Page 179 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 6 Original Research

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months. In a study conducted in a cohort of 241 adolescents The aim of our study was to evaluate the acceptability of
in South Africa between 2007 and 2015, 89% were retained in using SMS-based mHealth interventions as the tool for
care and 81% achieved viral suppression. Furthermore, mHealth in adolescents living with HIV from KZN,
adolescents attending designated adolescent clinics had higher comparing a rural and urban clinic, with the aim to support
retention rates (95%) compared with those attending paediatric adherence and retention in care. Furthermore, we explored
clinics (85%). The needs of adolescents should be addressed the preferred type of mHealth support (peer support or daily
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differently from the general population, with individualised or weekly reminders).
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care associated with higher adolescent retention in care.
Mobile communication technologies in medical care (mHealth) Methodology
have the potential to address some of these issues.
We conducted a cross-sectional observational survey in a rural
and urban clinic in KZN from January 2018 to June 2019. The
mHealth refers to the use of mobile devices (MODs), such as
mobile phones to support practice of medicine and public two study sites, a rural clinic (Umbumbulu clinic) and an
urban clinic (King Edward VIII Hospital [KEH]) were selected
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health. There are several variations to mHealth interventions,
including short messaging service (SMS) reminders, gaming based on the geographic location and patient profile.
applications (apps) and interactive mobile apps. A mobile app Umbumbulu clinic is in a deep rural area in a sub-district of
study conducted in New England found improved motivation KZN, 30 km south of Durban. The Umbumbulu clinic is a
in taking antiretroviral therapy, while a MedMinder pill primary healthcare centre serving the marginalised community
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counter that generates automated SMS to adolescents found of Umbumbulu, with a high rate of unemployment, poor
that there was a significant increase in CD4 counts. 18 transport system and patients have to walk 3 km – 5 km to
access the clinic. Umbumbulu clinic is a combined service
serving children, adolescents and adults. The ARV clinic
A randomised controlled trial of a personalised SMS reminder (Philani clinic) at KEH, Durban, serves an urban and peri-
to promote adherence in adults in Kenya improved adherence urban area, including patients from formal and informal
from 28% to 64% after 3 months. In studies conducted in housing in Umbilo, Cato Manor, Manor Gardens and Mayville.
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Uganda and Kenya found that 97% of the surveyed participants These communities include low- and middle-class families.
thought that SMS reminders would improve treatment
adherence. 19,20 A study conducted in Ethembeni clinic in Durban
found that 98% of the adult participants remembered their Population and sample
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medications and would recommend the service to a friend. We sequentially enrolled 100 adolescents (12–19 years of
Concerns expressed regarding mHealth included privacy and age) living with HIV on ART from the adolescent clinics in
security with unintentional sharing of personal information the two sites. As an exploratory pilot study, the sample
being of most concern. Sharing of MODs is common in Africa size of 100 was based on availability of limited resources
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and has implications on mHealth interventions. The majority and the patient numbers at each of the study sites. The
(88%) of respondents from a study in Mozambique felt that sample size was powered to detect a difference in mHealth
unauthorised access to text messages could result in accidental acceptability of 70% between the rural and urban sites
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disclosure of their HIV status because they share MODs. with a power of 95% and alpha of 0.05. A further study
Sharing of MODs may also result in a delay in relaying of the with a larger sample size would need to be performed to
message or message not being delivered to right person. determine smaller differences between the two groups.
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Intermittent and limited funding for public health and Fifty participants were enrolled from each clinic with an
sustainable mHealth interventions is a major problem especially equal distribution of males and females. Informed consent
in resource-limited countries with competing priorities. to participate in the study was provided by the parent or
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guardian (telephonic consent was provided when the
The majority of mHealth studies have been based on an SMS adolescent came alone), the adolescent provided signed
reminder that is sent as daily or weekly reminders. More assent and those above 18 years signed informed consent.
research is needed to determine the optimal frequency of S.N. at Umbumbulu Clinic and C.K. at KEH recruited
messages to support adherence. Improvements in mobile participants while registering their details before the
technology have allowed interactive text messages that have doctor consultation. No patient incentives were provided
been shown to help with emotional support and build patient for participation in the study as patients were recruited
knowledge and allowed the adolescents to ask questions. during scheduled visits and the questionnaire was
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However, SMS provides an easy, cheap and accessible completed while waiting for their consultations. The
technology for mHealth that is accessible even in remote investigator conducted a 2-h workshop 2 months prior to
areas with limited resources. An mHealth intervention the commencement of the study at both clinics, to engage
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(MomConnect) in pregnant women was launched in South with S.N. and C.K. and standardise the survey collection.
Africa in 2014 and has been successfully implemented in the Participants were provided with a pen and questionnaire
adult population. To our knowledge, there is limited data in the waiting area and answered the questionnaire
evaluating mHealth interventions in adolescent populations while waiting for their consultation. After completion,
in KwaZulu-Natal (KZN), especially comparing rural and the questionnaire was dropped in the box inside the
urban populations. consultation room.

http://www.sajhivmed.org.za 172 Open Access