancies registered in the intervention area and compliance was measured as the proportion of women receiving the minimum standard of monthly POM home visits. Acceptance of recommendation and was summarized and rates of outcome for women in intervention areas with and without a recommendation presented. Results In total 21,416/36,077 eligible women received 151,893 POM visits (76.2% antepartum, 23.8% postpartum) during the CLIP Trials. Coverage was 90.0% in India, 56.6% in Pakistan and 61.2% in Mozambique. Compliance rates were 55.4% in India; 63.4% in Pakistan; and 77.0% in Mozambique. Rate of triage recommendation was 5.6% (1194/21,416) of the covered population in total. The primary reason for referral was non-severe hypertension. Women’s acceptance of recommendations was 77.0% overall. In intervention clusters, the rate of adverse maternal outcomes in women who received recommendations compared to those who did not was higher in India (11.7% vs 4.3%) and Mozambique (11.3% vs. 7.7%) but similar in Pakistan (5.0% vs. 5.0%). Conclusion During the CLIP Trials there was good coverage and compliance and a high rate of community acceptance of triage recommendations after implementation of the POM app but limited apparent impact on maternal health outcomes.