Efficacy of phone use on adherence to nevirapine prophylaxis and retention in care among HIV-exposed infants in prevention of mother to child transmission of HIV: a randomized clinical trial

Abstract

Background HIV is a major contributor to infant mortality. A significant gap remains between the uptake of infant and maternal ARV regimens and only a minority of HIV-exposed infants receives prophylaxis and safe infant feeding. Losses to follow-up of HIV-exposed infants are associated with shortcomings of facility-based PMTCT models with weak community support of linkages. The rapid expansion of mobile phone coverage in Africa, and in Kenya, presents an opportunity to strengthen linkages between caregivers and health providers. Mobile phone use offers an option to improving care and promoting retention for the mother-baby pairs, which is a major challenge in efforts to achieving an HIV-free generation. Objectives To compare self-reported adherence to infant nevirapine (NVP) prophylaxis and retention in care over 10 weeks in HIV exposed infants randomized to 2-weekly mobile phone calls (intervention) versus no phone calls (control). Design Open label Randomized controlled trial Methods One hundred and fifty HIV infected women drawn from 3 health facilities in Western Kenya and their infants were randomly assigned to receive either phone-based reminders on PMTCT messages or standard health care messages (no calls) within 24 hours of delivery. The group in the intervention arm received phone calls fortnightly. At 6 and 10 weeks following randomization we collected data on infant adherence to nevirapine, mode of infant feeding, early HIV testing and retention in care in both study arms. All analyses were intention to treat. Results Seventy five women were each randomized to the intervention and control arms respectively. At 6 weeks follow-up 68 (90.7%) of participants in the intervention arm reported adherence to infant NVP prophylaxis, compared with 54 (72%) participants in the control group (p = 0.005). Participants in the intervention arm were also significantly more likely to be retained in care than those in the control group. At 6 weeks 59 mother-infant pairs (78.7%) attended scheduled visits with the visits coinciding with the appointment date versus 44 (58.7%) in the control arm (p = 0.009). At 10 weeks the revisit rates were 69.3% (52) in intervention arm and 37.3% (28) in control arm for the 150 mother-infant pairs evaluated (p < 0.001). Conclusion These results suggest that phone calls can be an important tool to improve adherence to infant NVP prophylaxis and retention in care for HIV exposed infants