Cluster-Randomized Controlled Study of SMS Text Messages for Prevention of Mother-to-Child Transmission of HIV in Rural Kenya

Background. Antiretroviral medications are key for prevention of mother-to-child transmission (PMTCT) of HIV, and transmission mitigation is affected by service delivery, adherence, and retention. Methods. We conducted a cluster-randomized controlled study in 26 facilities in Nyanza, Kenya, to determine the efficacy of SMS text messages on PMTCT outcomes. The relative risk and confidence intervals were estimated at the facility level using STATA. Results. 550 women were enrolled, from June 2012 to July 2013. The median age was 25.6 years, and 85.3% received ARVs. Maternal ARV use was similar between the intervention and control arms: 254/261 (97.3%) versus 241/242 (99.6%) at 34–36 weeks of gestation and 234/247 (94.7%) versus 229/229 (100%) at delivery. Among infants, 199/246 (80.9%) and 209/232 (90.1%) received ARVs (RR: 0.91; 95% CI: 0.77–1.14); 88% versus 88.6% were tested for HIV at 6 weeks, with 1/243 (0.4%) and 3/217 (1.4%) positive results in the intervention and control arms, respectively. Communication increased in both the intervention and control arms, with the mean number of 7.5 (SD: 5.70) compared with 6 (SD: 9.96), p<0.0001. Conclusions. We identified high ARV uptake and infant HIV testing, with very low HIV transmission. Increased communication may influence health-seeking behaviors irrespective of technology. The long-term effectiveness of facilitated communication on PMTCT outcomes needs to be tested. The study has been registered on ClinicalTrials.gov under the identifier NCT01645865

Community-based approaches for prevention of mother to child transmission in resource-poor settings: a social ecological review.

INTRODUCTION: Numerous barriers to optimal uptake of prevention of mother to child transmission (PMTCT) services occur at community level (i.e., outside the healthcare setting). To achieve elimination of paediatric HIV, therefore, interventions must also work within communities to address these barriers and increase service use and need to be informed by evidence. This paper reviews community-based approaches that have been used in resource-limited settings to increase rates of PMTCT enrolment, retention in care and successful treatment outcomes. It aims to identify which interventions work, why they may do so and what knowledge gaps remain. METHODS: First, we identified barriers to PMTCT that originate outside the health system. These were used to construct a social ecological framework categorizing barriers to PMTCT into the following levels of influence: individual, peer and family, community and sociocultural. We then used this conceptual framework to guide a review of the literature on community-based approaches, defined as interventions delivered outside of formal health settings, with the goal of increasing uptake, retention, adherence and positive psychosocial outcomes in PMTCT programmes in resource-poor countries. RESULTS: Our review found evidence of effectiveness of strategies targeting individuals and peer/family levels (e.g., providing household HIV testing and training peer counsellors to support exclusive breastfeeding) and at community level (e.g., participatory women's groups and home-based care to support adherence and retention). Evidence is more limited for complex interventions combining multiple strategies across different ecological levels. There is often little information describing implementation; and approaches such as "community mobilization" remain poorly defined. CONCLUSIONS: Evidence from existing community approaches can be adapted for use in planning PMTCT. However, for successful replication of evidence-based interventions to occur, comprehensive process evaluations are needed to elucidate the pathways through which specific interventions achieve desired PMTCT outcomes. A social ecological framework can help analyze the complex interplay of facilitators and barriers to PMTCT service uptake in each context, thus helping to inform selection of locally relevant community-based interventions

TIMING OF MESSAGES AND PERCEIVED SELF-EFFICACY FOR TREATMENT AMONG PEOPLE LIVING WITH HIV/AIDS IN HOMA BAY COUNTY, KENYA

Purpose: The purpose of this study was to ascertain the effect of timing of mobile phone text messaging (as a communication strategy employed in the text for adherence intervention) on perceived self-efficacy for treatment among people living with HIV/AIDS in Homa Bay County, Kenya.&#x0D; Methodology: Overall the study used a quasi-experimental design involving a control and an intervention group to assess the effect of the text messaging. This paper focusses on the intervention group. The key variables discussed in this paper are timing and perceived self-efficacy. The study comprised of both quantitative and qualitative data. Simple linear regression models and multi-linear regression models were used to estimate the relationship between the independent variable (timing of messages) and the dependent variable (self-efficacy). Qualitative data was analysed thematically and narratives provided under each section in verbatim.&#x0D; Findings: The intervention group of the study achieved a sample size of 77.92 per cent (n=247/317). Timing of the messages was found to have a statistically significant relationship with perceived self-efficacy as a standalone predictor variable. However when broken down into components (morning, noon and evening) none had a relationship with self-efficacy index. Similarly, when combined with other variables that were studied (type of messages, frequency and language), timing did not have a relationship with self-efficacy.&#x0D; Unique contribution to theory, practice and policy: Programs and partners involved in designing and implementing mHealth solutions need to consider and involve participants in determining communication strategies that can be effective. Timing is one of the many strategies that patients should take part in. This would ensure that interventions are highly acceptable and effective and ensure that it provides a sufficiently interesting and rewarding experience.</jats:p

FREQUENCY OF MESSAGES AND PERCEIVED SELF-EFFICACY FOR TREATMENT AMONG PEOPLE LIVING WITH HIV/AIDS IN HOMA BAY COUNTY, KENYA

Purpose: The purpose of this study was to ascertain the effect of frequency of text messaging on perceived self-efficacy for treatment among people living with HIV/AIDS in Homa Bay County.&#x0D; Methodology: The study used a quasi-experimental design. This involved a control and an intervention group to assess the effect of the text messaging. Data was collected using an interview schedule for participants and questionnaires for key informant interview. The study triangulated quantitative and qualitative data. Results shared in this paper are for the intervention group. Spearman’s rho correlations and simple linear regression models were used to estimate the relationship between the independent variable (frequency of messages) and the dependent variable (self-efficacy), and ANOVA test was done to test the hypothesis and presented in tables and graphs. Qualitative data was analyzed thematically and narratives are provided under each section in verbatim.&#x0D; Findings: The desired sample size for the intervention group was 317. Out which the study achieved 77.92 percent (n=247). Frequency of messages, did not yield a statistically significant relationship on perceived self-efficacy for appointment adherence (p&lt;0.52; CI=95 per cent). However, receiving messages on a monthly basis had a significant but relatively week, inverse relationship with perceived self-efficacy (C= -0.181; p&lt;0.02 ;&lt; 0.05,). Qualitative findings established the messages were not boring&#x0D; Unique Contribution to Theory, Practice and Policy: Frequency of messages may depend on other factors such as type and content of messages being sent. Individual characteristics such as the social environment, level of education and general interest of HIV information and ART adherence may also influence the frequency of messages. Mobile interventions should ensure that the right number of required messages is sent to patients for optimum utilization and achievement of the desired outcomes.</jats:p

Lessons from the deployment and management of public handwashing stations in response to the COVID-19 pandemic in Kenya: A cross- sectional, observational study

Abstract Background: At the onset of the pandemic in Kenya, a multisector taskforce was set up to coordinate the COVID-19 response. The taskforce identified 7500 COVID-19 transmissions ‘hotspots’ in public spaces across Kenya, coordinated partners and implemented hand hygiene interventions. To complement these efforts, the National Business Compact Coalition procured and distributed 5311 handwashing stations (HWSs); conducted behavior change communications; and provided technical support on operation, maintenance and monitoring to HWSs caretakers across the country. In view of these interventions, it was paramount to assess the functionality, usability and accessibility of the public HWSs in order to improve the operation and maintenance and inform strategies for future roll-out of HWSs in public settings. Methods: This was a mixed-methods observational study conducted in five randomly selected counties in Kenya: Nairobi, Kwale, Embu, Mombasa and Homabay. Quantitative data were collected through spot checks of randomly selected HWSs in these counties, caretaker surveys, user observations and user exit interviews. Qualitative data were collected through key informant interviews, focus group discussions and in-depth interviews. Quantitative data were analyzed using Chi-square tests, or where applicable, Fisher’s exact tests to assess the accessibility, usability and functionality of the HWSs. Qualitative data were analysed thematically and used to support the quantitative findings. Results: A total of 430 HWSs were targeted for this study and 316 (73%) were located and surveyed. The remainder were largely absent because the caretakers were absent or had relocated, or had been stolen, in storage or in the caretakers’ home. Of the located handwashing facilities, 83.9% were functional (meaning the facility had water in it, soap available for use and a functioning tap). A significantly higher proportion of functional handwashing stations were managed by a paid caretaker (95.9%) compared to an unpaid caretaker (78.4%) (P=0.001). Only 35% of HWSs were accessible for a person using a wheelchair, 76.9 accessible for child under 12 years, and 76.3% accessible for older persons, 81.6% of users reported HWSs to be of comfortable height, and about half (49.1%) of the HWSs were set up on uneven and/or muddy ground. Conclusion: This study has demonstrated distribution of public handwashing facilities can have a limited lifespan. HWSs future distributions should prioritise long-term plans for follow-up with caretakers responsible for operation and maintenance of public handwashing stations to provide support and to sustain accountability. It is also imperative to make HWSs accessible for wheelchair users and those less able to walk. Finally, design considerations should be made for comfortable height, placement in stable surfaces, soap placement and drainage of wastewater.</jats:p

Behavioral and social predictors of COVID-19 vaccine uptake among persons with disabilities in Kenya

Access and uptake of COVID-19 vaccine by persons with disabilities remains largely unknown in low-and middle-income countries, despite the unique barriers they face, their special vulnerabilities and higher risk to severe outcomes. We aimed to identify behavioral and social predictors of COVID-19 uptake among persons with disability in Kenya. A convergent parallel mixed method study design was conducted among 792 persons with disability in four regions (counties) in Kenya. Purposive sampling was used to identify the respondents from the National Council for Persons with Disabilities Registration database. Quantitative data were analyzed using STATA statistical analysis software (version 14). Chi-square (X2) and Fisher's exact tests were used to test for differences in categorical variables; and multivariate regression analysis done to ascertain the factors that influence the uptake of COVID-19 among persons with disabilities in Kenya. Qualitative data from 7 Focus Group Discussions and 4 Key Informant Interviews were transcribed and themes developed using the Behavioral and Social Drivers of vaccination framework by the World Health Organization. Approximately 59% of persons with disabilities reported to be fully vaccinated with significant disparities noted among those with cognition (34.2%) and self-care (36.6%) impairments. Key predictors of vaccine uptake included confidence in vaccine benefits (Odds ratio [OR]; 11.3, 95% CI[5.2–24.2]), health worker recommendation (OR; 2.6 [1.8–3.7]), employment (OR; 2.1 [1.4–3.1]), perceived risk (OR; 2.0 [1.3–3.1]), age 18–24 years (OR; 0.18 [0.09–0.36]), and rural area of residence (OR; 0.48 [0.29–0.79]). The primary reasons for low uptake included perceived negative vaccine effects and lack of adequate information. Qualitative findings revealed unique motivations for vaccination among persons with disabilities (PWDs), including safeguarding against risks from assistive devices and the influence of political leaders. Barriers included perceived vaccine effects, transportation challenges, and limited access to trusted information, highlighting the need for targeted sensitization, improved healthcare worker engagement, and collaboration with PWD organizations. Subsequent vaccination deployments should map and reach people in all disability domains through relevant institutions of PWDs and localized vaccination campaigns. Related communication strategies should leverage the credibility and trust in health workers and behavior change techniques that inspire confidence in vaccines to improve vaccine uptake

Cluster-Randomized Controlled Study of SMS Text Messages for Prevention of Mother-to-Child Transmission of HIV in Rural Kenya

Background. Antiretroviral medications are key for prevention of mother-to-child transmission (PMTCT) of HIV, and transmission mitigation is affected by service delivery, adherence, and retention. Methods. We conducted a cluster-randomized controlled study in 26 facilities in Nyanza, Kenya, to determine the efficacy of SMS text messages on PMTCT outcomes. The relative risk and confidence intervals were estimated at the facility level using STATA. Results. 550 women were enrolled, from June 2012 to July 2013. The median age was 25.6 years, and 85.3% received ARVs. Maternal ARV use was similar between the intervention and control arms: 254/261 (97.3%) versus 241/242 (99.6%) at 34–36 weeks of gestation and 234/247 (94.7%) versus 229/229 (100%) at delivery. Among infants, 199/246 (80.9%) and 209/232 (90.1%) received ARVs (RR: 0.91; 95% CI: 0.77–1.14); 88% versus 88.6% were tested for HIV at 6 weeks, with 1/243 (0.4%) and 3/217 (1.4%) positive results in the intervention and control arms, respectively. Communication increased in both the intervention and control arms, with the mean number of 7.5 (SD: 5.70) compared with 6 (SD: 9.96), p<0.0001. Conclusions. We identified high ARV uptake and infant HIV testing, with very low HIV transmission. Increased communication may influence health-seeking behaviors irrespective of technology. The long-term effectiveness of facilitated communication on PMTCT outcomes needs to be tested. The study has been registered on ClinicalTrials.gov under the identifier NCT01645865

Cluster-Randomized Controlled Study of SMS Text Messages for Prevention of Mother-to-Child Transmission of HIV in Rural Kenya

Background. Antiretroviral medications are key for prevention of mother-to-child transmission (PMTCT) of HIV, and transmission mitigation is affected by service delivery, adherence, and retention. Methods. We conducted a cluster-randomized controlled study in 26 facilities in Nyanza, Kenya, to determine the efficacy of SMS text messages on PMTCT outcomes. The relative risk and confidence intervals were estimated at the facility level using STATA. Results. 550 women were enrolled, from June 2012 to July 2013. The median age was 25.6 years, and 85.3% received ARVs. Maternal ARV use was similar between the intervention and control arms: 254/261 (97.3%) versus 241/242 (99.6%) at 34-36 weeks of gestation and 234/247 (94.7%) versus 229/229 (100%) at delivery. Among infants, 199/246 (80.9%) and 209/232 (90.1%) received ARVs (RR: 0.91; 95% CI: 0.77-1.14); 88% versus 88.6% were tested for HIV at 6 weeks, with 1/243 (0.4%) and 3/217 (1.4%) positive results in the intervention and control arms, respectively. Communication increased in both the intervention and control arms, with the mean number of 7.5 (SD: 5.70) compared with 6 (SD: 9.96), &lt; 0.0001. Conclusions. We identified high ARV uptake and infant HIV testing, with very low HIV transmission. Increased communication may influence health-seeking behaviors irrespective of technology. The long-term effectiveness of facilitated communication on PMTCT outcomes needs to be tested. The study has been registered on ClinicalTrials.gov under the identifier NCT01645865