Browsing by Author "Phillips, Tamsin K"
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- ItemOpen AccessCareConekta: study protocol for a randomized controlled trial of a mobile health intervention to improve engagement in postpartum HIV care in South Africa(2020-03-12) Clouse, Kate; Phillips, Tamsin K; Camlin, Carol; Noholoza, Sandisiwe; Mogoba, Phepo; Naidoo, Julian; Langford, Richard; Weiss, Martin; Seebregts, Christopher J; Myer, LandonAbstract Background South Africa is home to the world’s largest antiretroviral therapy program but sustaining engagement along the HIV care continuum has proven challenging in the country and throughout the wider region. Population mobility is common in South Africa, but there are important research gaps in describing this mobility and its impact on engagement in HIV care. Postpartum women and their infants in South Africa are known to be at high risk of dropping out of HIV care after delivery and are frequently mobile. Methods In 2017, we developed a beta version of a smartphone application (app) - CareConekta - that detects a user’s smartphone location to allow for prospective characterization of mobility. Now we will adapt and test CareConekta to conduct essential formative work on mobility and evaluate an intervention - the CareConekta app plus text notifications and phone calls and/or WhatsApp messages - to facilitate engagement in HIV care during times of mobility. During the 3-year project period, our first objective is to evaluate the feasibility, acceptability, and initial efficacy of using CareConekta as an intervention to improve engagement in HIV care. Our second objective is to characterize mobility among South African women during the peripartum period and its impact on engagement in HIV care. We will enroll 200 eligible pregnant women living with HIV and receiving care at the Gugulethu Midwife Obstetric Unit in Cape Town, South Africa. Discussion This work will provide critical information about mobility during the peripartum period and the impact on engagement in HIV care. Simultaneously, we will pilot test an intervention to improve engagement with rigorously assessed outcomes. If successful, CareConekta offers tremendous potential as a research and service tool that can be adapted and evaluated in multiple geographic regions, study contexts, and patient populations. Trial registration ClinicalTrials.gov: NCT03836625. Registered on 8 February 2019.
- ItemOpen AccessPatterns of mobility, and the effect of mobility on viral suppression and retention among postpartum women living with HIV in South Africa(2020) Mazriel, Robyn; Phillips, Tamsin KIntroduction: In South Africa postpartum women have been shown to be at high risk of disengagement from HIV care and postpartum mobility may be related to disruptions in care. This study aimed to describe patterns of mobility, and explore associations with viral suppression and retention in the postpartum period. Methods: This study used data from a prospective cohort study that enrolled women who initiated life-long antiretroviral therapy (ART) during their pregnancy in Gugulethu, Cape Town (March 2013 -June 2014), and an additional follow-up study at approximately 4 years postpartum. Patterns of self-reported mobility between delivery and the 4 year measurement visit were examined. Logbinomial models were used to explore the association between mobility (moving in the 3, 6 or 12 months prior to the study visit) and i) viral suppression (viral load (VL) ≤50 and ≤1000 copies/mL measured at the 12 month and 4 year measurement visit) and ii) retention in care (based on routine medical record data at approximately 12 months and 4 years postpartum). Results: Among the 353 women in this analysis, 98 (28%) reported having ever moved between delivery and 4 years postpartum. Mobility was more likely to occur soon after delivery with 50% of the moves occurring within the first year following delivery; the most common reason for moving being to live with and receive support from family (44%). Moving within 3 months of the viral load measurement at 12 months postpartum was associated with having a VL≤50 copies/mL (aRR=1.61, 95% CI: 1.17-2.21). Moving in any window prior to the 12 month or 4 year postpartum viral load was not associated with viral suppression. Retention in care at both 12 months and 4 years postpartum was not associated with mobility. Conclusions: These results demonstrate that movement following delivery is a common occurrence among postpartum women, but this movement did not seem to disrupt engagement in HIV care. There is a need for further research to understand the impact of this movement on postpartum women's viral suppression and retention in care, as well as on ways to support continued engagement in HIV care after delivery.
- ItemOpen AccessRe-recruiting postpartum women living with HIV into a follow-up study in Cape Town, South Africa(2019-07-26) Mogoba, Phepo; Gomba, Yolanda; Brittain, Kirsty; Phillips, Tamsin K; Zerbe, Allison; Myer, Landon; Abrams, Elaine JAbstract Objective Recruitment and retention present major challenges to longitudinal research in maternal and child health, yet there are few insights into optimal strategies that can be employed in low-resource settings. Following prior participation in a longitudinal study following women living with HIV through pregnancy and breastfeeding in Cape Town, women were re-contacted at least 18 months after the last study contact and were invited to attend an additional follow-up visit. We describe lessons learnt and offer recommendations for a multiphase recruitment approach. Results Using telephone calls, home visits, clinic tracing and Facebook/WhatsApp messages, we located 387 of the 463 eligible women and successfully enrolled 353 (91% of those contacted). Phone calls were the most successful strategy, yielding 67% of enrolments. Over half of the women had changed their contact information since participation in the previous study. We recommend that researchers collect multiple contact details and use several recruitment strategies in parallel from the start of a study. Participants in longitudinal studies may require frequent contact to update contact information, particularly in settings where mobility is common.
- ItemOpen AccessSmartphone usage and preferences among postpartum HIV-positive women in South Africa(2018) Mogoba, Pheposadi L; Phillips, Tamsin KIntroduction. 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.