Page 178 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 6 Original Research

Acceptability of short text messages to support

treatment adherence among adolescents living with

HIV in a rural and urban clinic in KwaZulu-Natal

Authors: Background: The use of mobile communication technologies (mHealth) has improved
Mthokozisi A. Cele 1 adherence and viral suppression among HIV-infected adults. Adolescents have disproportionally
Moherndran Archary 1
lower levels of adherence and viral suppression compared with adults, potentially impacting
Affiliations: the goal of 90% viral suppression by 2030.
1 Department of Paediatrics
and Child Health, University Objectives: The aim of this study was to evaluate the acceptability of using short message
of KwaZulu-Natal, Durban, service (SMS)-based mHealth interventions as a tool to improve adherence in HIV-infected
South Africa adolescents in a rural and urban clinic in KwaZulu-Natal (KZN).
Corresponding author: Method: A cross-sectional study with a sample size of 100 participants was conducted in a
Mthokozisi Cele, rural and urban clinic in KZN, from January 2018 to June 2019. Fifty participants were
mthokozisicele@rocketmail.
com sequentially enrolled from each clinic. A questionnaire was self-administered with the
assistance of the treating clinician depending on the adolescent’s level of understanding.
Dates: Informed consent was obtained from guardians and questionnaires were anonymised.
Received: 31 Mar. 2019 Appropriate descriptive and comparative statistics were used.
Accepted: 16 July 2019
Published: 03 Oct. 2019 Results: The mean age of participants was 15 years, with 88% having access to a mobile device
How to cite this article: (MOD). There was no significant difference in MOD ownership between rural and urban
CeleMA, Archary M, participants. Majority of participants (65%) were willing to receive SMS-based adherence

Acceptability of short text support with no difference between rural and urban area.
messages to support
treatment adherence among Conclusion: With high rates of MOD ownership and acceptability (willingness to use mHealth
adolescents living with HIV in to improve health status), SMS-based mHealth interventions have the potential to improve
a rural and urban clinic in adherence and viral suppression in adolescents living with HIV in both rural and urban KZN.
KwaZulu-Natal. S Afr J HIV
Med. 2019;20(1), a976. Further studies with a larger sample size need to be conducted to further explore these
https://doi.org/10.4102/ findings.
sajhivmed.v20i1.976
Keywords: adolescents on antiretroviral therapy; HIV; text messaging system; adherence
Copyright: support; retention cell phone technology; mHealth.
© 2019. The Authors.
Licensee: AOSIS. This work
is licensed under the
Creative Commons Introduction
Attribution License.
In 2015, an estimated 1.8 million adolescents worldwide were living with HIV, with over two-
1
thirds living in sub-Saharan Africa (SSA). In 2018, an estimated 310 000 adolescents were living
2
with HIV in South Africa. The earlier initiation of antiretroviral treatment (ART) in vertically
3
HIV-infected children has resulted in more children surviving into adolescence potentially
increasing these estimates in the future. With the aim of controlling the HIV epidemic, the World
Health Organization (WHO) launched the 90-90-90 campaign, which aims for 90% of people
living with HIV knowing their HIV status, 90% started on ART and 90% with a suppressed HIV
viral load. 4
One of the challenges in achieving the 90-90-90 targets is the poor adherence among adolescents
in Africa. Poor adherence is associated with lower rates of viral suppression both in adult and
5
adolescent populations. 6,7,8 A recent systemic review estimated that viral suppression ranged from
27% to 89% in Africa. West and Central Africa had the lowest viral suppression rate (8%), while
9
East Africa had the highest (56%). In South Africa, a study conducted in Gauteng and
10
Read online: Mpumalanga found that adolescents were more likely to be unsuppressed by 12 months (Risk
Read online:
Scan this QR Ratio 2.30, 95% CI, 1.38–3.82) than adult patients. 11
Scan this QR
code with your
code with your
smart phone or
smart phone or
mobile device Adolescents also have lower rates of retention in care compared with adults. An evaluation of lost
mobile device
12
to read online.
to read online.
to follow-up in adolescents starting ART in four SSA countries was 20% at 3 months and 44% at 12
http://www.sajhivmed.org.za 171 Open Access