Mobile Phone Technology for Prevention of Mother-to-Child Transmission of HIV (WHO)

Overview

Effective implementation of prevention of mother-to-child transmission of HIV (PMTCT) strategies has resulted in the virtual elimination of pediatric HIV in resource-rich settings. Weak health systems and inadequate health infrastructures impede universal provision of PMTCT services in sub-Saharan Africa. Transportation challenges and costs further influence individuals’ decisions to access static health facilities, and are often cited causes for suboptimal retention in HIV treatment programs. Mobile outreach clinical services bring medical services into the community, and are currently being implemented to improve uptake of basic (standard) maternal child health services.

This study compared the impact of provision of standard mobile outreach clinical services to the provision of enhanced mobile outreach clinical services that includes point-of-care CD4 testing and use of short message system (SMS) mobile phone technology to improve turnaround times in infant HIV DNA PCR test results. The enhanced mobile outreach clinical service also introduced the use of existing community health workers to create demand for outreach services; mobilize pregnant women to access antenatal clinic (ANC) services; and support referrals and linkages between mobile units and static facilities. Proposed measurements included the effect of the intervention on decreasing the gestational age at the first ANC visit; retention of mothers and infants in care; and uptake of critical health care services including immunizations, laboratory testing, and antiretroviral (ARV) prophylaxis and treatment (ART). The study determined whether the enhanced mobile outreach services result in increased administration of appropriate antiretrovirals to HIV-positive women, and whether more HIV-positive infants gain access to life-saving treatment. Costs associated with the standard and enhanced mobile outreach clinical services were determined, and along with the measured differential effect on selected outcomes, were useful in guiding policy regarding the optimal scope of mobile outreach clinical service delivery.