Abstract
Background. Antiretroviral medications are key for prevention of mother-to-child transmission (PMTCT) of HIV, and transmission mitigation is affected by service delivery, adherence, and retention. Methods. We conducted a cluster-randomized controlled study in 26 facilities in Nyanza, Kenya, to determine the efficacy of SMS text messages on PMTCT outcomes. The relative risk and confidence intervals were estimated at the facility level using STATA. Results. 550 women were enrolled, from June 2012 to July 2013. The median age was 25.6 years, and 85.3% received ARVs. Maternal ARV use was similar between the intervention and control arms: 254/261 (97.3%) versus 241/242 (99.6%) at 34–36 weeks of gestation and 234/247 (94.7%) versus 229/229 (100%) at delivery. Among infants, 199/246 (80.9%) and 209/232 (90.1%) received ARVs (RR: 0.91; 95% CI: 0.77–1.14); 88% versus 88.6% were tested for HIV at 6 weeks, with 1/243 (0.4%) and 3/217 (1.4%) positive results in the intervention and control arms, respectively. Communication increased in both the intervention and control arms, with the mean number of 7.5 (SD: 5.70) compared with 6 (SD: 9.96), p < 0.0001. Conclusions. We identified high ARV uptake and infant HIV testing, with very low HIV transmission. Increased communication may influence health-seeking behaviors irrespective of technology. The long-term effectiveness of facilitated communication on PMTCT outcomes needs to be tested. The study has been registered on ClinicalTrials.gov under the identifier NCT01645865.
Highlights
HIV remains a significant cause of morbidity and mortality among children worldwide, with the primary mode of transmission being through vertical transmission of HIV from mothers to infants during pregnancy, delivery, and breastfeeding [1]
Antiretrovirals were given to 86.8% and 83.7% of women in antenatal care (ANC) in the intervention and control arms, respectively, of whom 98.4% reported taking their antiretroviral medications at 34–36 weeks with no significant difference between arms (adjusted relative risk 1.04, 95% CI: 0.91–1.18)
We were unable to find a significant effect of short message service (SMS) text messages on any of the key prevention of mother-to-child transmission (PMTCT) milestones, including uptake and adherence to antiretroviral medications among mothers and infants, facility-based deliveries, or infant HIV testing at 6 weeks of age
Summary
HIV remains a significant cause of morbidity and mortality among children worldwide, with the primary mode of transmission being through vertical transmission of HIV from mothers to infants during pregnancy, delivery, and breastfeeding [1]. Over 90% of these infections were in sub-Saharan Africa where limited access to and usage of health services promotes vertical transmission of HIV. 199/246 (80.9%) and 209/232 (90.1%) received ARVs (RR: 0.91; 95% CI: 0.77–1.14); 88% versus 88.6% were tested for HIV at 6 weeks, with 1/243 (0.4%) and 3/217 (1.4%) positive results in the intervention and control arms, respectively. Communication increased in both the intervention and control arms, with the mean number of 7.5 (SD: 5.70) compared with 6 (SD: 9.96), p < 0.0001. The study has been registered on ClinicalTrials.gov under the identifier NCT01645865
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