Abstract
BackgroundThe Millennium Villages Project (MVP) implemented in Western Kenya a mobile Health tool that uses text messages to coordinate Community Health Worker (CHW) activities around antenatal care (ANC) and Prevention of Mother-to-Child Transmission of HIV (PMTCT), named the ANC/PMTCT Adherence System (APAS).MethodsEnd-user changes in health-seeking behavior in ANC and postnatal care (PNC) were investigated following registration of 800 women into APAS. These investigations employed interviews of pregnant women or new mothers (n = 67) and CHWs (n = 20). Ordinal logistic regressions and exact binomial tests were used in the routine data analyses (n = 650, health registers).ResultsAll CHWs interviewed agreed that APAS helped them track pregnant woman efficiently, compared to paper-based tracking forms. Women registered in APAS reported that CHWs reminded them of appointments more regularly than before its inception.The routine data analysis showed that among women who had their 1st ANC visit in the 2nd trimester, women who resided in the MVP cluster and were in APAS had:3 times the odds of going for more ANC visits compared to women who were not registered (but resided in the cluster), after adjusting for the mother’s HIV status in the multivariate model (Adjusted OR = 2.58, 95% CI [1.10-6.01]);twice the odds of going for more ANC visits compared to women who were not registered and resided outside the cluster (Adjusted OR = 2.37, 95% CI [0.99-5.67])Among women not registered, residence inside or outside the cluster did not affect the number of ANC visits made (Adjusted OR = 0.86, 95% CI [0.45-1.69]).The APAS also greatly increased the likelihood of women making the 6 recommended post-delivery baby follow-ups.For women registered in APAS, the MTCT rate at 18 months was significantly different from that of women not registered, and from the global rate of 30%. Women not registered had a 9% MTCT rate at 18 months regardless of residence, while women registered had a 0% transmission rate at both 9 and 18 months.ConclusionsThe incorporation of mHealth tools in CHW programs can improve adherence to ANC and PNC and enhance PMTCT efforts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1358-5) contains supplementary material, which is available to authorized users.
Highlights
The Millennium Villages Project (MVP) implemented in Western Kenya a mobile Health tool that uses text messages to coordinate Community Health Worker (CHW) activities around antenatal care (ANC) and Prevention of Mother-to-Child Transmission of Human Immunodeficiency Virus (HIV) (PMTCT), named the ANC/Prevention of Mother-to-Child Transmission of HIV (PMTCT) Adherence System (APAS)
The toll-free Short Message System (SMS) service contract was terminated in April 2011, but the disruption in service did not significantly affect the use of the system as most CHWs resorted to using their own phone credit to send text messages to the system and were subsequently reimbursed by the MVP office for this expense
Women who resided inside the MVP cluster had twice the odds of going for more, rather than less, baby follow-ups compared to women who resided outside the MVP cluster; women who were in the ANC/PMTCT Adherence System (APAS) and resided in the MVP cluster had 9 times the odds of going for more, rather than less, baby follow-ups compared to women who were not in the APAS and resided outside the MVP cluster; among women who resided in the MVP cluster, women who were in the APAS had 5 times the odds of going for more, rather than less, baby follow ups compared to women who were not in the APAS
Summary
The Millennium Villages Project (MVP) implemented in Western Kenya a mobile Health tool that uses text messages to coordinate Community Health Worker (CHW) activities around antenatal care (ANC) and Prevention of Mother-to-Child Transmission of HIV (PMTCT), named the ANC/PMTCT Adherence System (APAS). According to WHO estimates, 50% of HIV-positive pregnant women worldwide did not receive prevention of mother-to-child transmission (PMTCT) services in 2010, which resulted in 1000 new pediatric infections daily [1]. The number of children living with HIV currently exceeds 3 million, most of them living in Sub-Saharan Africa [1]. This alarming figure represents 90% of all HIV-infected children globally, with less than a tenth of them being reached with basic health services [4]. The estimated antiretroviral therapy (ART) coverage for PMTCT was only 53% in Kenya for 2012 [6]. Cultural and societal factors may influence utilization, including: HIV-related stigmas, fears of status disclosure, lack of financial resources and motivation to access PMTCT services, and poor education or knowledge about PMTCT [7,8]
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