Background HIV is a major contributor to infant mortality. A significant gap remains between the uptake of infant and maternal antiretroviral regimens and only a minority of HIV-exposed infants receives prophylaxis and safe infant feeding. Losses to follow-up of HIV-exposed infants are associated with shortcomings of facility-based PMTCT models with weak community support of linkages. Use of mobile phones offers an opportunity to improving care and promoting retention for the mother-baby pairs, which is a major challenge in efforts to achieving an HIV-free generation.
Objectives To compare self-reported adherence to infant nevirapine (NVP) prophylaxis and retention in care in HIV exposed infants randomised to 2-weekly mobile phone call versus control (no phone calls).
Design Randomised controlled trial.
Methods 150 mother infant pairs were drawn from postnatal wards of 3 health facilities in Kisumu, and randomly assigned to receive either phone-based reminders on PMTCT messages or standard health care messages (no calls). The group in the intervention arm received phone calls fortnightly. Data on infant adherence to nevirapine, retention in care, safe infant feeding and early HIV testing among HIV-exposed infants were collected by use of a questionnaire at the scheduled Maternal Child Health (MCH) visits (6 and 10 weeks). All analyses were intention to treat.
Results At 6 weeks follow-up, 90.7% (n = 68) of participants receiving phone calls reported adherence to infant NVP prophylaxis, compared with 72% (n = 54) of participants in the control group (p = 0.005). Participants in the intervention arm were also significantly more likely to remain in care than participants in the control group [78.7% (n = 59) vs. 58.7% (n = 44), p = 0.009 at 6 weeks and 69.3% (n = 52) vs. 37.3% (n = 28), p < 0.001 at 10 weeks].
Conclusions These results suggest that phone calls can be an important tool to improve adherence to infant NVP prophylaxis and retention in care for HIV-exposed infants.