Use of text
messaging significantly improved the rate of early infant diagnosis (EID) among
HIV-positive pregnant women enrolled in a prevention of mother-to-child
transmission (PMTCT) programme in Kenya, researchers reported in a poster at the
7th International AIDS Society Conference on HIV Pathogenesis, Treatment and
Prevention last week in Kuala Lumpur,
randomised controlled trial, postpartum retention also improved significantly in
the intervention group compared to the control group: 19.6% (38/194) and 11.8%
(22/187) respectively, yet the overall proportion of women attending remained
availability of effective antiretroviral treatment (ART) for prevention of
mother-to-child transmission and expansion of ART and access to PMTCT services
in many countries in sub-Saharan Africa has resulted in considerable declines
in transmission rates. For example, Botswana and South Africa have reduced
transmission rates to under 5%; without any intervention, transmission rates
would range between 25 and 40%.
better access to ART, PMTCT services are still under used. For PMTCT services to
be effective, an integrated continuum of care comprising maternal counselling
and testing, CD4 count to determine ART eligibility, starting and monitoring
ART, care at labour and delivery, infant ART and cotrimoxazole prophylaxis,
early infant diagnosis (EID) and ART for HIV-positive infants are all needed.
numbers of children in need of ART and getting it have increased. Yet, in most
resource-poor settings, only three-in-ten children eligible for ART are getting
often diagnosed late in pregnancy – maternal diagnosis is the key to access to
PMTCT services and prevention of new paediatric HIV infections. Yet only an
estimated 35% of pregnant women in low- and middle-income countries get an HIV
EID is a key step
to linking children born to HIV-positive mothers to care and treatment, so
reducing death and disease. Retaining mothers and their infants in care, especially after birth, is a singularly critical issue. Studies have reported loss-to-follow-up
(LTFU) from PMTCT programmes ranging from 43% to as high as 75%.
the latest UNAIDS progress report, only four countries – Namibia, South Africa,
Swaziland and Zambia – provided EID to over 50% of children born to HIV-positive
women. Five – Angola, Chad, the Democratic Republic of Congo, Malawi and Nigeria – had coverage under 10%.
researchers wanted to see whether interactive text messaging would improve rates
of clinic attendance and early infant diagnosis.
pregnant women over 18 years of age enrolled in a PMTCT programme were
randomised to receive either SMS text messages (195) or the usual care (193).
developed according to the constructs of the Health Belief Model:
susceptibility – an individual’s assessment of the risk of the medical
consequences of not attending clinic and infant not being tested.
severity – individual’s assessment of seriousness of this and consequences.
barriers – an individual's assessment of the influences that
facilitate or discourage adoption of the promoted behaviour.
benefits - an individual's assessment of the positive
consequences of adopting the behavior.
gestational age those in the SMS group received up to eight text messages before
delivery and six after. Primary outcomes were maternal attendance at the clinic
after giving birth and infant HIV testing by DNA PCR by eight weeks after birth.
In total, there were outcome data for 381 (98.2%)
women, with a median age of 27 years. At baseline, median
gestational age was 34 weeks (IQR: 32-36).
Close to 20%
(38/194) of those in the SMS group attended a maternal postpartum clinic,
compared to 11.8% (22/187) in the control. Those in the control group had over
one and half times the increased risk of not attending clinic after giving
birth, RR 1.66, 95% CI: 1.02-2.70.
Altogether, 92% (172/187) of infants in the SMS group were tested within eight weeks, compared to 85.1% (154/181)
in the control group, RR, 1.08, 95% CI: 1.00-1.16.
another randomised controlled trial, researchers found a structured series of
SMS reminders sent to HIV-positive pregnant women, followed for twelve months while
attending five clinics in Maputo Province (one urban, two peri-urban and two rural),
resulted in a significant uptake of EID at eight weeks, 77.1% compared to
Of the 1012
HIV-positive pregnant women interviewed, 490 (47%) were ineligible: either they
did not own a cell phone (35%) or they were illiterate (21%). Of the 468 births
(90%), only 315 infants were followed up until eight weeks.
births in peri-urban sites also increased significantly, compared to the control
group, at 97 and 88%, p=0.018, respectively.
getting SMS reminders whose child was born anywhere other than at the study centres were more
likely to bring their infants for EID: 75% compared to 38%, p=0.034.
findings lend further support to mobile technology as a cost-effective, easily
accessible tool with a potential for increased adherence and improved EID. In addition, the researchers from the Maputo
study highlight the need for more research into how best to reach rural,
illiterate women with such health interventions.