title: Effectiveness of an SMS-based maternal mHealth intervention to improve clinical outcomes of HIV-positive pregnant women.
abstract: We conducted a retrospective study to investigate the effectiveness of an mHealth messaging intervention aiming to improve maternal health and HIV outcomes. Maternal health SMSs were sent to 235 HIV-infected pregnant women twice per week in pregnancy and continued until the infant's first birthday. The messages were timed to the stage of the pregnancy/infant age and covered maternal health and HIV-support information. Outcomes, measured as antenatal care (ANC) visits, birth outcomes and infant HIV testing, were compared to a control group of 586 HIV-infected pregnant women who received no SMS intervention. Results showed that intervention participants attended more ANC visits (5.16 vs. 3.95, p < 0.01) and were more likely to attend at least the recommended four ANC visits (relative risk (RR): 1.41, 95% confidence interval (CI): 1.15-1.72). Birth outcomes of intervention participants improved as they had an increased chance of a normal vaginal delivery (RR: 1.10, 95% CI: 1.02-1.19) and a lower risk of delivering a low-birth weight infant (<2500 g) (RR: 0.14, 95% CI: 0.02-1.07). In the intervention group, there was a trend towards higher attendance to infant polymerase chain reaction (PCR) testing within six weeks after birth (81.3% vs. 75.4%, p = 0.06) and a lower mean infant age in weeks at HIV PCR testing (9.5 weeks vs. 11.1 weeks, p = 0.14). These results add to the growing evidence that mHealth interventions can have a positive impact on health outcomes and should be scaled nationally following comprehensive evaluation.
authors.affiliation: a Wits Reproductive Health and HIV Institute, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.|b Department of Public Health Sciences , Karolinska Institute , Stockholm , Sweden.
authors.forename: Jesse
authors.identifier: 0000-0002-3601-7854
authors.initials: J
authors.lastname: Coleman
authors.affiliation: c Division of Clinical Pharmacology, Department of Laboratory Medicine , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden.
authors.forename: Kate C
authors.initials: KC
authors.lastname: Bohlin
authors.affiliation: b Department of Public Health Sciences , Karolinska Institute , Stockholm , Sweden.
authors.forename: Anna
authors.identifier: 0000-0002-8703-6561
authors.initials: A
authors.lastname: Thorson
authors.affiliation: d Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Vivian
authors.identifier: 0000-0003-2274-8581
authors.initials: V
authors.lastname: Black
authors.affiliation: e HealthEnabled, Personal Connected Health Alliance , Johns Hopkins University and Princeton University , Arlington , VA , USA.
authors.forename: Patricia
authors.identifier: 0000-0002-1034-0549
authors.initials: P
authors.lastname: Mechael
authors.affiliation: f Mobile Alliance for Maternal Action , United Nations Foundation , Washington , DC , USA.
authors.forename: Josie
authors.initials: J
authors.lastname: Mangxaba
authors.affiliation: b Department of Public Health Sciences , Karolinska Institute , Stockholm , Sweden.|c Division of Clinical Pharmacology, Department of Laboratory Medicine , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden.
authors.forename: Jaran
authors.identifier: 0000-0003-1146-5615
authors.initials: J
authors.lastname: Eriksen
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D010349:Patient Compliance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy*; D011295:Prenatal Care / Q000379:methods*; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D017216:Telemedicine
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; global health; mHealth; maternal health; vertical infectious disease transmission