Ronen Keshet, Unger Jennifer A, Drake Alison L, Perrier Trevor, Akinyi Pamela, Osborn Lusi, Matemo Daniel, O'Malley Gabrielle, Kinuthia John, John-Stewart Grace
a Department of Global Health , University of Washington , Seattle , WA , USA.
b Department of Epidemiology , University of Washington , Seattle , WA , USA.
AIDS Care. 2018 Apr;30(4):500-505. doi: 10.1080/09540121.2017.1417971. Epub 2017 Dec 18.
There is growing evidence that mobile health (mHealth) approaches including short messaging service (SMS) can improve antiretroviral therapy (ART) adherence, but consensus is lacking regarding communication of HIV-related information. Most interventions to date have delivered SMS that do not overtly refer to HIV or ART in order to avoid risk of status disclosure. In formative work for an ongoing randomized controlled trial (RCT) evaluating one-way and two-way educational SMS for prevention of mother-to-child-transmission (PMTCT) adherence in Kenya, we conducted 10 focus group discussions (FGDs) with 87 HIV-infected peripartum women to determine desirability and preferred terminology of HIV-related content. SMS for the RCT were developed based on FGD findings. Roughly half of FGD participants supported receiving SMS containing overtly HIV-related terms, such as "HIV" and "medication", citing desire for detailed educational messages about ART and PMTCT. Those opposed to overt content expressed concerns about confidentiality. Many participants argued that acceptability of HIV-related content depended on the recipient's disclosure status and others' access to her phone. Based on these findings, both covert and overt SMS were developed for the RCT and participants who owned their phone or had disclosed their HIV status to anyone with access to their phone were able to choose one of three options: (1) covert SMS only, (2) overt SMS only in response to HIV-related questions from the participant, (3) overt SMS routinely, initiated by the study. Of the 825 participants in the RCT, 94% were eligible to receive overt SMS. Of these, 66% opted to receive routine overt SMS and 10% to receive participant-initiated overt SMS. These findings show there may be interest in overt HIV-related information by SMS when risk of status disclosure is low, and support use of messaging strategies that allows participant choice in HIV-related content while protecting against undesired disclosure.
越来越多的证据表明，包括短信服务（SMS）在内的移动健康（mHealth）方法可以提高抗逆转录病毒疗法（ART）的依从性，但在HIV相关信息的沟通方面缺乏共识。迄今为止，大多数干预措施发送的短信都没有明确提及HIV或ART，以避免身份暴露的风险。在一项正在进行的随机对照试验（RCT）的前期工作中，该试验评估了用于肯尼亚预防母婴传播（PMTCT）依从性的单向和双向教育短信，我们与87名感染HIV的围产期妇女进行了10次焦点小组讨论（FGD），以确定HIV相关内容的可取性和首选术语。基于FGD的结果为RCT开发了短信。大约一半的FGD参与者支持接收包含明确HIV相关术语的短信，如“HIV”和“药物”，理由是希望获得有关ART和PMTCT的详细教育信息。那些反对明确内容的人表达了对保密性的担忧。许多参与者认为，HIV相关内容的可接受性取决于接收者的披露状态以及其他人对其手机的访问权限。基于这些发现，为RCT开发了隐蔽和公开两种短信，拥有手机或已向任何可以访问其手机的人披露其HIV状态的参与者能够从三个选项中选择一个：（1）仅接收隐蔽短信，（2）仅在参与者提出HIV相关问题时接收公开短信，（3）由研究常规发起公开短信。在RCT的825名参与者中，94%有资格接收公开短信。其中，66%选择接收常规公开短信，10%选择接收参与者发起的公开短信。这些发现表明，当身份暴露风险较低时，通过短信传递明确的HIV相关信息可能会受到关注，并支持使用允许参与者在HIV相关内容上进行选择同时防止不必要披露的信息传递策略。
