Technical feasibility and uptake of tailored mobile health support for people with HIV in Lesotho

  1. Malebanye D. Lerotholi
  2. Mathebe Kopo
  3. Mpho Kao
  4. Lipontso Motaboli
  5. Moleboheng Mokebe
  6. Ntoiseng Chejane
  7. Makobefo Chakela
  8. Bienvenu L. Nsakala
  9. Blaise Lukau
  10. Irene Ayakaka
  11. Morongoe Nyakane
  12. Tapiwa Tarumbiswa
  13. Adrienne E. Shapiro
  14. Mirko S. Winkler
  15. Niklaus D. Labhardt
  16. Nadine Tschumi
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Abstract

Background Mobile health (mHealth) interventions may improve HIV care in the context of healthcare professional shortages. Here, we evaluate the performance of four mHealth components implemented during the Viral Load Triggered ART Care in Lesotho (VITAL) cluster randomised trial. VITAL enrolled adults with HIV receiving antiretroviral therapy (ART) at rural nurse-led clinics in Lesotho, southern Africa. This secondary analysis includes the nine intervention clinics where participants were offered the following tailored mHealth support: 1) short message services (SMS): viral load result communication, visit and adherence reminders; 2) adherence counselling by phone; 3) callback service; and 4) automated remote tuberculosis screening. We assessed the technical success and uptake of these four mHealth support options. Results Between 14 October 2020 and 7 August 2024, 376,168 SMS notifications were sent to 2,520 participants, with 288,786 (76.8%) successfully delivered messages. Among those, 277,061 (73.7%) were adherence reminders, 6,949 (1.8%) were clinic visit reminders, and 4,776 (1.3%) were viral load result notifications. Among 435 participants with viremia, 316 (72.6%) were successfully informed by SMS, 11 (2.5%) completed remote adherence counselling via phone. Of 129 nurse callback requests from 114 participants, most related to questions regarding ART intake 49 (37.9%) and questions about the VITAL trial 48 (37.2%), followed by other medical issues such as COVID-19 or body pains 9 (7.0%). Of 1,654 automated tuberculosis symptom calls triggered to participants, 31 (1.9%) were answered. Among these, 11 (35.5%) reported tuberculosis symptoms. Conclusions Automated SMS notifications to communicate viral load results and provide reminders for ART adherence and clinic visits encountered high uptake and were technically successful. However, uptake of other phone-based services was low, and technical challenges hindered the implementation of automated remote tuberculosis symptom screening calls. Trial Registration: ClinicalTrials.gov: NCT04527874 (registered 31 August 2020).

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  1. Version published to 10.21203/rs.3.rs-8214790/v1 on Research Square