Mobile Phone Communication for Improving Uptake of Antiretroviral Therapy in HIV-infected Pregnant Women: Review

Abstract

Background About 1.4 million pregnant women are living with HIV in low and middle income countries with about 91% of these women residing in sub-Saharan Africa. HIV-infected pregnant women face several challenges that could decrease antiretroviral therapy adherence. Studies reported challenges such as poor mental health, lack of social support, fears of infecting children, medication side effects, cultural factors, economic instability, nausea and vomiting during pregnancy. This review investigated whether mobile phone text messaging could improve antiretroviral therapy in during and after pregnancy. Objectives To assess the effectiveness mobile phone text messaging for improving adherence to antiretroviral therapy in HIV-infected pregnant women. To investigate whether mobile phone text messaging could improve follow up in HIV-exposed infants. Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, MEDLINE via PubMed, Web of Science, CINAHL (EBSCO). Furthermore, we searched studies through HIV/AIDS conferences websites: International AIDS conferences, The European AIDS Clinical Society (EACS) conferences, International AIDS Society conference on HIV Pathogenesis and Treatment (IAS). Two authors extracted data in the study eligibility form. Selection criteria We selected randomized controlled trials (RCTs) assessing mobile phone text messaging as reminders for antiretroviral therapy uptake in HIV-infected pregnant women. Data collection and analysis Two authors independently identified and assessed all studies that met inclusion criteria. Study design, characteristics of study populations, interventions and controls and study results were extracted by two review authors. In addition, the risk of bias of included studies was assessed independently by two reviewers. We reported the results narratively as meta-analysis was not feasible because of differences in the study design. We reported the odds ratio with 95% confidence intervals for the different outcomes. Main results We identified five eligible studies; three ongoing and two completed studies. Findings from the included studies showed that mobile phone text messaging did not increase antiretroviral therapy initiation (OR 1.79 95%CI 1.09 to 2.94, 307 participants, 1 study). However, there was an increase in maternal clinic attendance and HIV tested infants; (RR 1.66 95%CI 1.02 to 2.70, 381 participants, 1 study) and (OR 2.01 95%CI 1.03 to 3.92, 325 participants, 1 study), respectively. The overall quality of evidence was assessed as moderate. None of the included studies reported on adherence to antiretroviral therapy. Authors' conclusions The review revealed that mobile phone text messaging may improve maternal clinic attendance and number infants tested for HIV compared to the standard care. Mobile phone communication did not improve ART initiation compared to standard care. Further studies are needed to evaluate the value of mobile phone communication in promoting adherence to antiretroviral drugs among pregnant women and reduction of mother-to-child transmission of HIV.