JMIR Publications

ABSTRACT

Background:

Use of short message system (SMS) is expanding for data collection but coverage, bias, and logistical constraints are poorly described.

Objective:

To assess the utility of SMS to capture clinical outcomes that occur at home, and potential bias in reporting compared to in-person ascertainment.

Methods:

In a program (PrIYA) that integrated pre-exposure prophylaxis (PrEP) into antenatal care (ANC), postnatal care (PNC), and family planning (FP) facilities in Kisumu County, Kenya, HIV-negative women ≥14 years were offered oral HIV self-tests (HIVST) to take home to male partners. Women who brought their phone to clinic and had a Safaricom SIM were offered registration in an automated communication SMS system (mSurvey) to collect information on HIVST outcomes. Specifically, women were asked questions about whether they offered the test to their male partner, the test process, and test results. HIVST outcomes were ascertained via SMS (sent 2.5 weeks later) and/or in-person if women returned to clinic for a follow-up visit scheduled 1 month later (women who initiated PrEP had scheduled follow-up visits while women who did not initiate PrEP did not). SMS prompted women to reply at no charge. HIVST outcomes were compared between women with scheduled follow-up visits and those without scheduled follow-up visits. HIVST outcomes were also compared between women reporting via SMS vs. in-person at follow-up visits.

Results:

Among 2,123 women offered HIVST and registration in mSurvey, 486 (23%) accepted HIVST, of whom 359 (74%) were eligible for mSurvey; 76 of 170 (45%) women with scheduled follow-up visits and 146 of 189 (77%) without scheduled follow-up visits registered in mSurvey. Among women with scheduled follow-up, 62 (82%) had HIVST outcomes ascertained; 31% in-person, 37% in-person and via SMS, and 32% from SMS alone. Among women without scheduled visits, 87 (60%) had HIVST outcomes ascertained; 3% in-person, 2% in-person and via SMS, and 94% from SMS alone. SMS increased HIVST outcome ascertainment substantially for women with scheduled follow-up (1.48-fold), and captured 82 additional reports from women without scheduled follow-up. Among 222 women with reported HIVST outcomes, frequencies of offering partner HIVST (89% in-person vs 94% SMS only, p=0.31), partner using HIVST (98% vs 96%), women testing with partner HIVST (99% vs 99%), and seeing partner HIVST results (99% vs 97%) were similar between women reporting in-person only versus by SMS only. However, frequency of reports of experiencing harm or negative reactions from partners was more commonly reported in the SMS group (17% vs 2%; p=0.003). Barriers to SMS system registration included not having a Safaricom SIM and not having a functioning phone.

Conclusions:

Our results suggest use of SMS substantially improves completeness of outcome data, does not bias reporting of non-sensitive information, and may increase reporting of sensitive information.