Effectiveness of an SMS-based maternal mHealth intervention to improve clinical outcomes of HIV-positive pregnant women

ABSTRACT

We conducted a retrospective study to investigate the effectiveness of an mHealth messaging intervention aiming to improve maternal health and HIV outcomes. Maternal health SMSs were sent to 235 HIV-infected pregnant women twice per week in pregnancy and continued until the infant’s first birthday. The messages were timed to the stage of the pregnancy/infant age and covered maternal health and HIV-support information. Outcomes, measured as antenatal care (ANC) visits, birth outcomes and infant HIV testing, were compared to a control group of 586 HIV-infected pregnant women who received no SMS intervention. Results showed that intervention participants attended more ANC visits (5.16 vs. 3.95, p < 0.01) and were more likely to attend at least the recommended four ANC visits (relative risk (RR): 1.41, 95% confidence interval (CI): 1.15–1.72). Birth outcomes of intervention participants improved as they had an increased chance of a normal vaginal delivery (RR: 1.10, 95% CI: 1.02–1.19) and a lower risk of delivering a low-birth weight infant (<2500 g) (RR: 0.14, 95% CI: 0.02–1.07). In the intervention group, there was a trend towards higher attendance to infant polymerase chain reaction (PCR) testing within six weeks after birth (81.3% vs. 75.4%, p = 0.06) and a lower mean infant age in weeks at HIV PCR testing (9.5 weeks vs. 11.1 weeks, p = 0.14). These results add to the growing evidence that mHealth interventions can have a positive impact on health outcomes and should be scaled nationally following comprehensive evaluation.

KEYWORDS:

• HIV
• maternal health
• mHealth
• vertical infectious disease transmission
• global health

Acknowledgements

The study team would like to thank the Johannesburg Department of Health for allowing the study team to conduct the study in their facilities.

JC contributed to the study’s conception, design and performance, was the principal investigator, and is the lead author; KB contributed to the study’s performance and provided input to the manuscript; AT and VB provided strategic oversight and supervision throughout the study and provided input in the manuscript; PM and JM contributed to the study design, and provided input to the manuscript; JE contributed to the study design, data analysis and interpretation, provided strategic supervision to the study and gave significant input in the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Jesse Coleman http://orcid.org/0000-0002-3601-7854

Anna Thorson http://orcid.org/0000-0002-8703-6561

Vivian Black http://orcid.org/0000-0003-2274-8581

Patricia Mechael http://orcid.org/0000-0002-1034-0549

Jaran Eriksen http://orcid.org/0000-0003-1146-5615

Additional information

Funding

This study was funded in part by Johnson & Johnson; Vodacom Foundation; United States Agency for International Development [grant number AID-674-A-12-00004]; the European Union Horizon 2020 Sci-GaIA project [grant number 654237]; and the Swedish Foundation for Clinical Pharmacology and Pharmacotherapy.