Research Article
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Published Online: 2 February 2012

Investigation into the Use of Short Message Services to Expand Uptake of Human Immunodeficiency Virus Testing, and Whether Content and Dosage Have Impact

Publication: Telemedicine and e-Health
Volume 18, Issue Number 1

Abstract

Objective: South Africa has one of the highest human immunodeficiency virus (HIV) prevalence rates in the world, but despite the well-established benefits of HIV counseling and testing (HCT), there is low uptake of HCT. The study aimed to investigate the effectiveness of using short message services (SMSs) to encourage HCT while interrogating the impact of altering SMS content and dosage (the number of SMSs). Materials and Methods: About 2,533 participants were recruited via an SMS sent to 24,000 mobiles randomly sampled from a pre-existing database. Recruits were randomly allocated to four intervention groups that received 3 or 10 informational (INFO) or motivational (MOTI) SMSs, and a control group. After the intervention, participants were prompted to go for HCT, and postintervention assessment was done after 3 weeks. Results: In comparison with the control, receipt of 10 MOTI messages had the most impact on uptake of HCT with a 1.7-fold increased odds of testing (confidence interval 95%; p=0.0036). The lack of efficacy of three SMSs indicates a threshold effect, that is, a minimum number of MOTI SMSs is required. INFO SMSs, whether 3 or 10 were sent, did not have a statistically significant effect. The cost can be calculated for the marginal effect of the SMSs, that is, the cost to get people to test over and above those who were likely to test without the intervention. Use of 10 MOTI SMSs yielded a cost-per-tester of $2.41. Conclusions: While there are methodological issues apparent in our study, the results demonstrate the potential of SMSs to influence the uptake of HCT, the importance of appropriate content, and the need to determine a threshold for SMS-based interventions. These results indicate a potential for SMSs to be used more generally for interventions encouraging people to take health-related actions, and the need for further research in this field. The reasonable cost-per-tester is promising for the scale-up of such an intervention.

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References

1.
UNAIDS. Report on the global AIDS epidemic 2010www.unaids.org/globalreport/Global_report.htmMarch312011. 1. UNAIDS. Report on the global AIDS epidemic 2010. Available at www.unaids.org/globalreport/Global_report.htm (last accessed March 31, 2011).
2.
Shisana OSimbayi LCRehle TZungu NPZuma KNgogo NJooste SPillay-Van Wyk VParker WPezi SDavids ANwanyanwu ODinh TH. SABSSM III Implementation Team(2010). South African National HIV Prevalence, Incidence, Behaviour and Communication Survey2008The health of our childrenCape TownHSRC Press2009. 2. Shisana O, Simbayi LC, Rehle T, Zungu NP, Zuma K, Ngogo N, Jooste S, Pillay-Van Wyk V, Parker W, Pezi S, Davids A, Nwanyanwu O, Dinh TH and SABSSM III Implementation Team (2010). South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2008: The health of our children. Cape Town: HSRC Press, 2009.
3.
Scott-Sheldon LACarey MPCarey KBCain DVermaak RMthembu JHarel OSimbayi LCKalichman SC. Impact of HIV testing on sexual health communication in South AfricaSex Transm Infect201187242-247. 3. Scott-Sheldon LA, Carey MP, Carey KB, Cain D, Vermaak R, Mthembu J, Harel O, Simbayi LC, Kalichman SC. Impact of HIV testing on sexual health communication in South Africa. Sex Transm Infect2011;87:242–247.
4.
Kalichman SCCain DSimbayi LC. Behavioral changes associated with testing HIV-positive among sexually transmitted infection clinic patients in Cape Town, South AfricaAm J Public Health2010100714-719. 4. Kalichman SC, Cain D, Simbayi LC. Behavioral changes associated with testing HIV-positive among sexually transmitted infection clinic patients in Cape Town, South Africa. Am J Public Health2010;100:714–719.
5.
South African Government. HIV and AIDS and STI Strategic Plan for South Africa, 2007–2011. South African Governmentwww.doh.gov.za/docs/misc/stratplan-f.htmlMarch312011. 5. South African Government. HIV and AIDS and STI Strategic Plan for South Africa, 2007–2011. South African Government. Available at www.doh.gov.za/docs/misc/stratplan-f.html (last accessed March 31, 2011).
6.
van Dyk ACvan Dyk PJ. “To know or not to know”: Service-related barriers to voluntary HIV counseling and testing (VCT) in South AfricaCurationis2003264-10. 6. van Dyk AC, van Dyk PJ. “To know or not to know”: Service-related barriers to voluntary HIV counseling and testing (VCT) in South Africa. Curationis2003;26:4–10.
7.
Meiberg AEBos AEOnya HESchaalma HP. Fear of stigmatization as barrier to voluntary HIV counselling and testing in South AfricaEast Afr J Public Health2008549-54. 7. Meiberg AE, Bos AE, Onya HE, Schaalma HP. Fear of stigmatization as barrier to voluntary HIV counselling and testing in South Africa. East Afr J Public Health2008;5:49–54.
8.
Peltzer KMlambo GPhaweni K. Factors determining prenatal HIV testing for prevention of mother to child transmission of HIV in Mpumalanga, South AfricaAIDS Behav2010141115-1123. 8. Peltzer K, Mlambo G, Phaweni K. Factors determining prenatal HIV testing for prevention of mother to child transmission of HIV in Mpumalanga, South Africa. AIDS Behav2010;14:1115–1123.
9.
Peltzer KMatseke GMzolo TMajaja M. Determinants of knowledge of HIV status in South Africa: Results from a population-based HIV surveyBMC Public Health20099174. 9. Peltzer K, Matseke G, Mzolo T, Majaja M. Determinants of knowledge of HIV status in South Africa: Results from a population-based HIV survey. BMC Public Health2009;9:174.
10.
Sethosa EPeltzer K. Evaluation of HIV counselling and testing, self-disclosure, social support and sexual behaviour change among a rural sample of HIV reactive patients in South AfricaCurationis20052829-41. 10. Sethosa E, Peltzer K. Evaluation of HIV counselling and testing, self-disclosure, social support and sexual behaviour change among a rural sample of HIV reactive patients in South Africa. Curationis2005;28:29–41.
11.
International Telecommunication Union. Mobile cellular subscriptions 2009www.itu.int/ITU-D/ICTEYE/Indicators/Indicators.aspx#March162011. 11. International Telecommunication Union. Mobile cellular subscriptions 2009. Available at www.itu.int/ITU-D/ICTEYE/Indicators/Indicators.aspx# (last accessed March 16, 2011).
12.
Vodacom Group Annual Report2010http://vodacom.investoreports.com/vodacom_ar_2010/downloads/vodacom_ar_2010.pdfMarch162011. 12. Vodacom Group Annual Report. 2010. Available at http://vodacom.investoreports.com/vodacom_ar_2010/downloads/vodacom_ar_2010.pdf (last accessed March 16, 2011).
13.
Bourne CKnight VGuy RWand HLu HMcNulty A. Short message service reminder intervention doubles sexually transmitted infection/HIV re-testing rates among men who have sex with menSex Transm Infect201187229-231. 13. Bourne C, Knight V, Guy R, Wand H, Lu H, McNulty A. Short message service reminder intervention doubles sexually transmitted infection/HIV re-testing rates among men who have sex with men. Sex Transm Infect2011;87:229–231.
14.
Lester RTRitvo PMills EJKariri AKaranja SChung MHJack WHabyarimana JSadatsafavi MNajafzadeh MMarra CAEstambale BNgugi EBall TBThabane LGelmon LJKimani JAckers MPlummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): A randomised trialLancet20103761838-1845. 14. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball TB, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): A randomised trial. Lancet2010;376:1838–1845.
15.
Juzang IFortune TBlack SWright EBull S. A pilot programme using mobile phones for HIV preventionJ Telemed Telecare201117150-153. 15. Juzang I, Fortune T, Black S, Wright E, Bull S. A pilot programme using mobile phones for HIV prevention. J Telemed Telecare2011;17:150–153.
16.
PopTech. Project Masiluleke: A breakthrough initiative to combat HIV/AIDS utilizing mobile technology & HIV self-testing in South Africawww.poptech.org/system/uploaded_files/27/original/Project_Masiluleke_Brief.pdfMarch312006. 16. PopTech. Project Masiluleke: A breakthrough initiative to combat HIV/AIDS utilizing mobile technology & HIV self-testing in South Africa. Available at www.poptech.org/system/uploaded_files/27/original/Project_Masiluleke_Brief.pdf (last accessed March 31, 2006).
17.
Cole-Lewis HKershaw T. Text messaging as a tool for behavior change in disease prevention and managementEpidemiol Rev20103256-69. 17. Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev2010;32:56–69.
18.
Wei JHollin IKachnowski S. A review of the use of mobile phone text messaging in clinical and healthy behaviour interventionsJ Telemed Telecare20111741-48. 18. Wei J, Hollin I, Kachnowski S. A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions. J Telemed Telecare2011;17:41–48.
19.
Fisher JDFisher WA. Changing AIDS-risk behaviorPsychol Bull1992111455-474. 19. Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull1992;111:455–474.
20.
Zhang HLiao MNie XPan RWang CRuan SZhang CTao XKang DJiang B. Predictors of consistent condom use based on the Information-Motivation-Behavioral Skills (IMB) model among female sex workers in Jinan, ChinaBMC Public Health201111113. 20. Zhang H, Liao M, Nie X, Pan R, Wang C, Ruan S, Zhang C, Tao X, Kang D, Jiang B. Predictors of consistent condom use based on the Information-Motivation-Behavioral Skills (IMB) model among female sex workers in Jinan, China. BMC Public Health2011;11:113.
21.
Fisher JDAmico KRFisher WAHarman JJ. The information-motivation-behavioral skills model of antiretroviral adherence and its applicationsCurr HIV/AIDS Rep20085193-203. 21. Fisher JD, Amico KR, Fisher WA, Harman JJ. The information-motivation-behavioral skills model of antiretroviral adherence and its applications. Curr HIV/AIDS Rep2008;5:193–203.
22.
Kalichman SCSimbayi LC. HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South AfricaSex Transm Infect200379442-447. 22. Kalichman SC, Simbayi LC. HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sex Transm Infect2003;79:442–447.
23.
Mobilisrwww.cell-life.org/cellphones-4-hiv/mobilisrMarch312011. 23. Mobilisr. Available at www.cell-life.org/cellphones-4-hiv/mobilisr (last accessed March 31, 2011).
24.
Cell-Lifewww.cell-life.orgMarch312011. 24. Cell-Life. Available at www.cell-life.org (last accessed March 31, 2011).
25.
Health and Development Africa. Soul City, its real: Evaluation Report Series 2007www.soulcity.org.za/research/evaluations/soul-city-its-real-evaluation-report-2007/evaluation-report-2007/at_download/fileMarch312011. 25. Health and Development Africa. Soul City, its real: Evaluation Report Series 2007. Available at www.soulcity.org.za/research/evaluations/soul-city-its-real-evaluation-report-2007/evaluation-report-2007/at_download/file (last accessed March 31, 2011).
26.
Ihaka RGentleman R. R: A language for data analysis and graphicsJ Comput Graph Stat19965299-314. 26. Ihaka R, Gentleman R. R: A language for data analysis and graphics. J Comput Graph Stat1996;5:299–314.
27.
Weinhardt LSForsyth ADCarey MPJaworski BCDurant LE. Reliability and validity of self-report measures of HIV-related sexual behavior: Progress since 1990 and recommendations for research and practiceArch Sex Behav199827155-180. 27. Weinhardt LS, Forsyth AD, Carey MP, Jaworski BC, Durant LE. Reliability and validity of self-report measures of HIV-related sexual behavior: Progress since 1990 and recommendations for research and practice. Arch Sex Behav1998;27:155–180.
28.
Colleen CFred HRussel LT. A meta-analysis of response rates in Web- or Internet-based surveysEduc Psychol Meas20006821-836. 28. Colleen C, Fred H, Russel LT. A meta-analysis of response rates in Web- or Internet-based surveys. Educ Psychol Meas2000;6:821–836.

Information & Authors

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Published In

cover image Telemedicine and e-Health
Telemedicine and e-Health
Volume 18Issue Number 1January/February 2012
Pages: 18 - 23
PubMed: 22150712

History

Published online: 2 February 2012
Published in print: January/February 2012
Published ahead of print: 8 December 2011
Accepted: 11 July 2011
Received: 31 March 2011

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Authors

Affiliations

Katherine de Tolly
Cell-Life, CPUT BARC Building, Cape Town, South Africa.
Donald Skinner
Research on Health and Society, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa.
Victoria Nembaware
Cell-Life, CPUT BARC Building, Cape Town, South Africa.
Peter Benjamin
Cell-Life, CPUT BARC Building, Cape Town, South Africa.

Notes

Address correspondence to:Katherine de Tolly, M.Phil.Cell-LifeCPUT BARC Building80 Roeland St.Cape Town 8001South Africa
E-mail: [email protected]

Disclosure Statement

No competing financial interests exist.

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