Impact of short message service and peer navigation on linkage to care and antiretroviral therapy initiation in South Africa

Objective: We examine the efficacy of short message service (SMS) and SMS with peer navigation (SMS + PN) in improving linkage to HIV care and initiation of antiretroviral therapy (ART). Design: I-Care was a cluster randomized trial conducted in primary care facilities in North West Province, South Africa. The primary study outcome was retention in HIV care; this analysis includes secondary outcomes: linkage to care and ART initiation. Methods: Eighteen primary care clinics were randomized to automated SMS (n = 7), automated and tailored SMS + PN (n = 7), or standard of care (SOC; n = 4). Recently HIV diagnosed adults (n = 752) were recruited from October 2014 to April 2015. Those not previously linked to care (n = 352) contributed data to this analysis. Data extracted from clinical records were used to assess the days that elapsed between diagnosis and linkage to care and ART initiation. Cox proportional hazards models and generalized estimating equations were employed to compare outcomes between trial arms, overall and stratified by sex and pregnancy status. Results: Overall, SMS (n = 132) and SMS + PN (n = 133) participants linked at 1.28 [95% confidence interval (CI): 1.01–1.61] and 1.60 (95% CI: 1.29–1.99) times the rate of SOC participants (n = 87), respectively. SMS + PN significantly improved time to ART initiation among non-pregnant women (hazards ratio: 1.68; 95% CI: 1.25–2.25) and men (hazards ratio: 1.83; 95% CI: 1.03–3.26) as compared with SOC. Conclusion: Results suggest SMS and peer navigation services significantly reduce time to linkage to HIV care in sub-Saharan Africa and that SMS + PN reduced time to ART initiation among men and non-pregnant women. Both should be considered candidates for integration into national programs. Trial registration: NCT02417233, registered 12 December 2014; closed to accrual 17 April 2015.

[1]  J. Hubbard,et al.  Improving ART initiation among men who use HIV self‐testing in Malawi: a qualitative study , 2022, Journal of the International AIDS Society.

[2]  S. Baral,et al.  A Systematic Review of Linkage-to-Care and Antiretroviral Initiation Implementation Strategies in Low- and Middle-Income Countries Across Sub-Saharan Africa , 2022, AIDS and Behavior.

[3]  Wayne T. Steward,et al.  Impact of SMS and peer navigation on retention in HIV care among adults in South Africa: results of a three‐arm cluster randomized controlled trial , 2021, Journal of the International AIDS Society.

[4]  N. Sewankambo,et al.  Strategies for retention of heterosexual men in HIV care in sub-Saharan Africa: A systematic review , 2021, PloS one.

[5]  G. Fitzmaurice,et al.  The Treatment Ambassador Program: A Highly Acceptable and Feasible Community-Based Peer Intervention for South Africans Living with HIV Who Delay or Discontinue Antiretroviral Therapy , 2020, AIDS and Behavior.

[6]  A. Wade,et al.  Does peer-navigated linkage to care work? A cross-sectional study of active linkage to care within an integrated non-communicable disease-HIV testing centre for adults in Soweto, South Africa , 2020, PloS one.

[7]  Jennifer A. Unger,et al.  An Interactive Text Messaging Intervention to Improve Adherence to Option B+ Prevention of Mother-to-Child HIV Transmission in Kenya: Cost Analysis , 2020, JMIR mHealth and uHealth.

[8]  E. Igumbor,et al.  Towards achieving the 90–90–90 HIV targets: results from the south African 2017 national HIV survey , 2020, BMC Public Health.

[9]  B. Maughan-Brown,et al.  Poor rates of linkage to HIV care and uptake of treatment after home-based HIV testing among newly diagnosed 15-to-49 year-old men and women in a high HIV prevalence setting in South Africa , 2020, AIDS care.

[10]  L. Myer,et al.  CareConekta: study protocol for a randomized controlled trial of a mobile health intervention to improve engagement in postpartum HIV care in South Africa , 2020, Trials.

[11]  W. Miller,et al.  Improving Monitoring of Engagement in HIV Care for Women in Option B+: A Pilot Test of Biometric Fingerprint Scanning in Lilongwe, Malawi , 2019, AIDS and Behavior.

[12]  T. Peter,et al.  Which community-based HIV initiatives are effective in achieving UNAIDS 90-90-90 targets? A systematic review and meta-analysis of evidence (2007-2018) , 2019, PloS one.

[13]  C. Suraratdecha,et al.  Implementing the package of CDC and WHO recommended linkage services: Methods, outcomes, and costs of the Bukoba Tanzania Combination Prevention Evaluation peer-delivered, linkage case management program, 2014-2017 , 2018, PloS one.

[14]  S. Norris,et al.  “I will leave the baby with my mother”: Long‐distance travel and follow‐up care among HIV‐positive pregnant and postpartum women in South Africa , 2018, Journal of the International AIDS Society.

[15]  T. Bärnighausen,et al.  Why do people living with HIV not initiate treatment? A systematic review of qualitative evidence from low- and middle-income countries , 2018, Social science & medicine.

[16]  Wayne T. Steward,et al.  Engaging HIV-positive clients in care: acceptability and mechanisms of action of a peer navigation program in South Africa , 2018, AIDS care.

[17]  I. Jani,et al.  A combination intervention strategy to improve linkage to and retention in HIV care following diagnosis in Mozambique: A cluster-randomized study , 2017, PLoS medicine.

[18]  R. Sahabo,et al.  Effectiveness of a combination strategy for linkage and retention in adult HIV care in Swaziland: The Link4Health cluster randomized trial , 2017, PLoS medicine.

[19]  A. Kamali,et al.  Brief counselling after home‐based HIV counselling and testing strongly increases linkage to care: a cluster‐randomized trial in Uganda , 2017, Journal of the International AIDS Society.

[20]  G. Woelk,et al.  Optimizing linkage to care and initiation and retention on treatment of adolescents with newly diagnosed HIV infection , 2017, AIDS.

[21]  T. Bärnighausen,et al.  Determinants of time from HIV infection to linkage-to-care in rural KwaZulu-Natal, South Africa , 2017, AIDS.

[22]  R. Lester,et al.  Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya , 2017, Medicine.

[23]  B. Hall,et al.  Enhancing Public Health HIV Interventions: A Qualitative Meta-Synthesis and Systematic Review of Studies to Improve Linkage to Care, Adherence, and Retention , 2017, EBioMedicine.

[24]  A. Lifson,et al.  Implementation of a Peer HIV Community Support Worker Program in Rural Ethiopia to Promote Retention in Care , 2017, Journal of the International Association of Providers of AIDS Care.

[25]  M. Petersen,et al.  High levels of retention in care with streamlined care and universal test and treat in East Africa , 2016, AIDS.

[26]  R. Walensky,et al.  Sizanani: A Randomized Trial of Health System Navigators to Improve Linkage to HIV and TB Care in South Africa , 2016, Journal of acquired immune deficiency syndromes.

[27]  A. Puren,et al.  Attrition and Opportunities Along the HIV Care Continuum: Findings From a Population-Based Sample, North West Province, South Africa , 2016, Journal of acquired immune deficiency syndromes.

[28]  N. Crepaz,et al.  Identifying Best Practices for Increasing Linkage to, Retention, and Re-engagement in HIV Medical Care: Findings from a Systematic Review, 1996–2014 , 2016, AIDS and Behavior.

[29]  Wayne T. Steward,et al.  Evaluation of short message service and peer navigation to improve engagement in HIV care in South Africa: study protocol for a three-arm cluster randomized controlled trial , 2016, Trials.

[30]  P. Braitstein,et al.  Improving Engagement in the HIV Care Cascade: A Systematic Review of Interventions Involving People Living with HIV/AIDS as Peers , 2016, AIDS and Behavior.

[31]  D. Celentano,et al.  Does marital status matter in an HIV hyperendemic country? Findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey , 2016, AIDS care.

[32]  T. Bärnighausen,et al.  Interventions to improve the rate or timing of initiation of antiretroviral therapy for HIV in sub-Saharan Africa: meta-analyses of effectiveness , 2016, Journal of the International AIDS Society.

[33]  Wayne T. Steward,et al.  Why increasing availability of ART is not enough: a rapid, community-based study on how HIV-related stigma impacts engagement to care in rural South Africa , 2015, BMC Public Health.

[34]  T. Quinn,et al.  Effectiveness of Peer Support on Care Engagement and Preventive Care Intervention Utilization Among Pre-antiretroviral Therapy, HIV-Infected Adults in Rakai, Uganda: A Randomized Trial , 2015, AIDS and Behavior.

[35]  M. Siedner,et al.  A combination SMS and transportation reimbursement intervention to improve HIV care following abnormal CD4 test results in rural Uganda: a prospective observational cohort study , 2015, BMC Medicine.

[36]  M. Hughes,et al.  An Augmented SMS Intervention to Improve Access to Antenatal CD4 Testing and ART Initiation in HIV-Infected Pregnant Women: A Cluster Randomized Trial , 2015, PloS one.

[37]  Peng Li,et al.  Small sample performance of bias‐corrected sandwich estimators for cluster‐randomized trials with binary outcomes , 2015, Statistics in medicine.

[38]  N. Ford,et al.  Interventions to promote adherence to antiretroviral therapy in Africa: a network meta-analysis. , 2014, The lancet. HIV.

[39]  N. Thielman,et al.  Enhancing Linkage and Retention in HIV Care: a Review of Interventions for Highly Resourced and Resource-Poor Settings , 2014, Current HIV/AIDS Reports.

[40]  Davies Kimanga,et al.  If you text them, they will come: using the HIV infant tracking system to improve early infant diagnosis quality and retention in Kenya , 2014, AIDS.

[41]  T. Bärnighausen,et al.  Interventions to improve adherence to antiretroviral therapy: a rapid systematic review , 2014, AIDS.

[42]  A. Stein,et al.  Pregnant Women Living with HIV (WLH) Supported at Clinics by Peer WLH: A Cluster Randomized Controlled Trial , 2014, AIDS and Behavior.

[43]  N. Ford,et al.  Interventions to improve or facilitate linkage to or retention in pre-ART (HIV) care and initiation of ART in low- and middle-income settings – a systematic review , 2014, Journal of the International AIDS Society.

[44]  F. Behets,et al.  Patient Retention From HIV Diagnosis Through One Year on Antiretroviral Therapy at a Primary Health Care Clinic in Johannesburg, South Africa , 2013, Journal of acquired immune deficiency syndromes.

[45]  I. Sanne,et al.  Linkage to Care and Treatment for TB and HIV among People Newly Diagnosed with TB or HIV-Associated TB at a Large, Inner City South African Hospital , 2013, PloS one.

[46]  M. Egger,et al.  Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub‐Saharan Africa: systematic review and meta‐analysis , 2012, Tropical medicine & international health : TM & IH.

[47]  D. Watson-Jones,et al.  Patient Attrition Between Diagnosis With HIV in Pregnancy-Related Services and Long-Term HIV Care and Treatment Services in Kenya: A Retrospective Study , 2012, Journal of acquired immune deficiency syndromes.

[48]  Michael Rayment,et al.  Prevention of HIV-1 infection with early antiretroviral therapy , 2012, Journal of Family Planning and Reproductive Health Care.

[49]  S. Shade,et al.  Predictors of Linkage to Care Following Community-Based HIV Counseling and Testing in Rural Kenya , 2012, AIDS and Behavior.

[50]  Rebecca Guy,et al.  How effective are short message service reminders at increasing clinic attendance? A meta-analysis and systematic review. , 2012, Health services research.

[51]  F. Wabwire-mangen,et al.  A Single-Blind randomized controlled trial to evaluate the effect of extended counseling on uptake of pre-antiretroviral care in eastern uganda , 2011, Trials.

[52]  E. Katabira,et al.  Improving Clinic Attendance and Adherence to Antiretroviral Therapy Through a Treatment Supporter Intervention in Uganda: A Randomized Controlled Trial , 2011, AIDS and Behavior.

[53]  G. Cooke,et al.  Retention in HIV Care for Individuals Not Yet Eligible for Antiretroviral Therapy: Rural KwaZulu-Natal, South Africa , 2011, Journal of acquired immune deficiency syndromes.

[54]  W. Jack,et al.  Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial , 2010, The Lancet.

[55]  S. Lawn,et al.  Linkage to HIV Care and Antiretroviral Therapy in Cape Town, South Africa , 2010, PloS one.

[56]  M J van der Laan,et al.  Covariate adjustment in randomized trials with binary outcomes: Targeted maximum likelihood estimation , 2009, Statistics in medicine.

[57]  Christopher Dye,et al.  Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model , 2009, The Lancet.

[58]  K. Zuma,et al.  South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017: towards achieving the UNAIDS 90-90-90 targets , 2019 .

[59]  B. Giraudeau,et al.  [Cluster randomised trials]. , 2014, Annales de dermatologie et de venereologie.

[60]  Josip Car,et al.  Mobile phone messaging reminders for attendance at healthcare appointments. , 2012, The Cochrane database of systematic reviews.