You Will Know That Despite Being HIV Positive You Are Not Alone: Qualitative Study to Inform Content of a Text Messaging Intervention to Improve Prevention of Mother-to-Child HIV Transmission

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Abstract

Background

Prevention of mother-to-child HIV transmission (PMTCT) relies on long-term adherence to antiretroviral therapy (ART). Mobile health approaches, such as text messaging (short message service, SMS), may improve adherence in some clinical contexts, but it is unclear what SMS content is desired to improve PMTCT-ART adherence.

Objective

We aimed to explore the SMS content preferences related to engagement in PMTCT care among women, male partners, and health care workers. The message content was used to inform an ongoing randomized trial to enhance the PMTCT-ART adherence.

Methods

We conducted 10 focus group discussions with 87 HIV-infected pregnant or postpartum women and semistructured individual interviews with 15 male partners of HIV-infected women and 30 health care workers from HIV and maternal child health clinics in Kenya. All interviews were recorded, translated, and transcribed. We analyzed transcripts using deductive and inductive approaches to characterize women’s, partners’, and health care workers’ perceptions of text message content.

Results

All women and male partners, and most health care workers viewed text messages as a useful strategy to improve engagement in PMTCT care. Women desired messages spanning 3 distinct content domains: (1) educational messages on PMTCT and maternal child health, (2) reminder messages regarding clinic visits and adherence, and (3) encouraging messages that provide emotional support. While all groups valued reminder and educational messages, women highlighted emotional support more than the other groups (partners or health care workers). In addition, women felt that encouraging messages would assist with acceptance of their HIV status, support disclosure, improve patient-provider relationship, and provide support for HIV-related challenges. All 3 groups valued not only messages to support PMTCT or HIV care but also messages that addressed general maternal child health topics, stressing that both HIV- and maternal child health–related messages should be part of an SMS system for PMTCT.

Conclusions

Women, male partners, and health care workers endorsed SMS text messaging as a strategy to improve PMTCT and maternal child health outcomes. Our results highlight the specific ways in which text messaging can encourage and support HIV-infected women in PMTCT to remain in care, adhere to treatment, and care for themselves and their children.

Trial Registration

ClinicalTrials.gov NCT02400671; https://clinicaltrials.gov/ct2/show/NCT02400671 (Archived by WebCite at http://www.webcitation.org/70W7SVIVJ)

Related collections

Most cited references 21

Record: found
Abstract: found
Article: not found

Depression and adherence to antiretroviral therapy in low-, middle- and high-income countries: a systematic review and meta-analysis.

Olalekan A Uthman, Jessica Magidson, Steven Safren … (2014)

We investigated the associations between depressive symptoms and adherence to antiretroviral therapy (ART) among people living with HIV (PLHIV). We searched the PubMed, EMBASE and Cochrane CENTRAL databases for studies that reported an association between depression and adherence to ART as a primary or secondary outcome. We used a random-effect model to pool the risk estimates from the individual studies. The odds ratio (OR) with their 95 % CIs were used as summary estimates. Of 2861 citations, 111 studies that recruited 42,366 PLHIV met our inclusion criteria. When reported, the rate of PLHIV with depressive symptoms ranged from 12.8 to 78 % and the proportion of PLHIV who achieved good adherence (≥ 80 %) ranged from 20 to 98 %. There were no significant differences in rate of depressive symptoms in PLHIV by country income group; however, the proportion of PLHIV who achieved good adherence was significantly higher in lower-income countries (as defined in the 2012 World Bank Country Income Groups) (pooled rate=86 %) compared to higher-income countries (pooled rate=67.5 %; p< .05). We found that the likelihood of achieving good ART adherence was 42 % lower among those with depressive symptoms compared to those without (pooled OR=0.58, 95 % CI 0.55 to 0.62). The relationship between depressive symptoms and adherence to ART was consistent across the country's income group, study design and adherence rates. We found that the magnitude of the association significantly decreases with more recent publications and increasing study sample size. The higher the prevalence of depressive symptoms of PLHIV recruited in the studies, the lower the likelihood of achieving good adherence to ART. In conclusion, the likelihood of achieving good adherence was lower among those with depressive symptoms compared to those without.

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Record: found
Abstract: found
Article: not found

"What they wanted was to give birth; nothing else": barriers to retention in option B+ HIV care among postpartum women in South Africa.

Kate Clouse, Sheree Schwartz, Annelies van Rie … (2014)

Women initiating antiretroviral therapy during pregnancy have high rates of dropout, particularly after delivery. We aimed to identify challenges to postpartum retention in care under Option B+, which expands antiretroviral therapy access to all HIV-positive pregnant women regardless of CD4 count.

0 comments Cited 85 times – based on 0 reviews      Review now

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Record: found
Abstract: found
Article: not found

Health Behavior Change Models for HIV Prevention and AIDS Care: Practical Recommendations for a Multi-Level Approach

Michelle Kaufman, Flora Cornish, Rick S Zimmerman … (2014)

Abstract: Despite increasing recent emphasis on the social and structural determinants of HIV-related behavior, empirical research and interventions lag behind, partly because of the complexity of social–structural approaches. This article provides a comprehensive and practical review of the diverse literature on multi-level approaches to HIV-related behavior change in the interest of contributing to the ongoing shift to more holistic theory, research, and practice. It has the following specific aims: (1) to provide a comprehensive list of relevant variables/factors related to behavior change at all points on the individual–structural spectrum, (2) to map out and compare the characteristics of important recent multi-level models, (3) to reflect on the challenges of operating with such complex theoretical tools, and (4) to identify next steps and make actionable recommendations. Using a multi-level approach implies incorporating increasing numbers of variables and increasingly context-specific mechanisms, overall producing greater intricacies. We conclude with recommendations on how best to respond to this complexity, which include: using formative research and interdisciplinary collaboration to select the most appropriate levels and variables in a given context; measuring social and institutional variables at the appropriate level to ensure meaningful assessments of multiple levels are made; and conceptualizing intervention and research with reference to theoretical models and mechanisms to facilitate transferability, sustainability, and scalability.

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Author and article information

Contributors

Keshet Ronen:

Department of Global HealthUniversity of Washington325 9th AvenueSeattle, WA, 98104United States1 206 685 43631 206 543 4818keshet@uw.edu

ORCID: http://orcid.org/0000-0001-5625-4884

Journal

Journal ID (nlm-ta): JMIR Mhealth Uhealth

Journal ID (iso-abbrev): JMIR Mhealth Uhealth

Journal ID (publisher-id): JMU

Title: JMIR mHealth and uHealth

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2291-5222

Publication date Collection: July 2018

Publication date (Electronic): 19 July 2018

Volume: 6

Issue: 7

Electronic Location Identifier: e10671

Affiliations

[1] ¹ Department of Global Health University of Washington Seattle, WA United States

[2] ² Kenyatta National Hospital Nairobi Kenya

[3] ³ Department of Obstetrics and Gynecology University of Washington Seattle, WA United States

[4] ⁴ Department of Obstetrics and Gynecology University of Nairobi Nairobi Kenya

[5] ⁵ Department of Epidemiology University of Washington Seattle, WA United States

[6] ⁶ Department of Pediatrics University of Washington Seattle, WA United States

[7] ⁷ Department of Medicine University of Washington Seattle, WA United States

Author notes

Corresponding Author: Keshet Ronen keshet@ 123456uw.edu

Author information

Jade Fairbanks http://orcid.org/0000-0001-9606-6757

Kristin Beima-Sofie http://orcid.org/0000-0002-3408-7410

Pamela Akinyi http://orcid.org/0000-0001-6788-5964

Daniel Matemo http://orcid.org/0000-0002-7209-1648

Jennifer A Unger http://orcid.org/0000-0002-6317-226X

John Kinuthia http://orcid.org/0000-0001-6571-8927

Gabrielle O'Malley http://orcid.org/0000-0002-7514-8240

Alison L Drake http://orcid.org/0000-0002-4178-7706

Grace John-Stewart http://orcid.org/0000-0002-4301-1573

Keshet Ronen http://orcid.org/0000-0001-5625-4884

Article

Publisher ID: v6i7e10671

DOI: 10.2196/10671

PMC ID: 6072973

PubMed ID: 30026177

SO-VID: d0d76d42-4e98-41b2-a24e-13ecbd2a2106

Copyright © ©Jade Fairbanks, Kristin Beima-Sofie, Pamela Akinyi, Daniel Matemo, Jennifer A Unger, John Kinuthia, Gabrielle O'Malley, Alison L Drake, Grace John-Stewart, Keshet Ronen. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 19.07.2018.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

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