Pumwani Maternity Hospital, in the impoverished Nairobi neighbourhood of Eastlands, is the site of a trial project using mobile phones to help HIV-positive mothers avoid passing the virus on to their children.
Juliet Wangari Njuguna is a research nurse with Kenya Aids Control Project. She works at the Pumwani hospital to assist HIV-positive mothers.
“We help with enrolment, and as patients come in they are sifted. We talk to those who happen to be HIV positive and find out how long they have known their status and if they have disclosed it to anyone,” said Ms Njuguna.
They also find out if the women have mobile phones. In July, the Kenya Aids Control Project started using Pumwani as a site for a study on the potential of following up on HIV positive patients using mobile phones.
The phone contact is intended to ensure that mothers keep taking their antiretroviral medicines and stay informed on what they need to do during pregnancy to reduce the risk of passing the virus on to their unborn child.
Mobile phones have become a popular means of communication in Kenya. The recent lowering of calling costs by service providers has encouraged more people to embrace the technology.
Pumwani Maternity Hospital chief executive, paediatrician Frida Govedi, said; “through this telephony they are being empowered with information. How they should eat, when they should take their vitamins, when they should come for their CD4 count; it is an interactive medium between the mother and the healthcare worker.”
Ms Njuguna and other research nurses at Pumwani take HIV-positive mothers through a questionnaire to determine whether they are candidates for the mobile phone programme.
The questionnaire records details such as a woman’s age, her general health, how long she has known that she is HIV positive, and if she is already on medication.
The mother also has to live within a reasonable distance of the hospital and be able to understand English or Kiswahili.
Questionnaire responses are entered into a database. All women subjected to the questionnaire receive antiretroviral therapy, but a randomly selected group also receives SMS messages.
The women are followed-up after they give birth to assess the success of the course of treatment. This is also aimed at measuring the effectiveness of the SMS prompts.
“The women start receiving one message per week, reminding them to come for their antenatal care visit,” said Ms Njuguna.
“In their last month of pregnancy, the message changes to remind them to take their drugs. But we write, ‘Remember to take your vitamins.’ We don’t want to put ‘ARVs’ in a text message, because we don’t know who can come across their phones.”
Ms Njuguna said stigma and the pressure to hide one’s HIV status were a major challenge for HIV positive women.
Extreme poverty is another challenge, with women sometimes missing appointments due to lack of money for transport or being tied down by the struggle to make ends meet.
Literacy is yet another obstacle. “Another thing is that some of them understand English and Kiswahili but they can’t read, so the text messages do not help them. Some say we should call them instead.”
Ms Govedi worries that the potential advantages of the SMS notification system are limited by many women’s late enrolment into the programme.
Such women are far into their pregnancy by the time they come to Pumwani.
“We would have loved to have gotten them as early as 14 weeks, when we are able to institute their antiretroviral therapy. But most of the mothers come to us well after 20 weeks,” said Ms Govedi.
Health workers providing the mobile support have a busy schedule.
Ms Njuguna, for instance, responds to numerous text messages and calls from the over 90 women enrolled in the programme, as well as ensuring crucial information is sent out to them at the right time.
Routine messages are programmed into a computer and sent out automatically, but when the system is down a health worker must send them out to the women manually.
“It feels good to do something useful to others and the women are grateful. They tend to ask all sorts of questions. You feel like you are having an impact in people’s lives.” The initiative is expected to end in mid 2013. Researchers hope to find positive results in empowering women living with HIV to protect their health and that of their newborn children.