Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 B, 171 65, Solna, Sweden.
Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden.
Sci Rep. 2023 Jun 9;13(1):9389. doi: 10.1038/s41598-023-35817-x.
Retention in prevention of mother-to-child transmission (PMTCT) care is critical to prevent vertical HIV transmission and reduce morbidity and mortality of mother-infant pairs. We investigated whether weekly, interactive text-messaging improved 18-month postpartum retention in PMTCT care. This randomised, two-armed, parallel trial was conducted at six PMTCT clinics in western Kenya. Pregnant women with HIV at least 18 years of age with access to a mobile phone, able to text-message, or had somebody who could text on their behalf, were eligible. Participants were randomly assigned at a 1:1 ratio in block sizes of four to the intervention or control group. The intervention group received weekly text messages asking "How are you?" ("Mambo?" in Swahili) and were requested to respond within 48 h. Healthcare workers called women who indicated a problem or did not respond. The intervention was administered up to 24 months after delivery. Both groups received standard care. The primary outcome was retention in care at 18 months postpartum (i.e., clinic attendance 16-24 months after delivery based on data from patient files, patient registers and Kenya's National AIDS and STI Control Programme database), which was analysed by intention-to-treat. Researchers and data collectors were masked to group assignment, while healthcare workers were not. Between June 25th, 2015, and July 5th, 2016, we randomly assigned 299 women to the intervention and 301 to standard care only. Follow-up concluded on July 26th, 2019. The proportion of women retained in PMTCT care at 18 months postpartum was not significantly different between the intervention (n = 210/299) and control groups (n = 207/301) (risk ratio 1.02, 95% confidence interval 0.92-1.14, p = 0.697). No adverse events related to the mobile phone intervention were reported. Weekly, interactive text-messaging was not associated with improved retention in PMTCT care at 18 months postpartum or linkage to care up to 30 months postpartum in this setting. (ISRCTN No. 98818734).
预防母婴传播（PMTCT）护理的保留对于预防垂直 HIV 传播和降低母婴死亡率至关重要。我们调查了每周进行互动式短信是否可以改善产后 18 个月 PMTCT 护理的保留率。这项随机、双臂、平行试验在肯尼亚西部的六家 PMTCT 诊所进行。符合条件的是至少 18 岁、有手机、能够发短信或有人可以代表他们发短信的 HIV 感染孕妇。参与者以 1:1 的比例按 4 人的块大小随机分配到干预组或对照组。干预组每周收到一条短信，询问“你好吗？”（在斯瓦希里语中是“Mambo？”）并要求在 48 小时内回复。卫生保健工作者会打电话给那些表示有问题或未回复的妇女。干预措施在分娩后最多 24 个月内进行。两组均接受标准护理。主要结局是产后 18 个月时的护理保留率（即根据患者档案、患者登记册和肯尼亚国家艾滋病和性传播感染控制计划数据库中分娩后 16-24 个月的就诊情况），这是通过意向治疗进行分析的。研究人员和数据收集者对分组分配保持盲态，而卫生保健工作者则没有。2015 年 6 月 25 日至 2016 年 7 月 5 日期间，我们将 299 名女性随机分配到干预组，301 名女性仅分配到标准护理组。随访于 2019 年 7 月 26 日结束。产后 18 个月时，干预组（n=210/299）和对照组（n=207/301）中保留在 PMTCT 护理中的妇女比例无显著差异（风险比 1.02，95%置信区间 0.92-1.14，p=0.697）。没有报告与手机干预相关的不良事件。在这种情况下，每周进行互动式短信与产后 18 个月时 PMTCT 护理保留率的提高或 30 个月时护理的联系无关。（ISRCTN 编号：No. 98818734）
