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Cited by 37HIV/AIDS Research and InterventionsMobile Health and mHealth ApplicationsGlobal Maternal and Child Health

An augmented SMS intervention to improve access to antenatal CD4 testing and ART initiation in HIV-infected pregnant women: a cluster randomized trial

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Dryden-Peterson, Scott, Bennett, Kara, Hughes, Michael D., Veres, Adrian, John, Oaitse, Pradhananga, Rosina, Boyer, Matthew, Brown, Carolyn +10 more·2015·PLOS ONE
DOI 10.1371/journal.pone.0117181PMC PMC4334487
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Abstract

BACKGROUND: Less than one-third of HIV-infected pregnant women eligible for combination antiretroviral therapy (ART) globally initiate treatment prior to delivery, with lack of access to timely CD4 results being a principal barrier. We evaluated the effectiveness of an SMS-based intervention to improve access to timely antenatal ART. METHODS: We conducted a stepped-wedge cluster randomized trial of a low-cost programmatic intervention in 20 antenatal clinics in Gaborone, Botswana. From July 2011-April 2012, 2 clinics were randomly selected every 4 weeks to receive an ongoing clinic-based educational intervention to improve CD4 collection and to receive CD4 results via an automated SMS platform with active patient tracing. CD4 testing before 26 weeks gestation and ART initiation before 30 weeks gestation were assessed. RESULTS: Three-hundred-sixty-six ART-naïve women were included, 189 registering for antenatal care under Intervention and 177 under Usual Care periods. Of CD4-eligible women, 100 (59.2%) women under Intervention and 79 (50.6%) women under Usual Care completed CD4 phlebotomy before 26 weeks gestation, adjusted odds ratio (aOR, adjusted for time that a clinic initiated Intervention) 0.87 (95% confidence interval [CI]0.47-1.63, P = 0.67). The SMS-based platform reduced time to clinic receipt of CD4 test result from median of 16 to 6 days (P<0.001), was appreciated by clinic staff, and was associated with reduced operational cost. However, rates of ART initiation remained low, with 56 (36.4%) women registering under Intervention versus 37 (24.2%) women under Usual Care initiating ART prior to 30 weeks gestation, aOR 1.06 (95%CI 0.53-2.13, P = 0.87). CONCLUSIONS: The augmented SMS-based intervention delivered CD4 results more rapidly and efficiently, and this type of SMS-based results delivery platform may be useful for a variety of tests and settings. However, the intervention did not appear to improve access to timely antenatal CD4 testing or ART initiation, as obstacles other than CD4 impeded ART initiation during pregnancy.

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Authors
Dryden-Peterson, S., Bennett, K., Hughes, M. D., Veres, A., John, O., Pradhananga, R., Boyer, M., Brown, C., Sakyi, B., van Widenfelt, E., Keapoletswe, K., Mine, M., Moyo, S., Asmelash, A., Siedner, M., Mmalane, M., Shapiro, R. L., & Lockman, S.
Affiliations
  • Harvard University (US)
  • Botswana Harvard AIDS Institute Partnership (BW)
  • Yale University (US)
  • Marshall University (US)
  • Johns Hopkins University (US)
  • Ministry of Health (BW)
  • Beth Israel Deaconess Medical Center (US)
  • Brigham and Women's Hospital (US)
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2015-02-18
Volume
10
Issue
2
Pages
e0117181
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0117181
PMC
PMC4334487
OpenAlex
W2105285524
Cited by
37
References
6
Citations by year
2026: 1 · 2025: 1 · 2024: 5 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 2 · 2019: 6 · 2018: 7 · 2017: 2 · 2016: 4 · 2015: 3
FWCI
4.15
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Greater South Information System
Funders
  • National Institutes of Health (3r01hd044391-06s1)
  • National Institute of Mental Health (K23MH099916)
  • National Institute of Allergy and Infectious Diseases (K23AI091434)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (3R01HD044391-06S1, R01-HD-044391)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
HIV in pregnancy, antiretroviral therapy initiation, mobile health, patient tracing, prenatal care, Botswana, HIV care access
MeSH terms
Adult, Ambulatory Care Facilities, Female, Health Services Accessibility, Humans, Pregnancy, Pregnancy Complications, Infectious, Prenatal Diagnosis, Time Factors, HIV Infections, Telemedicine, Infectious Disease Transmission, Vertical, CD4 Lymphocyte Count, Phlebotomy, Anti-HIV Agents, Text Messaging

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