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Randomized Controlled Trial
. 2015 Feb 18;10(2):e0117181.
doi: 10.1371/journal.pone.0117181. eCollection 2015.

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

Scott Dryden-Peterson  1 , Kara Bennett  2 , Michael D Hughes  3 , Adrian Veres  4 , Oaitse John  5 , Rosina Pradhananga  6 , Matthew Boyer  7 , Carolyn Brown  8 , Bright Sakyi  9 , Erik van Widenfelt  5 , Koona Keapoletswe  9 , Madisa Mine  9 , Sikhulile Moyo  5 , Aida Asmelash  5 , Mark Siedner  10 , Mompati Mmalane  5 , Roger L Shapiro  11 , Shahin Lockman  1
Affiliations
Randomized Controlled Trial

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

Scott Dryden-Peterson et al. PLoS One. .

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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Conflict of interest statement

Competing Interests: The authors have read the journal’s policy. M.D.H. was previously a paid member of Data and Safety Monitoring Boards for Boehringer Ingelheim, Medicines Development, Pfizer and Tibotec. The remaining authors have declared that no competing interests exist. K.B. is the sole proprietor of Bennett Statistical Consulting, Inc. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Abstraction, eligibility, and analysis.
Women could have more than one reason for ineligibility for the analysis.
Fig 2
Fig 2. Stepped-wedge implementation of the intervention by study period.
Fig 3
Fig 3. Mobile SMS printer in use.
Printer is installed in an exam room of a study antenatal clinic.
See this image and copyright information in PMC

References

    1. World Health Organization, UNAIDS, UNICEF (2009) Towards universal access: scaling up priority HIV/AIDS interventions in the health sector: progress report, November 2009. Geneva: World Health Organization, UNAIDS, UNICEF;
    1. Shapiro RL, Hughes MD, Ogwu A, Kitch D, Lockman S, et al. (2010) Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med 362: 2282–2294. 10.1056/NEJMoa0907736 - DOI - PMC - PubMed
    1. Chasela CS, Hudgens MG, Jamieson DJ, Kayira D, Hosseinipour MC, et al. (2010) Maternal or infant antiretroviral drugs to reduce HIV-1 transmission. N Engl J Med 362: 2271–2281. 10.1056/NEJMoa0911486 - DOI - PMC - PubMed
    1. Kesho Bora Study G, de Vincenzi I (2011) Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. Lancet Infect Dis 11: 171–180. 10.1016/S1473-3099(10)70288-7 - DOI - PubMed
    1. Kilewo C, Karlsson K, Ngarina M, Massawe A, Lyamuya E, et al. (2009) Prevention of mother-to-child transmission of HIV-1 through breastfeeding by treating mothers with triple antiretroviral therapy in Dar es Salaam, Tanzania: the Mitra Plus study. J Acquir Immune Defic Syndr 52: 406–416. 10.1097/QAI.0b013e3181b323ff - DOI - PubMed

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