August 3, 2021

Researchers study text messaging to improve retention and viral suppression in prevention of mother-to-child HIV transmission programs in Kenya

Over the years, Global WACh utilized the Mobile WACh mobile health (mHealth) system that allows for both automated sending of tailored health-related short message service (SMS) text messages and two-way SMS interaction between participants and a health care provider in low- to middle-income countries for an array of maternal-child health (MCH) research studies.  The system sends messages through mobile phones, which have the potential to enhance access and reach of crucial health service interventions and to improve health outcomes.

Researchers of the Mobile Strategies for Women’s and Children’s Health: Optimizing Adherence and Efficacy of PMTCT/ART (Mobile WACh X) randomized clinical trial, funded by the National Institute of Health and led by Principal Investigator Grace John-Stewart, adapted Mobile WACh to reach pregnant and postpartum women living with HIV at six MCH clinics in Kenya.  Previous research has shown that interactive SMS can improve early antiretroviral therapy (ART) retention in perinatal women, but it was unknown whether long-term interactive SMS systems can durably improve retention and viral suppression in preventing mother-to-child transmission (PMTCT).

The five-year long 3-arm trial compared outcomes of ART adherence and retention in care among participants receiving two-way interactive and one-way SMS messages to participants who did not receive any SMS messages.  One-way participants received tailored visit reminders and weekly messages centered on ART adherence and MCH services.  Two-way participants could message nurses as needed.

In a recent publication in PLOS Medicine, the integrated HIV/MCH messaging did not improve HIV outcomes but was associated with improved initiation of postpartum contraception.  In PMTCT programs where most women are virally suppressed, targeted SMS informed by viral load data may improve effectiveness of this intervention approach.  More rigorous evaluation is needed to optimize mHealth interventions such as Mobile WACh.

Kenyatta National Hospital researchers John Kinuthia, Daniel Matemo, and Lusi Osborn; University of Washington faculty members Keshet Ronen, Jennifer Unger, Bhavna Chohan, Alison Drake, Barbra Richardson, and Grace John-Stewart; and Research Assistants Wenwen Jiang and Trevor Perrier contributed to the publication.