Department of Global Health, University of Washington, Seattle, Washington, USA.
Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA.
Glob Health Sci Pract. 2020 Mar 31;8(1):55-67. doi: 10.9745/GHSP-D-19-00347. Print 2020 Mar 30.
We evaluated a 2-way short message service (SMS) communication platform to improve continuation of pre-exposure prophylaxis (PrEP) for HIV prevention among Kenyan women who initiated PrEP within routine maternal child health (MCH) and family planning clinics.
We adapted an existing SMS platform (Mobile WACh [mWACh]) to send PrEP-tailored, theory-based SMS and allow clients to communicate with a remote nurse. Women who did not have HIV and who were initiating PrEP at 2 MCH/family planning clinics in Kisumu County, Kenya, from February to October 2018, were offered enrollment into the mWACh-PrEP program; SMS communication was free. We evaluated acceptability, satisfaction, and implementation metrics. In a pre/postevaluation, we compared PrEP continuation at 1-month postinitiation among women who initiated PrEP in the period before (n=166) versus after mWACh-PrEP implementation, adjusting for baseline differences.
Of the 334 women who were screened for enrollment into the mWACh-PrEP program; 193 (58%) were eligible and of those, 190 (98%) accepted enrollment. Reasons for ineligibility (n=141) included no phone access (29%) and shared SIM cards (25%). Median age was 25 years (interquartile range=22-30), and 91% were MCH clients. Compared to women who initiated PrEP in the month before mWACh-PrEP implementation, women who enrolled in mWACh-PrEP were more likely to return for their first PrEP follow-up visit (40% vs. 53%; adjusted risk ratio [aRR]=1.26; 95% confidence interval [CI]= 1.06, 1.50; =.008) and more likely to continue PrEP (22% vs. 43%; aRR=1.75; 95% CI=1.21, 2.55; =.003). Among those who returned, 99% reported successful receipt of SMS through the mWACh-PrEP system and 94% reported that mWACh-PrEP helped them understand PrEP better. Concerns about PrEP use, how it works, and side effects accounted for the majority (80%) of issues raised by participants using SMS.
Two-way SMS expanded support for PrEP and opportunities for dialogue beyond the clinic and enabled women to ask and receive answers in real time regarding PrEP, which facilitated its continued use.
我们评估了一种双向短信息服务（SMS）通信平台，以改善肯尼亚在常规母婴保健（MCH）和计划生育诊所开始接受暴露前预防（PrEP）的妇女继续使用 PrEP，用于预防艾滋病毒。
我们对现有的短信平台（Mobile WACh [mWACh]）进行了调整，以发送适合 PrEP 的、基于理论的短信，并允许客户与远程护士进行交流。2018 年 2 月至 10 月，在肯尼亚基苏木县的 2 个 MCH/计划生育诊所开始接受 PrEP 的没有 HIV 的妇女，有资格参加 mWACh-PrEP 计划；短信通讯是免费的。我们评估了可接受性、满意度和实施指标。在预/后评估中，我们比较了在 mWACh-PrEP 实施前（n=166）和实施后（n=166）开始接受 PrEP 的妇女在启动后 1 个月时 PrEP 的持续情况，同时调整了基线差异。
在 334 名接受 mWACh-PrEP 项目入组筛查的妇女中；193 名（58%）符合条件，其中 190 名（98%）接受了入组。不符合条件的原因（n=141）包括无电话接入（29%）和共享 SIM 卡（25%）。中位年龄为 25 岁（四分位距=22-30），91%为 MCH 客户。与 mWACh-PrEP 实施前开始接受 PrEP 的妇女相比，参加 mWACh-PrEP 的妇女更有可能返回接受首次 PrEP 随访（40% vs. 53%；调整风险比[aRR]=1.26；95%置信区间[CI]=1.06, 1.50；=0.008），更有可能继续使用 PrEP（22% vs. 43%；aRR=1.75；95%CI=1.21, 2.55；=0.003）。在返回的人群中，99%的人报告通过 mWACh-PrEP 系统成功接收短信，94%的人报告 mWACh-PrEP 帮助他们更好地了解 PrEP。参与者使用短信提出的大多数问题（80%）是关于 PrEP 的使用、工作原理和副作用的担忧。
双向短信扩展了对 PrEP 的支持和对话机会，超出了诊所的范围，并使妇女能够实时询问和接收有关 PrEP 的答案，这有助于其持续使用。
