Evaluation of an SMS-based mHealth intervention to enhance early infant diagnosis follow-up testing and assessment of postnatal prophylaxis.

Anele Dube-Pule,Moherndran Archary,Majahonkhe Shabangu,Brian C Zanoni,Cathy Connolly

doi:10.4102/sajhivmed.v22i1.1301

Abstract

BackgroundAdherence to infant antiretroviral (ARV) postnatal prophylaxis and early infant diagnosis (EID) uptake is low in Africa. Promoting EID and adherence are necessary for this age group.ObjectivesWe evaluated an SMS-based mobile health (mHealth) intervention to enhance adherence to ARV prophylaxis and knowledge of EID and prevention of mother-to-child transmission (PMTCT) among high-risk and low-risk mother–infant pairs.MethodTwo hundred and fifty-one mothers were recruited from King Edward VIII Hospital between December 2018 and October 2019. Participant information was captured, and SMS reminders were sent postnatally to promote immunisation attendance. Follow-up HIV polymerase chain reaction (PCR) test results were reviewed, and telephonic interviews were utilised for qualitative data.ResultsIn all, 73.3% of infants had HIV PCR tests performed at 10 weeks. This high rate could be attributed to the mHealth intervention as this is considerably higher than other national studies, though not statistically significant compared to rates reported in the district at the same time. Factors that have impacted follow-up EID rates include poor maternal knowledge of EID time points and inadequate implementation of national PMTCT protocols. High-risk mothers were younger, commenced antenatal clinic visit later, were less knowledgeable on prophylaxis and have lower-birthweight infants than lower-risk mothers.ConclusionmHealth can play an important role in improving EID by increasing maternal knowledge. Further studies should focus on whether maternal education over an mHealth platform can increase knowledge on PMTCT and subsequently increase EID.

Highlights

Mother-to-child transmission (MTCT) rates for HIV declined impressively by 84% between 2008 and 2015 in South Africa (SA); since there has been a slower decline, jeopardising the World Health Organization (WHO) targets of preventing 6 million new infections among children by 2030.1 Despite high antenatal HIV testing rates and universal maternal antiretroviral treatment (ART), SA has yet to eliminate MTCT, as the infant HIV transmission rate at 18 months in 2019 was still 3%.2 Gaps in the prevention of mother-to-child transmission (PMTCT) cascade after delivery contribute to these ongoing HIV transmissions
The HIV-exposed infants were defined as either low risk (LR) if the mother was on ART with an HIV viral load (VL) of < 1000 copies/mL in the last three months or high risk (HR) if the mother had no HIV VL available or an HIV VL of > 1000 copies/mL
In this study evaluating an SMS-based mHealth intervention to enhance early infant diagnosis (EID) uptake and assess maternal knowledge and adherence to infant ARV prophylaxis among the HR and LR mother– infant pairs (MIPs), the intervention was found to be useful by the interviewed participants, we could not prove that it promotes adherence

Summary

Introduction

Mother-to-child transmission (MTCT) rates for HIV declined impressively by 84% between 2008 and 2015 in South Africa (SA); since there has been a slower decline, jeopardising the World Health Organization (WHO) targets of preventing 6 million new infections among children by 2030.1 Despite high antenatal HIV testing rates and universal maternal antiretroviral treatment (ART), SA has yet to eliminate MTCT, as the infant HIV transmission rate at 18 months in 2019 was still 3%.2 Gaps in the prevention of mother-to-child transmission (PMTCT) cascade after delivery contribute to these ongoing HIV transmissions. Gaps in the prevention of mother-to-child transmission (PMTCT) cascade after delivery contribute to these ongoing HIV transmissions These include poor monitoring of HIV-negative mothers until the end of breastfeeding, poor viral load (VL) monitoring among HIV-positive mothers, poor adherence to both maternal ART and infant antiretroviral (ARV) prophylaxis and low rates of repeat testing for early infant diagnosis (EID) at the recommended 10-week, 6-month and 18-month visits.[3,4,5]. Promoting EID and adherence are necessary for this age group

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Results

Discussion

Conclusion