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Using mHealth to Deliver a Home-Based Testing and Counseling Program to Improve Linkage to Care and ART Adherence in Rural South Africa

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Abstract

Community-based HIV testing and counseling (HTC) programs have become an important part of the healthcare system in South Africa and other low- and middle-income countries with a high HIV prevalence and strained primary healthcare system. Current HTC programs excel at identifying people living with HIV (PLH) but leave gaps in linkage to care and antiretroviral therapy (ART) as most HTC programs do not have the capacity to ensure that linkage has occurred. This article presents the protocol for an mHealth study, that is, pilot testing a mobile platform in KwaZulu-Natal (KZN), South Africa, to improve linkage to care and ART adherence after home-based HTC. Testing data are shared with designated clinics. PLH are identified using fingerprint scans, mobile numbers, or South African IDs. If PLH do not present at a designated clinic after testing HIV positive, study field staff are sent SMS alerts to prompt follow-up visits. Similarly, if PLH do not refill ART prescriptions after their initial 1-month dose runs out, SMS alerts that are sent to field staff. This paper presents the mHealth study protocol and baseline sample characteristics (N = 101 PLH). Analyses will summarize rates of linkage to care and ART prescription refills. Cost-effectiveness analyses will examine the costs and benefits of linkage and ART adherence using our mHealth system. Linkage to care rates will be compared between our study and a historical control, that is, provided by a prior HTC program that was conducted in KZN without our mHealth system (n = 615).

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Funding

This research was supported by the National Institute of Mental Health (R21MH106351; P30MH58107).

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Authors and Affiliations

  1. Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Blvd. Suite 350, Los Angeles, CA, 90024, USA

    W. Scott Comulada

  2. Department of Health Policy Management, University of California, Los Angeles, CA, USA

    Adriane Wynn

  3. Human and Social Development Research Programme, Human Sciences Research Council, Pretoria, South Africa

    Heidi van Rooyen & Alastair van Heerden

  4. Global Health and Medicine, University of Washington, Seattle, WA, USA

    Ruanne V. Barnabas

  5. eHealth Directorate, KwaZulu-Natal Provincial Department of Health, Durban, South Africa

    Rajeev Eashwari

  6. Developmental Pathways to Health Research Unit, School of Community Medicine, University of the Witwatersrand, Johannesburg, South Africa

    Alastair van Heerden

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  1. W. Scott Comulada
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  2. Adriane Wynn
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Correspondence to W. Scott Comulada.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The UCLA Institutional Review Board (IRB# 16-001207) and the HSRC Research Ethics Committee (REC 7/15/06/16) has approved and monitors the study protocol over time.

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Informed consent was obtained from all individual participants included in the study.

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Comulada, W.S., Wynn, A., van Rooyen, H. et al. Using mHealth to Deliver a Home-Based Testing and Counseling Program to Improve Linkage to Care and ART Adherence in Rural South Africa. Prev Sci 20, 126–136 (2019). https://doi.org/10.1007/s11121-018-0950-1

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