Antiretroviral Drug Management Tool and Performance of HIV/AIDS projects in Kisumu County, Kenya: A Digital Heath Solution Approach

The aim of this study was to assess the influence of utilization of the digital health intervention for antiretroviral drug management on performance of HIV/AIDS projects in Kisumu County. An ex-post facto cross-sectional descriptive study was conducted to gain understanding on the influence of the use of the digital health intervention for antiretroviral drug management on the performance of the HIV/AIDS projects. The study was conducted in eight (2 level V and 6 level IV) health facilities providing HIV/AIDS care and treatment in Kisumu. Using a census approach the study recruited 191 participants who were health service providers across the study sites. The study used a 5-point Likert scale to measure the perspectives of the participants on aspects of utilization of the digital health intervention for antiretroviral drug management and performance of HIV/AIDS projects. A key informant interview guide was used to collect qualitative data. There was a positive significant relationship between utilization of digital health interventions for antiretroviral drug management and performance of HIV/AIDS projects with a Pearson Coefficient value=0.507, p value<0.001. A linear regression model gave an R square value of = 0.332, indicating that utilization of the digital health intervention for ARV drug management could positively influence up to 33.2% of improvement in performance of HIV/AIDS projects. This study concluded that using technology to manage drugs has potential to significantly improve overall performance of a health project. Increased investment towards scaling implementation of the Web antiretroviral dispensing tool as the commonly used intervention

Enhancing Performance of HIV/AIDS Projects through Digital Health Interventions for Client Appointments in Kisumu County, Kenya

This study examined the perceptions of health service providers on the relationship between utilization of digital health intervention (DHI) for clients’ adherence to appointments and performance of HIV/AIDS projects in Kisumu County using an ex-post facto cross-sectional descriptive survey design. A census approach was used to recruit 191 participants who were at work during the data collection period across eight health facilities where the DHI was being used. Quantitative data was collected electronically using a questionnaire built a 5-point Likert scale and analyzed using SPSS version 26. Descriptive analysis involved generating the means and standard deviations while inferential analysis involved determining correlations and linear regression modelling. Results for both descriptive and inferential statistics are presented using tables. Qualitative data was collected using a key informant interview guide and analyzed thematically. Data were collected in January 2022. Results show a high level of utilization of DHI for clients’ appointments adherence (composite mean =4.28; SD=0.77; CI=95%). Performance of HIV/AIDS projects was scored highly with a composite mean of 4.47 (SD=0.057; CI=95%). A Pearson correlation coefficient of 0.349; p value<0.001, showed a statistically significant positive relationship between the two variables. Utilization of DHI for clients’ appointments adherence could potentially influence performance of HIV/AIDS projects by up to 28% (R2=0.28, p value<0.001). The study concluded that the DHI for clients’ appointments adherence was critical in improving adherence to treatment plans and management of appointments as an electronic diary at the health facilities hence improving performance of HIV/AIDS projects

WHISPER or SHOUT study: protocol of a cluster-randomised controlled trial assessing mHealth sexual reproductive health and nutrition interventions among female sex workers in Mombasa, Kenya

Introduction New interventions are required to reduce unintended pregnancies among female sex workers (FSWs) in low- and middle-income countries and to improve their nutritional health. Given sex workers’ high mobile phone usage, repeated exposure to short messaging service (SMS) messages could address individual and interpersonal barriers to contraceptive uptake and better nutrition. Methods In this two-arm cluster randomised trial, each arm constitutes an equal-attention control group for the other. SMS messages were developed systematically, participatory and theory-driven and cover either sexual and reproductive health (WHISPER) or nutrition (SHOUT). Messages are sent to participants 2–3 times/week for 12 months and include fact-based and motivational content as well as role model stories. Participants can send reply texts to obtain additional information. Sex work venues (clusters) in Mombasa, Kenya, were randomly sampled with a probability proportionate to venue size. Up to 10 women were recruited from each venue to enrol 860 women. FSWs aged 16–35 years, who owned a mobile phone and were not pregnant at enrolment were eligible. Structured questionnaires, pregnancy tests, HIV and syphilis rapid tests and full blood counts were performed at enrolment, with subsequent visits at 6 and 12 months. Analysis The primary outcomes of WHISPER and SHOUT are unintended pregnancy incidence and prevalence of anaemia at 12 months, respectively. Each will be compared between study groups using discrete-time survival analysis. Potential limitations Contamination may occur if participants discuss their intervention with those in the other trial arm. This is mitigated by cluster recruitment and only sampling a small proportion of sex work venues from the sampling frame. Conclusions The design allows for the simultaneous testing of two independent mHealth interventions for which messaging frequency and study procedures are identical. This trial may guide future mHealth initiatives and provide methodological insights into use of reciprocal control groups

A Mobile Phone–Based Sexual and Reproductive Health Intervention for Female Sex Workers in Kenya: Development and Qualitative Study

Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women\u27s Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya. Objective: This paper aimed to (1) describe the process of development of the WHISPER intervention, its theoretical framework, key content domains and strategies and (2) explore workshop participants\u27 responses to the proposed intervention, particularly with regard to message content, behavior change constructs, and feasibility and acceptability. Methods: The research team worked closely with FSWs in two phases of intervention development. First, we drafted content for three different types of messages based on a review of the literature and behavior change theories. Second, we piloted the intervention by conducting six workshops with 42 FSWs to test and refine message content and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach. Results: The intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to intervention content revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the content empowering, and most said they would share the messages with others. The refined intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information. Conclusions: Our results highlight the need for health promotion interventions that incorporate broader components of SRHR, not only HIV prevention. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs\u27 lives and provides a feasible, acceptable approach for addressing SRHR concerns and needs. FSWs may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behavior change

“I now know I’m the boss”: Development of mobile phone-based sexual and reproductive health intervention for female sex workers in Kenya

Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and STI prevention and management, alcohol awareness, gender-based violence and rights, and healthcare utilization. The WHISPER mobile phone intervention uses a participatory development approach and behaviour change theory to address these high-priority concerns of FSWs in Mombasa, Kenya. Objective: This paper aims to describe the development and content of the WHISPER intervention, its theoretical framework and key content domains, and; explore workshop participants’ responses to the proposed intervention, particularly with regards to message content and behavior change constructs. Methods: The research team worked closely with FSWs in two phases of intervention development. First, we drafted content based on review of the literature and behavior change theories. Second, we conducted six workshops with 42 FSWs to test and refine message content, and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach. Results: The intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to content in these domains revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the messages empowering to themselves and their communities, and most said they would share the messages with others. The final intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information. Conclusions: Our results highlight the need for health promotion interventions that incorporate both HIV/STI prevention and management and broader components of SRHR. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs’ lives and provides a feasible approach for addressing their SRHR concerns and needs. FSW may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behaviour change

WHISPER or SHOUT study: protocol of a cluster-randomised controlled trial assessing mHealth sexual reproductive health and nutrition interventions among female sex workers in Mombasa, Kenya

Introduction: New interventions are required to reduce unintended pregnancies among female sex workers (FSWs) in low- and middle-income countries and to improve their nutritional health. Given sex workers' high mobile phone usage, repeated exposure to short messaging service (SMS) messages could address individual and interpersonal barriers to contraceptive uptake and better nutrition. Methods: In this two-arm cluster randomised trial, each arm constitutes an equal-attention control group for the other. SMS messages were developed systematically, participatory and theory-driven and cover either sexual and reproductive health (WHISPER) or nutrition (SHOUT). Messages are sent to participants 2-3 times/week for 12 months and include fact-based and motivational content as well as role model stories. Participants can send reply texts to obtain additional information. Sex work venues (clusters) in Mombasa, Kenya, were randomly sampled with a probability proportionate to venue size. Up to 10 women were recruited from each venue to enrol 860 women. FSWs aged 16-35 years, who owned a mobile phone and were not pregnant at enrolment were eligible. Structured questionnaires, pregnancy tests, HIV and syphilis rapid tests and full blood counts were performed at enrolment, with subsequent visits at 6 and 12 months. Analysis: The primary outcomes of WHISPER and SHOUT are unintended pregnancy incidence and prevalence of anaemia at 12 months, respectively. Each will be compared between study groups using discrete-time survival analysis. Potential limitations: Contamination may occur if participants discuss their intervention with those in the other trial arm. This is mitigated by cluster recruitment and only sampling a small proportion of sex work venues from the sampling frame. Conclusions: The design allows for the simultaneous testing of two independent mHealth interventions for which messaging frequency and study procedures are identical. This trial may guide future mHealth initiatives and provide methodological insights into use of reciprocal control groups.</p