Smartphone ownership and use among pregnant women with HIV in South Africa

Background: Mobile health (mHealth) initiatives are increasingly common in low-resource settings, but the appropriateness of smartphone interventions is uncertain. To inform future mHealth interventions, we describe smartphone ownership, preferences and usage patterns among women living with HIV (WLHIV) in Gugulethu, South Africa. Methods: We screened pregnant WLHIV from December 2019 - February 2021 for the CareConekta trial. We describe sociodemographic characteristics and mobile phone ownership of all women screened (n=639), and smartphone use patterns among those enrolled in the trial (n=193). Results: 91% owned a mobile phone; 87% of those owned smartphones. Among those with smartphones, 92% used Android operating system version 5.0 or above, 98% of phones had GPS and 96% charged their phones <twice/day. Among 193 women enrolled, 99% owned the smartphone themselves; 14% shared their smartphone with someone but 96% of these possessed the phone most of the day. Median duration of smartphone ownership and current phone number was 12 [IQR:5-24] and 25 [IQR: 12-60] months, respectively. Participants reported a median of two [IQR: 1-2] phone numbers in the preceding two years. Receiving (100%) and making (99%) phone calls were the most common smartphone uses; least used were GPS (55%) and email (47%). WhatsApp (94%) was the favourite app reported. Conclusion: Smartphone ownership is very common in this low-resource, peri-urban setting. Phone sharing was uncommon, nearly all used the Android system and phones retained sufficient battery life. These results are encouraging to the development of mHealth interventions. Existing messaging platforms -- particularly WhatsApp -- are exceedingly popular and could be leveraged for interventions.