Tanzania: Mobile Phones Help Mothers Avoid Passing HIV On to Their Children

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Pumwani Maternity Hospital, in the impoverished Nairobi neighbourhood of Eastlands, is the site of a trial project using mobile phones to help HIV-positive mothers avoid passing the virus on to their children. Juliet Wangari Njuguna is a research nurse with Kenya Aids Control Project. She works at the Pumwani clinic to assist HIV-positive mothers.

"We help with the enrolment, and as the patients are coming in they are sifted. We talk to the ones who happen to be HIV positive, and we find out how long they have known their status and if they have disclosed it to anyone." They also find out if the women have a mobile phone.

In July, the Kenya Aids Control Project started using the Pumwani Hospital as a site to study the potential of following up with HIV positive patients using mobile phones.

The phone contact is intended to make sure that mothers are keeping up with taking their antiretroviral medicines and stay informed on what they need to do during their pregnancy to reduce the risk of passing the virus on to their child.

Mobile phones have become a popular means of communication in Kenya. The recent lowering of costs by the various service providers is encouraging even more people to embrace the mobile phone.

Pediatrician Frida Govedi, the chief executive officer of Pumwani Maternity Hospital, says, "through this telephony they are being empowered with information. How they should eat, when they should take their vitamins, when they should come for their CD4 counts, it is an interactive medium between the mother and the healthcare worker."

Ms Njuguna and the other research nurses at Pumwani guide HIV-positive mothers at the clinic through a questionnaire to determine if they are candidates for the mobile phone programme. The questionnaire records details such as the woman's age, her general health, how long she has known that she is HIV positive and if she is already on any medication.

The mother also has to live within a reasonable distance of the hospital and be able to understand English or Kiswahili. The questionnaire responses are entered into a database. All the women will receive antiretroviral therapy, but a randomly selected group will also receive SMS messages.

All the women will be followed-up after they give birth to assess the success of the course of treatment. This is also aimed at measuring the effectiveness of the SMS prompts to the mothers receiving the messages against the results of a control group.

"The women start receiving one message per week reminding them to come for their antenatal care visit," says Ms Njuguna. "Then in their last month of pregnancy, the message changes to remind them to take their drugs.

"But we write, 'Remember to take your vitamins.' We don't want to put 'ARVs' in a text message, because we don't know who can come across their phones." Ms Njuguna says stigma and the pressure to hide one's HIV status are a major challenge for HIV positive women.

Extreme poverty is another challenge, with women sometimes missing appointments due to a lack of money for transport or at times not being able to make it as they struggle to make ends meet.

Literacy is yet another obstacle. "Another thing is that some of them understand English and Kiswahili, but they can't read, so the text messages will not help them. So there are some who feel like we should do calls in the future."

Dr Govedi worries that the potential advantages of the SMS notification system are also limited by the late enrolment into the programme of many of the women, who are far into their pregnancy by the time they first come to Pumwani.

"We would have loved to have gotten them as early as 14 weeks, when we are able to institute their antiretroviral therapy for PMTCT. But you find most of the mothers are coming to us well after 20 weeks," says Dr Govedi.

A day in the life of the health workers providing mobile support is busy. Njuguna must keep up with responding to various text messages and calls from the over 90 women enrolled in the programme, as well as ensuring crucial information is sent out at the right time.

The routine messages are programmed into a computer and sent out automatically, but when that system is down, a health worker must send them out manually to the women who depend on the reminders.

She feels it's worth the extra work. "It feels good that you are doing something and they are grateful.

Then they tend to ask you all sorts of questions, which is better than being at home and assuming things. So you feel like you are having an impact in people's lives."

The initiative is expected to end in mid-2013. Researchers hope to find positive results in empowering women living with HIV to protect their own health and that of their newborn children.