Evidence Supporting the Use of Text Messaging for Partner Services

Abstract

To the Editor: STD/HIV partner services need to adapt to changes in how people are communicating. More than 70% of US adults now use text messaging or short message service (SMS).1 Earlier this year, Kachur et al. provided examples of how disease intervention specialists (DISs) have used SMS for case management and partner services in New York.2 Here, we summarize our experiences at Multnomah County Health Department (Portland, OR) using SMS for partner services and report quantitative data on its utility. In Fall 2010, local DISs began a project to use SMS immediately after a phone call to cases and before mailing letters and making field visits. The project objectives were to (1) develop local procedures for using SMS for partner services, building on national guidelines3; and (2) implement these procedures for HIV, syphilis, and gonorrhea cases to reduce the need for mailings and field visits. We developed detailed local procedures from the national guidelines. They included explicit instructions that no protected health information be sent via SMS and provided messages to use for each of 3 attempts. For example, the first message is “I am with Multnomah County and I have information regarding an urgent health matter. Please call me at (phone number).” The goal of SMS is for clients to call back, so our procedures indicated that if a case responds with another text, DISs should call the case or send another text asking case to call. The procedures were approved by the local health officer and Health Insurance Portability and Accountability Act (HIPAA) officer. We purchased 2 mobile phones that allow for backing up messages, copying, and pasting messages from a master menu, remotely deleting messages, and password-protecting the phone. Our 5 local DISs are able to share the phones. When a DIS sends SMS, s/he simply needs to keep the phone near them and be available for an hour to answer incoming SMS or calls. Results to date have been promising. During January–September 2011, we sent an SMS to 149 clients immediately after a phone call; 56% of cases responded with a call after receiving the SMS. This response rate was more than 50% for HIV, early syphilis, and gonorrhea. DISs have indicated that cases respond to SMS within 10 to 15 minutes. In contrast, DISs usually wait 3 to 4 days for a response to a letter. Only one case responded that they did not want to be contacted by SMS. We found SMS to be a very useful way for DISs to reach cases, reducing the need for mailing letters and making field visits. Local DISs were initially resistant to use SMS because of discomfort with the phone technology, but this was addressed through one-on-one technical training. Once DISs used SMS several times and successfully reached cases, they became very enthusiastic about the approach. DISs are also using SMS to reach partners, and anecdotally, that is going well, but we do not yet have quantitative data to report. We recommend other STD prevention programs to use SMS for partner services. Juan Mendez, MA STD/HIV/Hep C Program Multnomah County Health Department Portland, Oregon Julie Maher, PhD Program Design and Evaluation Services Multnomah County Health Department and Oregon Public Health Division Portland, Oregon