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)

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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

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Most cited references 10

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Genetic diversity among Plasmodium falciparum field isolates in Pakistan measured with PCR genotyping of the merozoite surface protein 1 and 2

Najia Ghanchi, Andreas Mårtensson, Johan Ursing … (2010)

Background The genetic diversity of Plasmodium falciparum has been extensively studied in various parts of the world. However, limited data are available from Pakistan. This study aimed to establish molecular characterization of P. falciparum field isolates in Pakistan measured with two highly polymorphic genetic markers, i.e. the merozoite surface protein 1 (msp-1)and 2 (msp-2). Methods Between October 2005 and October 2007, 244 blood samples from patients with symptomatic blood-slide confirmed P. falciparum mono-infections attending the Aga Khan University Hospital, Karachi, or its collection units located in Sindh and Baluchistan provinces, Pakistan were collected. The genetic diversity of P. falciparum was analysed by length polymorphism following gel electrophoresis of DNA products from nested polymerase chain reactions (PCR) targeting block 2 of msp-1 and block 3 of msp-2, including their respective allelic families KI, MAD 20, RO33, and FC27, 3D7/IC. Results A total of 238/244 (98%) patients had a positive PCR outcome in at least one genetic marker; the remaining six were excluded from analysis. A majority of patients had monoclonal infections. Only 56/231 (24%) and 51/236 (22%) carried multiple P. falciparum genotypes in msp-1 and msp-2, respectively. The estimated total number of genotypes was 25 msp-1 (12 KI; 8 MAD20; 5 RO33) and 33 msp-2 (14 FC27; 19 3D7/IC). Conclusions This is the first report on molecular characterization of P. falciparum field isolates in Pakistan with regards to multiplicity of infection. The genetic diversity and allelic distribution found in this study is similar to previous reports from India and Southeast Asian countries with low malaria endemicity.

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Special delivery: an analysis of mHealth in maternal and newborn health programs and their outcomes around the world.

Tigest Tamrat, Stan Kachnowski (2012)

Mobile health (mHealth) encompasses the use of mobile telecommunication and multimedia into increasingly mobile and wireless health care delivery systems and has the potential to improve tens of thousands of lives each year. The ubiquity and penetration of mobile phones presents the opportunity to leverage mHealth for maternal and newborn care, particularly in under-resourced health ecosystems. Moreover, the slow progress and funding constraints in attaining the Millennium Development Goals for child and maternal health encourage harnessing innovative measures, such as mHealth, to address these public health priorities. This literature review provides a schematic overview of the outcomes, barriers, and strategies of integrating mHealth to improve prenatal and neonatal health outcomes. Six electronic databases were methodically searched using predetermined search terms. Retrieved articles were then categorized according to themes identified in previous studies. A total of 34 articles and reports contributed to the findings with information about the use and limitations of mHealth for prenatal and neonatal healthcare access and delivery. Health systems have implemented mHealth programs to facilitate emergency medical responses, point-of-care support, health promotion and data collection. However, the policy infrastructure for funding, coordinating and guiding the sustainable adoption of prenatal and neonatal mHealth services remains under-developed. The integration of mobile health for prenatal and newborn health services has demonstrated positive outcomes, but the sustainability and scalability of operations requires further feedback from and evaluation of ongoing programs.

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Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection

(2013)

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Author and article information

Contributors

Patricia Opondo Awiti: Patricia.Awiti@ki.se

Alessandra Grotta: Alessandra.Grotta@ki.se

Mia van der Kop: miavanderkop@gmail.com

John Dusabe: John.Dusabe@ki.se

Anna Thorson: Anna.Thorson@ki.se

Jonathan Mwangi: jonathanmwangi@gmail.com

Rino Belloco: Rino.Belloco@ki.se

Richard Lester: rlester.id@gmail.com

Laura Ternent: laura.ternent@newcastle.ac.uk

Edwin Were: eowere@gmail.com

Anna Mia Ekström: Anna.Mia.Ekstrom@ki.se

Journal

Journal ID (nlm-ta): BMC Med Inform Decis Mak

Journal ID (iso-abbrev): BMC Med Inform Decis Mak

Title: BMC Medical Informatics and Decision Making

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6947

Publication date (Electronic): 11 July 2016

Publication date PMC-release: 11 July 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 86

Affiliations

[ ]Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden

[ ]Department of Medical Epidemiology and Statistics, Karolinska Institutet, 171 77 Stockholm, Sweden

[ ]Division of Infectious diseases, University of British Columbia, Vancouver, Canada

[ ]Division of Global Health, University of British Columbia, Vancouver, Canada

[ ]Department of Public Health Sciences, 171 77 Stockholm, Sweden

[ ]Department of Medicine, University of British Columbia, Vancouver, Canada

[ ]Newcastle University, Tyne and Wear, NE1 7RU UK

[ ]Department of Reproductive Health, Moi University, P.O.BOX 3900–30100, Eldoret, Kenya

Article

Publisher ID: 321

DOI: 10.1186/s12911-016-0321-4

PMC ID: 4940723

PubMed ID: 27401475

SO-VID: 907c5258-8764-41b7-86d8-27ec38b92105

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 13 January 2016

Date accepted : 8 June 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004359, Vetenskapsrådet;

Award ID: C0288601

Award Recipient : Anna Mia Ekström

Custom metadata

ScienceOpen disciplines: Bioinformatics & Computational biology

Keywords: mobile health (m-health),retention,hiv/pmtct,antiretroviral therapy (art),kenya

Data availability:

ScienceOpen disciplines: Bioinformatics & Computational biology

Keywords: mobile health (m-health), retention, hiv/pmtct, antiretroviral therapy (art), kenya

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)

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Abstract

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Trial registration

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Most cited references 10

Genetic diversity among Plasmodium falciparum field isolates in Pakistan measured with PCR genotyping of the merozoite surface protein 1 and 2

Special delivery: an analysis of mHealth in maternal and newborn health programs and their outcomes around the world.

Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection

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