title: Use of mobile phones and text messaging to decrease the turnaround time for early infant HIV diagnosis and notification in rural Zambia: an observational study.
abstract: Early infant diagnosis of HIV infection is challenging in rural sub-Saharan Africa as blood samples are sent to central laboratories for HIV DNA testing, leading to delays in diagnosis and treatment initiation. Simple technologies to rapidly deliver results to clinics and notify mothers of test results would decrease many of these delays. The feasibility of using mobile phones to contact mothers was evaluated. In addition, the first two years of implementation of a national short message service (SMS) reporting system to deliver test results from the laboratory to the clinic were evaluated.
  
  
  
  The study was conducted in Macha, Zambia from 2013 to 2015 among mothers of HIV-exposed infants. Mothers were interviewed about mobile phone use and willingness to be contacted directly or through their rural health center. Mothers were contacted according to their preferred method of communication when test results were available. Mothers of positive infants were asked to return to the clinic as soon as possible. Dates of sample collection, delivery of test results to the clinic and notification of mothers were documented in addition to test results.
  
  
  
  Four hundred nineteen mothers and infants were enrolled. Only 30% of mothers had ever used a mobile phone. 96% of mobile phone owners were reached by study staff and 98% of mothers without mobile phones were contacted through their rural health center. Turnaround times for mothers of positive infants were approximately 2 weeks shorter than for mothers of negative infants. Delivery of test results by the national SMS system improved from 2013 to 2014, with increases in the availability of texted results (38 vs. 91%) and arrival of the texted result prior to the hardcopy report (27 vs. 83%). Texted results arriving at the clinic before the hardcopy were received a median of 19 days earlier. Four discrepancies between texted and hardcopy results were identified out of 340 tests.
  
  
  
  Mobile phone and text messaging technology has the potential to improve early infant diagnosis but challenges to widespread implementation need to be addressed, including low mobile phone ownership, use and coverage in rural areas.
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, USA. csutcli1@jhu.edu.
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Sutcliffe
authors.affiliation: Macha Research Trust, Macha Hospital, Choma, Zambia.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Thuma
authors.affiliation: Macha Research Trust, Macha Hospital, Choma, Zambia.|Department of Immunology and Infectious Diseases, Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Janneke H
authors.initials: JH
authors.lastname: van Dijk
authors.affiliation: Macha Research Trust, Macha Hospital, Choma, Zambia.
authors.forename: Kathy
authors.initials: K
authors.lastname: Sinywimaanzi
authors.affiliation: Macha Research Trust, Macha Hospital, Choma, Zambia.
authors.forename: Sydney
authors.initials: S
authors.lastname: Mweetwa
authors.affiliation: Macha Research Trust, Macha Hospital, Choma, Zambia.
authors.forename: Mutinta
authors.initials: M
authors.lastname: Hamahuwa
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Moss
mesh_terms: D000328:Adult; D040421:Cell Phone; D042241:Early Diagnosis; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009035:Mothers; D010342:Patient Acceptance of Health Care; D012423:Rural Health; D019035:Rural Health Services; D017216:Telemedicine / Q000379:methods*; D060145:Text Messaging; D013997:Time Factors; D015024:Zambia
keywords: HIV; Infant diagnosis; Sub-Saharan Africa; mhealth