Patient Preference and Adherence (Apr 2016)
Acceptability and feasibility of mHealth and community-based directly observed antiretroviral therapy to prevent mother-to-child HIV transmission in South African pregnant women under Option B+: an exploratory study
Abstract
Jean B Nachega,1,2 Donald Skinner,3 Larissa Jennings,4 Jessica F Magidson,5 Frederick L Altice,6 Jessica G Burke,7 Richard T Lester,8 Olalekan A Uthman,9,10 Amy R Knowlton,11 Mark F Cotton,12 Jean R Anderson,13 Gerhard B Theron14 1Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; 2Department of Medicine, Centre for Infectious Diseases, and ACTG Clinical Trial Unit (CTU)/Family Clinical Research Unit (FAMCRU), 3Research on Health and Society, Department of Interdisciplinary Health Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; 4Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 5Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 6Division of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, 7Department of Behavioral and Community Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; 8Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada; 9Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK; 10Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; 11Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 12Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; 13Department of Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; 14Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa Objective: To examine the acceptability and feasibility of mobile health (mHealth)/short message service (SMS) and community-based directly observed antiretroviral therapy (cDOT) as interventions to improve antiretroviral therapy (ART) adherence for preventing mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). Design and methods: A mixed-method approach was used. Two qualitative focus group discussions with HIV-infected pregnant women (n=20) examined the acceptability and feasibility of two ART adherence interventions for PMTCT: 1) SMS text messaging and 2) patient-nominated cDOT supporters. Additionally, 109 HIV-infected, pregnant South African women (18–30 years old) receiving PMTCT services under single-tablet antiretroviral therapy regimen during pregnancy and breastfeeding and continuing for life (“Option B+”) were interviewed about mobile phone access, SMS use, and potential treatment supporters. Setting: A community primary care clinic in Cape Town, South Africa. Participants: HIV-infected pregnant women. Main outcomes: Acceptability and feasibility of mHealth and cDOT interventions. Results: Among the 109 women interviewed, individual mobile phone access and SMS use were high (>90%), and 88.1% of women were interested in receiving SMS ART adherence support messages such as reminders, motivation, and medication updates. Nearly all women (95%) identified at least one person close to them to whom they had disclosed their HIV status and would nominate as a cDOT supporter. Focus group discussions revealed that cDOT supporters and adherence text messages were valued, but some concerns regarding supporter time availability and risk of unintended HIV status disclosure were expressed. Conclusion: mHealth and/or cDOT supporter as interventions to improve ART adherence are feasible in this setting. However, safe HIV status disclosure to treatment supporters and confidentiality of text messaging content about HIV and ART were deemed crucial. Keywords: HIV, AIDS, pregnancy, short messaging system, social support
