Abstract:
Background To improve future mobile health (mHealth) interventions in resource-limited settings, knowledge
of participants’ adherence to interactive interventions is needed, but previous studies are limited. We aimed to inves-
tigate how women in prevention of mother-to-child transmission of HIV (PMTCT) care in Kenya used, adhered to,
and evaluated an interactive text-messaging intervention.
Methods We conducted a cohort study nested within the WelTel PMTCT trial among 299 pregnant women living
with HIV aged ≥ 18 years. They received weekly text messages from their first antenatal care visit until 24 months post-
partum asking “How are you?”. They were instructed to text within 48 h stating that they were “okay” or had a “problem”.
Healthcare workers phoned non-responders and problem-responders to manage any issue. We used multivariable-
adjusted logistic and negative binomial regression to estimate adjusted odds ratios (aORs), rate ratios (aRRs) and 95% con-
fidence intervals (CIs) to assess associations between baseline characteristics and text responses. Perceptions of the inter-
vention were evaluated through interviewer-administered follow-up questionnaires at 24 months postpartum.
Results The 299 participants sent 15,183 (48%) okay-responses and 438 (1%) problem-responses. There were 16,017
(51%) instances of non-response. The proportion of non-responses increased with time and exceeded 50% around 14
months from enrolment. Most reported problems were health related (84%). Having secondary education was associ-
ated with reporting a problem (aOR:1.88; 95%CI: 1.08–3.27) compared to having primary education or less. Younger
age (18–24 years) was associated with responding to < 50% of messages (aOR:2.20; 95%CI: 1.03–4.72), compared
to being 35–44 years. Women with higher than secondary education were less likely (aOR:0.28; 95%CI: 0.13–0.64),
to respond to < 50% of messages compared to women with primary education or less. Women who had disclosed
their HIV status had a lower rate of non-response (aRR:0.77; 95%CI: 0.60–0.97). In interviews with 176 women, 167
(95%) agreed or strongly agreed that the intervention had been helpful, mainly by improving access to and commu-
nication with their healthcare providers (43Conclusion In this observational study, women of younger age, lower education, and who had not disclosed their
HIV status were less likely to adhere to interactive text-messaging. The majority of those still enrolled at the end
of the intervention reported that text-messaging had been helpful, mainly by improving access to healthcare
providers. Future mHealth interventions aiming to improve PMTCT care need to be targeted to attract the attention
of women with lower education and younger age.