Use of mobile phones and text messaging to decrease the turnaround time for early infant HIV diagnosis and notification in rural Zambia: an observational study

Catherine G Sutcliffe,Philip E Thuma,William J Moss,Janneke H Van Dijk,Kathy Sinywimaanzi,Sydney Mweetwa,Mutinta Hamahuwa

doi:10.1186/s12887-017-0822-z

Catherine G Sutcliffe, Philip E Thuma + Show 5 more

Open Access

https://doi.org/10.1186/s12887-017-0822-z

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Abstract

BackgroundEarly infant diagnosis of HIV infection is challenging in rural sub-Saharan Africa as blood samples are sent to central laboratories for HIV DNA testing, leading to delays in diagnosis and treatment initiation. Simple technologies to rapidly deliver results to clinics and notify mothers of test results would decrease many of these delays. The feasibility of using mobile phones to contact mothers was evaluated. In addition, the first two years of implementation of a national short message service (SMS) reporting system to deliver test results from the laboratory to the clinic were evaluated.MethodsThe study was conducted in Macha, Zambia from 2013 to 2015 among mothers of HIV-exposed infants. Mothers were interviewed about mobile phone use and willingness to be contacted directly or through their rural health center. Mothers were contacted according to their preferred method of communication when test results were available. Mothers of positive infants were asked to return to the clinic as soon as possible. Dates of sample collection, delivery of test results to the clinic and notification of mothers were documented in addition to test results.ResultsFour hundred nineteen mothers and infants were enrolled. Only 30% of mothers had ever used a mobile phone. 96% of mobile phone owners were reached by study staff and 98% of mothers without mobile phones were contacted through their rural health center. Turnaround times for mothers of positive infants were approximately 2 weeks shorter than for mothers of negative infants. Delivery of test results by the national SMS system improved from 2013 to 2014, with increases in the availability of texted results (38 vs. 91%) and arrival of the texted result prior to the hardcopy report (27 vs. 83%). Texted results arriving at the clinic before the hardcopy were received a median of 19 days earlier. Four discrepancies between texted and hardcopy results were identified out of 340 tests.ConclusionsMobile phone and text messaging technology has the potential to improve early infant diagnosis but challenges to widespread implementation need to be addressed, including low mobile phone ownership, use and coverage in rural areas.

Highlights

Infant diagnosis of Human immunodeficiency virus (HIV) infection is challenging in rural sub-Saharan Africa as blood samples are sent to central laboratories for HIV Deoxyribonucleic acid (DNA) testing, leading to delays in diagnosis and treatment initiation
Diagnosis of HIV infection in early infancy is difficult in sub-Saharan Africa, as assays based on HIV DNA or Ribonucleic acid (RNA) detection must be used rather than the serologic assays used in older children and adults [2]
The objective of this study was to evaluate the use of mobile phones in rural Zambia to improve the process of early infant diagnosis

Summary

Introduction

Infant diagnosis of HIV infection is challenging in rural sub-Saharan Africa as blood samples are sent to central laboratories for HIV DNA testing, leading to delays in diagnosis and treatment initiation. Diagnosis of HIV infection in early infancy is difficult in sub-Saharan Africa, as assays based on HIV DNA or RNA detection must be used rather than the serologic assays used in older children and adults [2] These assays require a high level of technology, training and cost, and are primarily available in major urban areas. HIV clinics in rural areas, where many HIV-exposed and infected infants reside, must transport specimens to central laboratories This can result in a delay in diagnosis as specimens and test results must be transported from and to the HIV clinics and disclosed to the mother at their clinic appointment. In rural Zambia, the median time from sample collection to disclosure of results to the mother was 92 days and delays were identified in returning results from the lab to the clinic and from the clinic to the caregiver [7]

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