Velloza Jennifer, Ngure Kenneth, Kiptinness Catherine, Quame-Amaglo Justice, Thuo Nicholas, Dew Kristin, Kimani Mary, Gakuo Stephen, Unger Jennifer A, Kolko Beth, Baeten Jared M, Celum Connie, Mugo Nelly, Heffron Renee
Department of Epidemiology, University of Washington, Seattle, WA, USA.
Department of Global Health, University of Washington, Seattle, WA, USA.
Mhealth. 2019 Feb 14;5:4. doi: 10.21037/mhealth.2019.01.04. eCollection 2019.
HIV serodiscordant couples are at heightened risk of HIV transmission when attempting to conceive, yet reproductive goals can outweigh concerns about HIV exposure. Safer conception strategies support fertility desires while minimizing HIV transmission risk and novel mHealth tools can optimize their use. The objective of this analysis is to examine the feasibility and usability of short message service (SMS) messages and a mobile application to support safer conception for HIV serodiscordant couples.
We enrolled 74 heterosexual HIV serodiscordant couples with immediate pregnancy desires into a pilot safer conception intervention study in Thika, Kenya. Prior to pregnancy, women received daily 6-item SMS surveys to capture fertility indicators (e.g., menses, basal body temperature) and sexual behavior. The intervention also provided daily oral pre-exposure prophylaxis (PrEP) for the HIV-negative partner and in-depth counseling to accompany publicly-provided antiretroviral therapy (ART) for the HIV-infected partner. Couples attended monthly visits until pregnancy occurred. We measured PrEP use with medication event monitoring system (MEMS) caps and ART use via quarterly viral load quantification. We imported SMS, MEMS, and viral load data into an Android tablet application designed specifically for this setting for couples to view during clinic visits and included predictions of peak fertility days using SMS data. We used descriptive statistics to summarize SMS response data and developed a Google Analytics platform to monitor tablet application usage during follow-up. We also conducted semi-structured interviews with a purposive sample of 5 healthcare providers and 19 couples. Qualitative data were analyzed using a modified constant comparative approach to identify themes related to mHealth intervention feasibility and acceptability.
In our sample, 34 (45.9%) couples had an HIV-infected female partner. The median age of the female partner was 30 years [interquartile range (IQR), 27-35 years], education was 10 years (IQR, 8-12 years), and partnership duration was 3 years (IQR, 2-7 years). Couples were followed for a median of 218 days (IQR, 116-348 days) prior to pregnancy. Participants completed 13,181 of 16,905 (78.0%) SMS surveys surveys sent with a median of 167 completed surveys (IQR, 74-299) per participant. Most participants completed at least 75% of the total SMS messages received (N=58; 77.3%). The tablet application was opened by counselors 1,806 times during the study period (March 2016 through April 2018). In qualitative interviews, the SMS messages were reportedly easy to respond to and "part of the daily routine". Few participants had concerns about message confidentiality. mHealth tools were also found to be acceptable for tracking fertility indicators and enhancing provider-patient communication.
mHealth strategies are feasible to use and acceptable to support the delivery of safer conception intervention services among HIV serodiscordant couples in Kenya.
艾滋病毒血清学不一致的夫妇在尝试怀孕时面临更高的艾滋病毒传播风险，然而生育目标可能超过对艾滋病毒暴露的担忧。更安全的受孕策略在支持生育愿望的同时可将艾滋病毒传播风险降至最低，新型移动健康（mHealth）工具可优化其使用。本分析的目的是研究短信服务（SMS）信息和一款移动应用程序对艾滋病毒血清学不一致夫妇支持更安全受孕的可行性和可用性。
我们在肯尼亚锡卡招募了74对有近期怀孕意愿的异性艾滋病毒血清学不一致夫妇，纳入一项更安全受孕试点干预研究。在怀孕前，女性每天会收到包含6个项目的短信调查，以获取生育指标（如月经、基础体温）和性行为信息。干预措施还为艾滋病毒阴性伴侣提供每日口服暴露前预防（PrEP），并为艾滋病毒感染伴侣在接受公共提供的抗逆转录病毒疗法（ART）时提供深入咨询。夫妇每月就诊直至怀孕。我们通过药物事件监测系统（MEMS）帽测量PrEP的使用情况，并通过每季度的病毒载量定量来测量ART的使用情况。我们将短信、MEMS和病毒载量数据导入专为该场景设计的安卓平板电脑应用程序，供夫妇在门诊就诊时查看，并利用短信数据预测生育高峰期。我们使用描述性统计来总结短信回复数据，并开发了一个谷歌分析平台来监测随访期间平板电脑应用程序的使用情况。我们还对5名医疗服务提供者和19对夫妇进行了有目的抽样的半结构化访谈。定性数据采用改良的持续比较法进行分析，以确定与移动健康干预可行性和可接受性相关的主题。
在我们的样本中，34对（45.9%）夫妇的女性伴侣感染了艾滋病毒。女性伴侣的年龄中位数为30岁[四分位间距（IQR），27 - 35岁]，受教育年限为10年（IQR，8 - 12年），伴侣关系持续时间为3年（IQR，2 - 7年）。夫妇在怀孕前的随访时间中位数为218天（IQR，116 - 348天）。参与者完成了16905条短信调查中的13181条（78.0%），每位参与者完成的调查中位数为167条（IQR，74 - 299）。大多数参与者至少完成了所接收短信总数的75%（N = 58；77.3%）。在研究期间（2016年3月至2018年4月），咨询师打开平板电脑应用程序1806次。在定性访谈中，据报道短信易于回复且是“日常生活的一部分”。很少有参与者担心信息保密性。移动健康工具在跟踪生育指标和加强医患沟通方面也被认为是可接受的。
移动健康策略在肯尼亚艾滋病毒血清学不一致夫妇中用于支持提供更安全受孕干预服务是可行且可接受的。
