title: Mobile health for early retention in HIV care: a qualitative study in Kenya (WelTel Retain).
abstract: Many people newly diagnosed with HIV are lost to follow-up before timely initiation of antiretroviral therapy (ART). A randomised controlled trial (RCT), WelTel Kenya1, demonstrated the effectiveness of the WelTel text messaging intervention to improve clinical outcomes among patients initiating ART. In preparation for WelTel Retain, an RCT that will evaluate the effect of the intervention to retain patients in care immediately following HIV diagnosis, we conducted an informative qualitative study with people living with HIV (n = 15) and healthcare providers (HCP) (n = 5) in October 2012. Study objectives included exploring the experiences of people living with HIV who have attempted to engage in HIV care, the use of cell phones in everyday life, and perceptions of communicating via text message with HCP. Participants were recruited through convenience sampling. Semi-structured, qualitative interviews were conducted and recorded, transcribed verbatim and analysed using NVivo software. Analysis was guided by the Theory of Reasoned Action and the Technology Acceptance Model. Results indicate that while individuals have many motivators for engaging in care after diagnosis, structural and individual barriers including poverty, depression and fear of stigma prevent them from doing so. All participants had access to a mobile phone, and most were comfortable communicating through text messages, or were willing to learn. Both people living with HIV and HCP felt that increased communication via the text messaging intervention has the potential to enable early identification of problems, leading to timely problem solving that may improve retention and engagement in care during the first year after diagnosis.
authors.affiliation: a British Columbia Centre for Disease Control , 655 West 12th Avenue, Vancouver , British Columbia , Canada , V5Z 4R4.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Smillie
authors.forename: Natasha
authors.initials: N
authors.lastname: Van Borek
authors.forename: Mia L
authors.initials: ML
authors.lastname: van der Kop
authors.forename: Abigael
authors.initials: A
authors.lastname: Lukhwaro
authors.forename: Neville
authors.initials: N
authors.lastname: Li
authors.forename: Sarah
authors.initials: S
authors.lastname: Karanja
authors.forename: Anik R
authors.initials: AR
authors.lastname: Patel
authors.forename: David
authors.initials: D
authors.lastname: Ojakaa
authors.forename: Richard T
authors.initials: RT
authors.lastname: Lester
mesh_terms: D000328:Adult; D003142:Communication; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D036301:Qualitative Research; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods; D060145:Text Messaging / Q000706:statistics & numerical data; D055815:Young Adult
keywords: HIV; engagement in care; mobile health; sub-Saharan Africa