A newly published, Canadian government funded study documents how a simple, inexpensive effort to send short, informative text messages regularly to young women's phones could help significantly reduce the ongoing scourge of human immunodeficiency virus (HIV) infection in Africa.
Writing in the journal Sexually Transmitted Diseases, researchers describe the results of sending once-a-week texts about HIV, contraceptives, sexually transmitted disease, and pregnancy to 300 female college students in rural Kenya.
Within six months of the last message, roughly two-thirds (201 women, or 67%) in the intervention group had taken an HIV test, compared with roughly half (155, or 51%) of 300 women in a control group who were not sent text message.
As well, monthly surveys of all 600 participants in both cohorts showed that women receiving a weekly message sought testing much sooner than those who got tested but didn't receive regular texts (median time: 12 weeks from the end of texting vs. 20).
Supported with a $112,000 grant from Grand Challenges Canada, funded by the Government of Canada, researchers based in Kenya (led by Kenyatta National Hospital, in association with Kenya Medical Research Institute, and Jomo Kenyatta University of Agriculture and Technology) and the University of Washington, Seattle, recruited the 600 participants from four colleges in largely rural central Kenya between September 2013 and March 2014.
Over five months, 300 participants received the weekly texts and completed a monthly survey; 300 were only surveyed monthly.
Sample text messages:
- Did you know that not all STIs (eg, HIV) have symptoms? Use a condom to prevent acquisition of STIs.
- Protect yourself against HIV and unwanted pregnancy by using condoms correctly and consistently during sex.
- Abstinence is the only 100% effective way to prevent pregnancy. The second best way is to use contraceptives. Contraceptives are safe for use by young women. However, only condoms can reduce your risk of acquiring HIV.
Messages evolved to avoid repetition and maintain participant interest; all ended with the statement "Get tested for HIV."
"This study documents a simple, inexpensive program to promote sexual health and early identification of HIV-infected individuals," said project lead Dr Njambi Njugana of Kenyatta National Hospital. "These results are promising because HIV testing is a fundamental part of HIV prevention programs. The majority -- 53% -- of HIV-infected individuals in Kenya is unaware of their status, and only half of young Kenyan women have extensive knowledge about how HIV is transmitted and prevented."
"Our work shows the feasibility of providing health education and collecting data from young women via SMS. We're hopeful that text messaging programs could be implemented and scaled widely, resulting in significant increases in HIV testing among college students in Kenya and beyond."
"Canada is determined to make a meaningful difference in improving the rights and health of women and children," said the Honourable Marie-Claude Bibeau, Canada's Minister of International Development and La Francophonie. "Women and girls are central to our efforts and we need to empower them to be in charge of their own health and their own future."
"In this study, 'I get the message,' took on important double meaning and led many who might not have otherwise to seek important testing for HIV ," said Dr. Peter A. Singer, Chief Executive Officer of Grand Challenges Canada.
"Without knowledge of sexual and reproductive health care services, women and girls cannot plan for their future or lift themselves out of poverty. These results offer a promising example of how Canada a making a meaningful difference to development through its funding of global health innovation."
Grand Challenges Canada's Stars in Global Health program provides seed funding for transformative solutions to global health problems identified by innovators in Canada and in low- and middle-income countries.
More than half of Kenyans infected human immunodeficiency virus (HIV) are unaware of their status.
The study involved 600 young women (ranging from 18 to 24; average age 21) at two technical colleges and two teachers training colleges in largely rural Kiambu County in Central Kenya. Half were assigned to receive weekly HIV-related text messages; all agreed to a monthly survey.
Of the women, 71.50% had had sex at least once in the past and 72.62% had never tested for HIV.
The participants chosen were either HIV uninfected or unaware of their HIV status, had not tested for HIV in the preceding 12 months, owned a mobile phone, had regular access to electricity to charge the phone, and knew how to send and receive text messages.
Training was provided on completing the monthly SMS survey about HIV testing and sexual behavior, including instructions to delete the messages after responding as a privacy measure.
Based on earlier discussions with college students, 63 text messages for the intervention group were developed in six topic categories: pregnancy, contraceptives, sexually transmitted infections, condoms, anal and oral sex, and HIV risk.
Recipients had the option to send a return SMS requesting additional messages on the same topic or access a menu enabling exploration of the other topics. Each woman could request up to 3 additional messages per week.
The monthly surveys were sent for five consecutive months and included questions about HIV testing, number of new and recurrent sex partners, sexual frequency and condom use, pregnancy and pregnancy intent, and perceived risk of HIV during the past month.
A total of 356 women reported testing at least once for HIV in six months of study follow-up: 201 (67%) in the intervention arm and 155 (51%) in the control arm.
Of the 356 participants who reported testing for HIV at least once during study follow-up, 106 (17.66%) reported testing once during study follow-up, 102 (17%) tested twice, and 148 (24.67%) tested 3 or more times.
The median time to first HIV test was 12 weeks for women in the intervention arm and 20 weeks for women in the control arm.
Kenya has 33.6 million mobile phone subscribers -- 83% of the population -- and subscribers prefer text messages to calling.
Previous studies have used text messaging in Kenya successfully to increase antiretroviral (ART) adherence, maintain care for HIV-exposed infants improve childhood vaccination and retain men in postoperative care after medical male circumcision.
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About Grand Challenges Canada
Grand Challenges Canada is dedicated to supporting Bold Ideas with Big Impact® in global health. We are funded by the Government of Canada and we support innovators in low- and middle-income countries and Canada. The bold ideas we support integrate science and technology, social and business innovation -- we call this Integrated Innovation®. Grand Challenges Canada focuses on innovator-defined challenges through its Stars in Global Health program and on targeted challenges in its Saving Lives at Birth, Saving Brains and Global Mental Health programs. Grand Challenges Canada works closely with Canada's International Development Research Centre (IDRC), the Canadian Institutes of Health Research (CIHR) and Global Affairs Canada to catalyze scale, sustainability and impact. We have a determined focus on results, and on saving and improving lives.