Abstract:
Background:
Improving retention in prevention of mother to
childtransmission(PMTCT)ofHIVprogramsis
critical to optimize maternal and infant health outcome
s, 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
