Abstract
Text messages (SMS) are being increasingly integrated into HIV programs across Southern Africa to improve patient adherence, linkage to care and provide psycho-social support. Careful attention needs to be paid to the design of SMS-based interventions for clients of HIV-care services to ensure that any potential harm, such as unwanted disclosure of HIV status, is minimized. In this article we propose a set of best practice recommendations to ensure that any SMS-based intervention considers ethical principles to safeguard safety, autonomy and confidentiality of its targeted HIV-positive beneficiaries. This analysis draws from our operational experience in Southern Africa in the design and conduct of mHealth interventions in the frame of HIV projects. The recommendations, framed in the context of the Belmont Report's three ethical pillars, may contribute to more safely operationalize any SMS service integrated into an HIV program if adopted by mHealth planners and implementers. We encourage actors to report on the ethical and methodological pathways followed when conducting SMS-based innovations to improve the wellbeing and quality provision of HIV-care for their targeted clients.
Highlights
MHealth is a term that stands for the capitalization of telecommunications infrastructure and uptake of mobile information and communication technologies to support the provision of health services and achieve global, community and individual-level health priorities [1,2]. mHealth has been identified as a potentially effective tool to improve the quality of HIV services [3]
As research is conducted to assess the effectiveness and impact of mHealth, we reviewed the Declaration of Helsinki to ensure that the recommendation made in this article do not conflict with the ethical principles set out to guide research [13]
These recommendations draw from our experience in Médecins Sans Frontiéres/Doctors Without Borders (MSF)-supported mHealth programs in Southern Africa
Summary
MHealth is a term that stands for the capitalization of telecommunications infrastructure and uptake of mobile information and communication technologies to support the provision of health services and achieve global, community and individual-level health priorities [1,2]. mHealth has been identified as a potentially effective tool to improve the quality of HIV services [3]. In the hands of people living with HIV, SMS is a ubiquitous technology that holds promise to improve their health, psycho-social wellbeing and HIVinfection management. In this matter, SMS may be sent to remind HIV patients to adhere to their ART regime, attend their clinic and lab appointments, and to communicate medical examination results [5]. Despite the developing evidence base of the effectiveness of mHealth as a patient support tool, it is still important to consider issues of confidentiality and privacy when designing an SMS program relating to a sensitive topic such as HIV. The potential harms of sending text messages must be considered in relation to other communication alternatives, especially in contexts such as subSaharan Africa, in which stigmatization towards people living with HIV is prevalent [10,11]
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