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      Two-Way Short Message Service (SMS) Communication May Increase Pre-Exposure Prophylaxis Continuation and Adherence Among Pregnant and Postpartum Women in Kenya

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          Abstract

          We evaluated a 2-way short messaging service (SMS) communication platform to improve continuation of pre-exposure prophylaxis (PrEP) for HIV prevention among Kenyan pregnant and postpartum women who initiated PrEP within routine maternal child health and family planning clinics. SMS increased support for PrEP, provided opportunities for dialogue beyond the clinic, and enabled women to ask and receive answers in real-time, which facilitated continued PrEP use.

          Abstract

          We evaluated a 2-way short messaging service (SMS) communication platform to improve continuation of pre-exposure prophylaxis (PrEP) for HIV prevention among Kenyan pregnant and postpartum women who initiated PrEP within routine maternal child health and family planning clinics. SMS increased support for PrEP, provided opportunities for dialogue beyond the clinic, and enabled women to ask and receive answers in real-time, which facilitated continued PrEP use.

          ABSTRACT

          Introduction:

          We evaluated a 2-way short message service (SMS) communication platform to improve continuation of pre-exposure prophylaxis (PrEP) for HIV prevention among Kenyan women who initiated PrEP within routine maternal child health (MCH) and family planning clinics.

          Methods:

          We adapted an existing SMS platform (Mobile WACh [mWACh]) to send PrEP-tailored, theory-based SMS and allow clients to communicate with a remote nurse. Women who did not have HIV and who were initiating PrEP at 2 MCH/family planning clinics in Kisumu County, Kenya, from February to October 2018, were offered enrollment into the mWACh-PrEP program; SMS communication was free. We evaluated acceptability, satisfaction, and implementation metrics. In a pre/postevaluation, we compared PrEP continuation at 1-month postinitiation among women who initiated PrEP in the period before (n=166) versus after mWACh-PrEP implementation, adjusting for baseline differences.

          Results:

          Of the 334 women who were screened for enrollment into the mWACh-PrEP program; 193 (58%) were eligible and of those, 190 (98%) accepted enrollment. Reasons for ineligibility (n=141) included no phone access (29%) and shared SIM cards (25%). Median age was 25 years (interquartile range=22–30), and 91% were MCH clients. Compared to women who initiated PrEP in the month before mWACh-PrEP implementation, women who enrolled in mWACh-PrEP were more likely to return for their first PrEP follow-up visit (40% vs. 53%; adjusted risk ratio [aRR]=1.26; 95% confidence interval [CI]= 1.06, 1.50; P=.008) and more likely to continue PrEP (22% vs. 43%; aRR=1.75; 95% CI=1.21, 2.55; P=.003). Among those who returned, 99% reported successful receipt of SMS through the mWACh-PrEP system and 94% reported that mWACh-PrEP helped them understand PrEP better. Concerns about PrEP use, how it works, and side effects accounted for the majority (80%) of issues raised by participants using SMS.

          Conclusions:

          Two-way SMS expanded support for PrEP and opportunities for dialogue beyond the clinic and enabled women to ask and receive answers in real time regarding PrEP, which facilitated its continued use.

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          Most cited references27

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          The Contribution of Maternal HIV Seroconversion During Late Pregnancy and Breastfeeding to Mother-to-Child Transmission of HIV

          The prevention of mother-to-child transmission (PMTCT) of HIV has been focused mainly on women who are HIV positive at their first antenatal visit, but there is uncertainty regarding the contribution to overall transmission from mothers who seroconvert after their first antenatal visit and before weaning. A mathematical model was developed to simulate changes in mother-to-child transmission of HIV over time, in South Africa. The model allows for changes in infant feeding practices as infants age, temporal changes in the provision of antiretroviral prophylaxis and counseling on infant feeding, as well as temporal changes in maternal HIV prevalence and incidence. The proportion of mother-to-child transmission (MTCT) from mothers who seroconverted after their first antenatal visit was 26% [95% confidence interval (CI): 22% to 30%] in 2008, or 15,000 of 57,000 infections. It is estimated that by 2014, total MTCT will reduce to 39,000 per annum, and transmission from mothers seroconverting after their first antenatal visit will reduce to 13,000 per annum, accounting for 34% (95% CI: 29% to 39%) of MTCT. If maternal HIV incidence during late pregnancy and breastfeeding were reduced by 50% after 2010, and HIV screening were repeated in late pregnancy and at 6-week immunization visits after 2010, the average annual number of MTCT cases over the 2010-2015 period would reduce by 28% (95% CI: 25% to 31%), from 39,000 to 28,000 per annum. Maternal seroconversion during late pregnancy and breastfeeding contributes significantly to the pediatric HIV burden and needs greater attention in the planning of prevention of MTCT programs.
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            Estimation of prevalence rate ratios for cross sectional data: an example in occupational epidemiology.

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              • Abstract: found
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              HIV acquisition during pregnancy and postpartum is associated with genital infections and partnership characteristics.

              The objective of this study is to determine the risk and cofactors for HIV acquisition during pregnancy and postpartum.
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                Author and article information

                Journal
                Glob Health Sci Pract
                Glob Health Sci Pract
                ghsp
                ghsp
                Global Health: Science and Practice
                Global Health: Science and Practice
                2169-575X
                30 March 2020
                30 March 2020
                : 8
                : 1
                : 55-67
                Affiliations
                [a ]Department of Global Health, University of Washington , Seattle, Washington, USA.
                [b ]Department of Biobehavioral Nursing and Health Informatics, University of Washington , Seattle, WA, USA.
                [c ]Department of Obstetrics/Gynecology, Kenyatta National Hospital , Nairobi, Kenya.
                [d ]Department of Epidemiology, University of Washington , Seattle, Washington, USA.
                [e ]Department of Medicine, University of Washington , Seattle, Washington, USA.
                [f ]Department of Pediatrics, University of Washington , Seattle, Washington, USA.
                [g ]Department of Obstetrics/Gynecology, University of Washington , Seattle, Washington, USA.
                Author notes
                Correspondence to: Jillian Pintye ( jpintye@ 123456uw.edu ).
                Article
                GHSP-D-19-00347
                10.9745/GHSP-D-19-00347
                7108943
                32139420
                fbe6cc3f-4c18-49b0-b54a-20d198c219ff
                © Pintye et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-19-00347

                History
                : 8 October 2019
                : 5 February 2020
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