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Introduction. In South Africa, HIV-positive women receiving antiretroviral therapy (ART) often are lost to care postpartum and strategies to support long-term engagement in care are needed. Mobile health (mHealth) interventions are emerging as potential strategies for supporting long-term engagement in the prevention of mother-to-child transmission (PMTCT) of HIV care continuum. Smartphone technology and mobile data are getting cheaper and more accessible, however little research has been done to explore the potential for smartphone-based interventions in the PMTCT cascade in low-resource settings. This study explored smartphone use and the acceptability and feasibility of mHealth interventions among postpartum women who were attending the Gugulethu Community Health Centre in Cape Town, South Africa. Methods. This mini-dissertation is composed of three parts. Part A, the protocol, outlines the study methodology and the ethical considerations of the proposed study. Part B, the structured literature review, synthesises available data on uses of mobile phone-based applications to support the PMTCT continuum as well as end-user perceptions and preference for mHealth interventions for PMTCT. The review considered published quantitative and qualitative studies that were conducted in sub-Saharan Africa, the most comparable settings to the study population. Part C, the journal ready manuscript, presents the results of six focus group discussions (FGDs) conducted with 27 HIV-positive, postpartum women who were using a smartphone. Questions assessed the respondent’s general smartphone use, as well as their exposure to and perceptions of mHealth interventions. Results. The review shows that, despite a range of evidence on short message service (SMS) and/or voice call interventions, smartphone-based interventions have not been a focus of prior research to support the PMTCT continuum of care or maternal lifelong ART. Results are promising for SMS and/or voice call to enhance maternal retention, infant HIV testing and infant ART initiation. The review found evidence of acceptability and feasibility of mHealth interventions offered directly to women, or also including their partners and health workers as support systems to address PMTCT challenges. The primary research found little turnover in phones and phone numbers, and about half the women shared their devices with family and friends. Respondents reported high familiarity with smartphone applications such as WhatsApp and Facebook, with WhatsApp cited as the preferred method of smartphone communication. Women had access to reliable data sources such as data bundles, airtime and Wi-Fi, with data bundles perceived as the most cost-effective method to access the internet. Nearly all women were familiar with MomConnect, a national mHealth text support service in South Africa, and most described it positively. Women expressed interest in future HIV mHealth applications including complementary health information on physical activity, nutrition, mental health and basic social services. Conclusions. In the context of rapidly increasing access to smartphones, even in low-resource settings, these findings suggest that future smartphone mHealth interventions may be appropriate to support the PMTCT continuum of care in low-income settings of South Africa. These results call for further studies to evaluate the feasibility and effectiveness of smartphone interventions in similar settings. |
