Odeny Thomas A, Bukusi Elizabeth A, Cohen Craig R, Yuhas Krista, Camlin Carol S, McClelland R Scott
aKenya Medical Research Institute (KEMRI), Nairobi, Kenya bDepartment of Epidemiology cDepartment of Global Health dDepartment of Obstetrics and Gynecology, University of Washington, Seattle, Washington eDepartment of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California fDepartment of Medicine, University of Washington, Seattle, Washington, USA gInstitute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
AIDS. 2014 Sep 24;28(15):2307-12. doi: 10.1097/QAD.0000000000000409.
Many sub-Saharan African countries report high postpartum loss to follow-up of mother-baby pairs. We aimed to determine whether interactive text messages improved rates of clinic attendance and early infant HIV testing in the Nyanza region of Kenya.
Parallel-group, unblinded, randomized controlled trial.
HIV-positive pregnant women at least 18 years old and enrolled in the prevention of mother-to-child transmission of HIV programme were randomized to receive either text messages (SMS group, n = 195) or usual care (n = 193). Messages were developed using formative focus group research informed by constructs of the Health Belief Model. The SMS group received up to eight text messages before delivery (depending on gestational age), and six messages postpartum. Primary outcomes included maternal postpartum clinic attendance and virological infant HIV testing by 8 weeks postpartum. The primary analyses were intention-to-treat.
Of the 388 enrolled women, 381 (98.2%) had final outcome information. In the SMS group, 38 of 194 (19.6%) women attended a maternal postpartum clinic compared to 22 of 187 (11.8%) in the control group (relative risk 1.66, 95% confidence interval 1.02-2.70). HIV testing within 8 weeks was performed in 172 of 187 (92.0%) infants in the SMS group compared to 154 of 181 (85.1%) in the control group (relative risk 1.08, 95% confidence interval 1.00-1.16).
Text messaging significantly improved maternal postpartum visit attendance, but overall return rates for these visits remained low. In contrast, high rates of early infant HIV testing were achieved in both arms, with significantly higher testing rates in the SMS compared to the control infants.
许多撒哈拉以南非洲国家报告母婴对产后随访失访率很高。我们旨在确定交互式短信是否能提高肯尼亚尼扬扎地区母婴到诊所就诊的比率以及婴儿早期HIV检测率。
平行组、非盲、随机对照试验。
年龄至少18岁且参加预防母婴传播HIV项目的HIV阳性孕妇被随机分为接受短信组（短信组，n = 195）或常规护理组（n = 193）。短信是根据健康信念模型构建的形成性焦点小组研究开发的。短信组在分娩前最多接收8条短信（取决于孕周），产后接收6条短信。主要结局包括产妇产后到诊所就诊情况以及产后8周时婴儿HIV病毒学检测情况。主要分析采用意向性分析。
在388名登记入组的妇女中，381名（98.2%）有最终结局信息。在短信组中，194名妇女中有38名（19.6%）到产妇产后诊所就诊，而对照组187名妇女中有22名（11.8%）就诊（相对危险度1.66，95%置信区间1.02 - 2.70）。短信组187名婴儿中有172名（92.0%）在8周内进行了HIV检测，而对照组181名婴儿中有154名（85.1%）进行了检测（相对危险度1.08，95%置信区间1.00 - 1.16）。
短信显著提高了产妇产后就诊率，但这些就诊的总体回访率仍然很低。相比之下，两组婴儿早期HIV检测率都很高，短信组婴儿的检测率显著高于对照组。
