Background: mHealth interventions show promise in improving ART adherence. However, mechanisms for their effect are poorly understood. We assessed participant engagement, and content of participant messages in an ongoing trial of an interactive SMS to support ART adherence among peripartum women.
Methods: Within the ongoing randomized trial of 2-way SMS vs. 1-way SMS vs. control (Mobile WAChX, NCT02400671), participants were recruited from public maternal child health (MCH) clinics in Nairobi and Nyanza region and were age ≥14, HIV-infected, pregnant and had daily access to a phone. Women received automated weekly SMS in pregnancy to 2 years postpartum. Messages addressed ART adherence and MCH care (ratio 2 adherence:1 MCH). Among women in the 2-way SMS arm, predictors of the number of SMS sent by participants per week were evaluated using univariate generalized estimating equation (GEE) with Poisson link clustered by participant. SMS adherence conversations were analyzed by content analysis.
Results: Between November 2015 and January 2018, 275 participants in the 2-way SMS arm received 15644 automated SMS. Median time in the study was 62 weeks (IQR 48-89). Median age was 27(23-31) and 196 (71.0%) owned their phone. The majority (82.9%) of women sent >1 SMS; participants sent a median of 0.41 SMS/week (IQR 0.13-0.68). Participants sent more messages during pregnancy than postpartum (0.74 SMS/week vs. 0.36 SMS/week, p< 0.0001). Engagement did not differ by phone ownership (0.50 SMS/week among phone-owners vs. 0.37 SMS/week among phone-sharers, p=0.19). Of 7718 participant messages, 1689 (21.9%) were about visit timing, 1308 (17.0%) were about ART adherence, 1283 (16.6%) about infant health and 881 (11.4%) about antenatal concerns. Of 1308 adherence SMS, 471 (36.0%) sought advice about adherence challenges while 759 (58.0%) reported no current challenges. Adherence challenges included medication side effects (114 SMS,24.2%), running out of medication (91,19.3%), infant medication administration and transmission concerns (79,16.8%), current illness (34,7.2%), clinic stock-outs (30,6.3%) and viral load and infant HIV testing (27,5.7%).
Conclusions: Engagement by SMS among HIV-infected peripartum women was high, particularly during pregnancy, and not dependent on phone ownership. Participants utilized SMS to gain advice about medication side effects and strategies for improving ART adherence for themselves and their infants.