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. 2020 May 24;20(1):752.
doi: 10.1186/s12889-020-08706-5.

Acceptability and feasibility of a behavioral and mobile health intervention (COMBIND) shown to increase uptake of prevention of mother to child transmission (PMTCT) care in India

Nishi Suryavanshi  1 , Abhay Kadam  2 , Savita Kanade  2 , Nikhil Gupte  3 , Amita Gupta  3 , Robert Bollinger  3 , Vidya Mave  3 , Anita Shankar  4
Affiliations

Acceptability and feasibility of a behavioral and mobile health intervention (COMBIND) shown to increase uptake of prevention of mother to child transmission (PMTCT) care in India

Nishi Suryavanshi et al. BMC Public Health. .

Abstract

Background: A cluster-randomized trial recently demonstrated that an integrated behavioral and mobile technology intervention improved uptake of key components of a Prevention of Mother to Child Transmission (PMTCT) Option B+ program, among HIV- infected pregnant/breastfeeding women in India. To guide scale-up and optimize programmatic implementation, we conducted a mixed-methods evaluation of the feasibility and acceptability of this intervention.

Methods: The COMmunity Home Based INDia (COMBIND) study, was conducted in four districts of Maharashtra, India and randomized 119 integrated counseling and testing centers (ICTC) and their outreach workers (ORWs) to the COMBIND intervention, an integrated mHealth application that allowed digital data capture, PMTCT educational videos, SMS alerts for missed visits and reminder for visits, combined with personal empowerment and motivational interviewing training for ORWs. This qualitative evaluation was done through 15 in-depth interviews (IDIs) with ORWs and 15 IDIs with HIV-infected pregnant/breastfeeding women from the intervention arm. Utilizing a concurrent nested mixed-method evaluation approach, we assess the feasibility and acceptability of the study intervention.

Results: All 30 participants reported that the PMTCT videos were essential in providing easy to understand information on critical aspects of HIV and necessary care related to PMTCT practices. A majority of the ORWs reported that the personal empowerment training with motivational interviewing skills training increased their confidence, motivation and gave them the tools for effectively supporting their clients. The mHealth application improved their working style as it facilitated targeted PMTCT information support, systemized data capture, streamlined their health education delivery practice and provided a sense of work satisfaction. The SMS appointment alerts improved retention in HIV care for mother and baby to the smaller proportion that had access to their phones. Despite reported improvements in knowledge and communication, few ORWs reported that structural challenges such as limited drug stocks, lack of HIV kits or unavailability of trained staff at ICTC, may hamper the uptake of PMTCT services, thus resulting in limited significant impacts of COMBIND on PMTCT outcomes.

Conclusion: This study found that COMBIND intervention is scalable, feasible, beneficial and very well accepted by ORWs and patients, however structural challenges in goods and services remain.

Keywords: HIV; Intervention; Mhealth; Option B +; PMTCT.

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Conflict of interest statement

Under a licensing agreement between emocha Mobile Health, Inc. and the Johns Hopkins University, R. Bollinger is entitled to royalties on an invention described in this article. R. Bollinger also is a Board of Directors member of emocha Mobile Health, Inc. This arrangement has been reviewed and approved by the Johns Hopkins University per its conflict of interest policies.

Figures

Fig. 1
Fig. 1
Study districts in Maharashtra state, India. Four high HIV burden study districts Sangli, Satara, Pune and Thane in Maharashtra state in India. This Map is prepared by AK using MS office (MS word and PowerPoint) tools
Fig. 2
Fig. 2
Concurrent Triangulation of data for Mixed Methods evaluation. Triangulation of quantitative and qualitative data is done to present the composite results for acceptability and feasibility of COMBIND intervention
See this image and copyright information in PMC

References

    1. Isbell Michael T, Kilonzo Nduku, Mugurungi Owen, Bekker Linda-Gail. We neglect primary HIV prevention at our peril. The Lancet HIV. 2016;3(7):e284–e285. doi: 10.1016/S2352-3018(16)30058-3. - DOI - PubMed
    1. Krishnaratne Shari, Hensen Bernadette, Cordes Jillian, Enstone Joanne, Hargreaves James R. Interventions to strengthen the HIV prevention cascade: a systematic review of reviews. The Lancet HIV. 2016;3(7):e307–e317. doi: 10.1016/S2352-3018(16)30038-8. - DOI - PubMed
    1. Pickles M, Boily MC, Vickerman P, Lowndes CM, Moses S, Blanchard JF, et al. Assessment of the population-level effectiveness of the Avahan HIV-prevention programme in South India: a preplanned, causal-pathway-based modelling analysis. Lancet Glob Health. 2013;1(5):e289–e299. doi: 10.1016/S2214-109X(13)70083-4. - DOI - PubMed
    1. http://naco.gov.in/strategy-document. NNACOda. In: document NACPN-IS, editor.
    1. Shapiro RL, Hughes MD, Ogwu A, Kitch D, Lockman S, Moffat C, et al. Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med. 2010;362(24):2282–2294. doi: 10.1056/NEJMoa0907736. - DOI - PMC - PubMed

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