Evaluation of mHealth strategies to optimize adherence and efficacy of Option B+ prevention of mother-to-child HIV transmission: Rationale, design and methods of a 3-armed randomized controlled trial

Abstract

Background: Lifelong antiretroviral therapy (ART) (Option B+) is recommended for all HIV-infected pregnant/postpartum women, but high adherence is required to maximize HIV prevention potential and maintain maternal health. Mobile health (mHealth) interventions may provide treatment adherence support for women during, and beyond, the pregnancy and postpartum periods.

Methods and design: We are conducting an unblinded, triple-arm randomized clinical trial (Mobile WACh X) of one-way short message service (SMS) vs. two-way SMS vs. control (no SMS) to improve maternal ART adherence and retention in care by 2years postpartum. We will enroll 825 women from Nairobi and Western Kenya. Women in the intervention arms receive weekly, semi-automated motivational and educational SMS and visit reminders via an interactive, human-computer hybrid communication system. Participants in the two-way SMS arm are also asked to respond to a question related to the message. SMS are based in behavioral theory, are tailored to participant characteristics through SMS tracks, and are timed along the pregnancy/postpartum continuum. After enrollment, follow-up visits are scheduled at 6weeks; 6, 12, 18, and 24months postpartum. The primary outcomes, virological failure (HIV viral load ≥1000copies/mL), maternal retention in care, and infant HIV infection or death, will be compared in an intent to treat analysis. We will also measure ART adherence and drug resistance.

Discussion: Personalized and tailored SMS to support HIV-infected women during and after pregnancy may be an effective strategy to motivate women to adhere to ART and remain in care and improve maternal and infant outcomes.

Keywords: Adherence; Antiretroviral therapy; Pregnancy; Prevention of mother-to-child HIV transmission; SMS; mHealth.

Copyright © 2017 Elsevier Inc. All rights reserved.

Figures

Figure 1

Formative research for SMS adaptation and refinement

Figure 2

SMS message themes and tracks

Figure 3. SMS System Architecture

Women (1) receive SMS messages on Safaricom using the standard GSM/SMS protocol. The Kenyan premium service provider (3) receives SMS messages over SS7 from Safaricom (2) and forwards them to the SMS management system on a virtual private server (4). Study staff can access the SMS management system to reply to SMS from women via a laptop and mobile data (5)

Figure 4

SMS system screenshot