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The effect of an interactive weekly mobile phone messaging on retention in prevention of mother to child transmission (PMTCT) of HIV program: study protocol for a randomized controlled trial (WELTEL PMTCT).

Awiti PO, Grotta A, van der Kop M, Dusabe J, Thorson A, Mwangi J, Belloco R, Lester R, Ternent L, Were E, Ekström AM - BMC Med Inform Decis Mak (2016)

Bottom Line: The aim of this study is to determine the effect of the WelTel SMS intervention compared to standard care on retention in PMTCT program in Kenya.The primary outcome will be retention in care defined as the proportion of mother-infant pairs coming for infant HIV testing at 24 months from delivery.Secondary outcomes include a) adherence to WelTel; (b) adherence to antiretroviral medicine; (c) acceptance of WelTel and (d) cost-effectiveness of the WelTel intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden. Patricia.Awiti@ki.se.

ABSTRACT

Background: Improving retention in prevention of mother to child transmission (PMTCT) of HIV programs is critical to optimize maternal and infant health outcomes, especially now that lifelong treatment is immediate regardless of CD4 cell count). The WelTel strategy of using weekly short message service (SMS) to engage patients in care in Kenya, where mobile coverage even in poor areas is widespread has been shown to improve adherence to antiretroviral therapy (ART) and viral load suppression among those on ART. The aim of this study is to determine the effect of the WelTel SMS intervention compared to standard care on retention in PMTCT program in Kenya.

Methods: WelTel PMTCT is a four to seven-centers, two-arm open randomized controlled trial (RCT) that will be conducted in urban and rural Kenya. Over 36 months, we plan to recruit 600 pregnant women at their first antenatal care visit and follow the mother-infant pair until they are discharged from the PMTCT program (when infant is aged 24 months). Participants will be randomly allocated to the intervention or control arm (standard care) at a 1:1 ratio. Intervention arm participants will receive an interactive weekly SMS 'How are you?' to which they are supposed to respond within 24 h. Depending on the response (ok, problem or no answer), a PMTCT nurse will follow-up and triage any problems that are identified. The primary outcome will be retention in care defined as the proportion of mother-infant pairs coming for infant HIV testing at 24 months from delivery. Secondary outcomes include a) adherence to WelTel; (b) adherence to antiretroviral medicine; (c) acceptance of WelTel and (d) cost-effectiveness of the WelTel intervention.

Discussion: This trial will provide evidence on the effectiveness of mHealth for PMTCT retention. Trial results and the cost-effectiveness evaluation will be used to inform policy and potential scale-up of mHealth among mothers living with HIV.

Trial registration: ISRCTN98818734 ; registered on 9th December 2014.

No MeSH data available.


Related in: MedlinePlus

WelTel SMS intervention
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Fig2: WelTel SMS intervention

Mentions: Participants in the intervention group will register their phone numbers in the WelTel system (online or via SMS) and then receive a weekly short text message question in Kiswahili “Mambo?” (Kiswahili for “How are you?”) asking about their general wellbeing (Fig. 2). The message will be sent on a fixed day of the week and will allow the patient to respond within 24 h either that they are well for example “ok” or “sawa” or that they have a problem (for example “problem” or “shida”). A female study coordinator will be in charge of centrally monitoring the WelTel SMS platform, which automatically sends the messages and registers responses from the participants and categorizes them. All participants who respond “problem” or who do not respond will be directly linked to a regular PMTCT nurse at the woman’s clinic to assist with identified problems. Problems that cannot be immediately resolved by the nurse follow routine procedures at the clinic and are normally referred to the PMTCT clinical officer at the respective facility who will then decide if the patient needs to visit the facility or should receive a follow up phone call. The study coordinator will follow up with the respective PMTCT nurses to record action taken, which is entered directly into the WelTel platform logs as notes. Patients who will not respond to the SMS within 24 h will be traced (first by telephone then at households) within the defaulter tracing outreach program in routine PMTCT care. At enrollment, the participants will be informed that the weekly SMS support service does not replace routine clinic services, and that all appointments made by PMTCT staff should be honored and all emergencies should be handled by usual means. A WelTel SMS platform technician will handle all technical problems that may arise.Fig. 2


The effect of an interactive weekly mobile phone messaging on retention in prevention of mother to child transmission (PMTCT) of HIV program: study protocol for a randomized controlled trial (WELTEL PMTCT).

Awiti PO, Grotta A, van der Kop M, Dusabe J, Thorson A, Mwangi J, Belloco R, Lester R, Ternent L, Were E, Ekström AM - BMC Med Inform Decis Mak (2016)

WelTel SMS intervention
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940723&req=5

Fig2: WelTel SMS intervention
Mentions: Participants in the intervention group will register their phone numbers in the WelTel system (online or via SMS) and then receive a weekly short text message question in Kiswahili “Mambo?” (Kiswahili for “How are you?”) asking about their general wellbeing (Fig. 2). The message will be sent on a fixed day of the week and will allow the patient to respond within 24 h either that they are well for example “ok” or “sawa” or that they have a problem (for example “problem” or “shida”). A female study coordinator will be in charge of centrally monitoring the WelTel SMS platform, which automatically sends the messages and registers responses from the participants and categorizes them. All participants who respond “problem” or who do not respond will be directly linked to a regular PMTCT nurse at the woman’s clinic to assist with identified problems. Problems that cannot be immediately resolved by the nurse follow routine procedures at the clinic and are normally referred to the PMTCT clinical officer at the respective facility who will then decide if the patient needs to visit the facility or should receive a follow up phone call. The study coordinator will follow up with the respective PMTCT nurses to record action taken, which is entered directly into the WelTel platform logs as notes. Patients who will not respond to the SMS within 24 h will be traced (first by telephone then at households) within the defaulter tracing outreach program in routine PMTCT care. At enrollment, the participants will be informed that the weekly SMS support service does not replace routine clinic services, and that all appointments made by PMTCT staff should be honored and all emergencies should be handled by usual means. A WelTel SMS platform technician will handle all technical problems that may arise.Fig. 2

Bottom Line: The aim of this study is to determine the effect of the WelTel SMS intervention compared to standard care on retention in PMTCT program in Kenya.The primary outcome will be retention in care defined as the proportion of mother-infant pairs coming for infant HIV testing at 24 months from delivery.Secondary outcomes include a) adherence to WelTel; (b) adherence to antiretroviral medicine; (c) acceptance of WelTel and (d) cost-effectiveness of the WelTel intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden. Patricia.Awiti@ki.se.

ABSTRACT

Background: Improving retention in prevention of mother to child transmission (PMTCT) of HIV programs is critical to optimize maternal and infant health outcomes, especially now that lifelong treatment is immediate regardless of CD4 cell count). The WelTel strategy of using weekly short message service (SMS) to engage patients in care in Kenya, where mobile coverage even in poor areas is widespread has been shown to improve adherence to antiretroviral therapy (ART) and viral load suppression among those on ART. The aim of this study is to determine the effect of the WelTel SMS intervention compared to standard care on retention in PMTCT program in Kenya.

Methods: WelTel PMTCT is a four to seven-centers, two-arm open randomized controlled trial (RCT) that will be conducted in urban and rural Kenya. Over 36 months, we plan to recruit 600 pregnant women at their first antenatal care visit and follow the mother-infant pair until they are discharged from the PMTCT program (when infant is aged 24 months). Participants will be randomly allocated to the intervention or control arm (standard care) at a 1:1 ratio. Intervention arm participants will receive an interactive weekly SMS 'How are you?' to which they are supposed to respond within 24 h. Depending on the response (ok, problem or no answer), a PMTCT nurse will follow-up and triage any problems that are identified. The primary outcome will be retention in care defined as the proportion of mother-infant pairs coming for infant HIV testing at 24 months from delivery. Secondary outcomes include a) adherence to WelTel; (b) adherence to antiretroviral medicine; (c) acceptance of WelTel and (d) cost-effectiveness of the WelTel intervention.

Discussion: This trial will provide evidence on the effectiveness of mHealth for PMTCT retention. Trial results and the cost-effectiveness evaluation will be used to inform policy and potential scale-up of mHealth among mothers living with HIV.

Trial registration: ISRCTN98818734 ; registered on 9th December 2014.

No MeSH data available.


Related in: MedlinePlus