Abstract
Background:Pregnant and breastfeeding Women Living with HIV (WLHIV) often have difficulties in reaching adequate levels of adherence (>95%) to Antiretroviral treatment. “Forgetting” is the most commonly mentioned reason. Sending reminders via SMS is expected to improve adherence. We conducted a pilot study to investigate acceptability, user experience and technical feasibility of sending reminder-SMS to WLHIV.Methods:This was a 6-months observational pilot-study among WLHIV attending antenatal and postnatal care at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. Women received a reminder-SMS 30 minutes before usual time of intake. One hour later, they received an SMS asking whether they took medication to which they could reply with ‘Yes’ or ‘No’. Messages were sent 3 times a week on randomly chosen days to prevent reliance on daily messages. We calculated the percentage of number of SMS delivered, failed to be delivered, and replied to. We analysed feedback from exit-interviews about experience with the SMS-reminders.Results:25 women were enrolled (age 18-45), 2 were lost to follow up. 5,054 messages were sent of which 53 failed to be delivered (1%). 1,880 SMS were sent with a question if medication was taken; 1,012 (54%) messages were replied to, of which 1,003 (99%) were replied with ‘YES’ and closely to ‘YES’, and a total of 9 (1%) with ‘NO’ and ‘closely to NO’. 868 messages (46%) were not responded to due to either dropout, change of phone number, loss of phone or network failure. Results from 18 interviews showed that 16 (89%) women were satisfied with SMS reminders. 2 (11%) were concerned about unwanted disclosure because of the content ‘don't forget to take medication’ and one reported other privacy issues (6%). 3 (17%) women experienced stigma.Conclusion:99%of SMS being delivered indicates that SMS reminders in this resource-limited setting are technically feasible. However, concerns regarding privacy were noted, specifically the risk of unwanted disclosure and the experience of stigma. Participants indicated that being made aware of their adherence, motivated them to adhere better. However, personalised and more neutral content of the SMS might be a way to improving the intervention.
Highlights
Pregnant and breastfeeding Women Living with HIV (WLHIV) often have difficulties in reaching adequate levels of adherence (>95%) to Antiretroviral treatment
Technical Feasibility of Sending and Receiving Messages In total, 5,054 Short Message Service (SMS) were scheduled and sent of which 5,001 (99%) were delivered. 53 (1%) were not delivered. (Table 2). 4 participants occasionally received SMS messages too late despite having been sent at the scheduled time, which appeared to be due to participants switching off their phone during the night or network failures
More question SMSs were sent than reminders, since the question was repeated after one hour if the reply was ‘Not yet’. (Table 2)
Summary
Pregnant and breastfeeding Women Living with HIV (WLHIV) often have difficulties in reaching adequate levels of adherence (>95%) to Antiretroviral treatment. According to the World Health Organization (WHO) guidelines, initiation of lifetime Antiretroviral Therapy (ART) by WLHIV under the recommended Option B+ programme has the potential to reduce the transmission of HIV to the newborn to below 5%.6 Their infants should receive nevirapine syrup till 6 weeks postpartum and exclusive breastfeeding up to month 6, preferably continuing breastfeeding up to 24 months in addition to solid foods.[7] In a prospective cohort study conducted in the Kilimanjaro region in 2016, out of 200 pregnant womenenrolled, 4.8% were found to be HIV positive while only 41% were in PMTC care.[5] Sustaining a high level of adherence to ART during pregnancy, postpartum and during breastfeeding are, a prerequisite to prevent HIV-transmission from mother to child.[8] Achieving optimal levels of adherence (>95%) is still a major challenge due to several factors including drug shortages and forgetting to take medication.[9] Adherence to ART entails that medication is taken at the right time and exactly as prescribed without missing a dose. Poor adherence to ART may lead to virological failure and HIV-transmission from mother to child and to creation of resistant HIV strains
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