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Nordberg B, Kaguiri E, Chamorro de Angeles KJ, Gabriel EE, van der Kop ML, Mwangi W, Lester RT, Were E, Ekström AM, Rautiainen S. The use, adherence, and evaluation of interactive text-messaging among women admitted to prevention of mother-to-child transmission of HIV care in Kenya (WelTel PMTCT). BMC Pregnancy Childbirth 2024; 24:25. [PMID: 38172881 PMCID: PMC10763426 DOI: 10.1186/s12884-023-06194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To improve future mobile health (mHealth) interventions in resource-limited settings, knowledge of participants' adherence to interactive interventions is needed, but previous studies are limited. We aimed to investigate how women in prevention of mother-to-child transmission of HIV (PMTCT) care in Kenya used, adhered to, and evaluated an interactive text-messaging intervention. METHODS We conducted a cohort study nested within the WelTel PMTCT trial among 299 pregnant women living with HIV aged ≥ 18 years. They received weekly text messages from their first antenatal care visit until 24 months postpartum asking "How are you?". They were instructed to text within 48 h stating that they were "okay" or had a "problem". Healthcare workers phoned non-responders and problem-responders to manage any issue. We used multivariable-adjusted logistic and negative binomial regression to estimate adjusted odds ratios (aORs), rate ratios (aRRs) and 95% confidence intervals (CIs) to assess associations between baseline characteristics and text responses. Perceptions of the intervention were evaluated through interviewer-administered follow-up questionnaires at 24 months postpartum. RESULTS The 299 participants sent 15,183 (48%) okay-responses and 438 (1%) problem-responses. There were 16,017 (51%) instances of non-response. The proportion of non-responses increased with time and exceeded 50% around 14 months from enrolment. Most reported problems were health related (84%). Having secondary education was associated with reporting a problem (aOR:1.88; 95%CI: 1.08-3.27) compared to having primary education or less. Younger age (18-24 years) was associated with responding to < 50% of messages (aOR:2.20; 95%CI: 1.03-4.72), compared to being 35-44 years. Women with higher than secondary education were less likely (aOR:0.28; 95%CI: 0.13-0.64), to respond to < 50% of messages compared to women with primary education or less. Women who had disclosed their HIV status had a lower rate of non-response (aRR:0.77; 95%CI: 0.60-0.97). In interviews with 176 women, 167 (95%) agreed or strongly agreed that the intervention had been helpful, mainly by improving access to and communication with their healthcare providers (43%). CONCLUSION In this observational study, women of younger age, lower education, and who had not disclosed their HIV status were less likely to adhere to interactive text-messaging. The majority of those still enrolled at the end of the intervention reported that text-messaging had been helpful, mainly by improving access to healthcare providers. Future mHealth interventions aiming to improve PMTCT care need to be targeted to attract the attention of women with lower education and younger age.
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Affiliation(s)
- Björn Nordberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden.
| | | | | | - Erin E Gabriel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Winfred Mwangi
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Directorate of Reproductive Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Richard T Lester
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
| | - Edwin Were
- Department of Reproductive Health, Moi University, Eldoret, Kenya
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, South General Hospital, Stockholm, Sweden
| | - Susanne Rautiainen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
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Hopkins L, Schier H, May L, Westrick M, O'Piela D, Mazurek Melnyk B, Smith L, Gunther C. Patterns of participation in summer programming among United States' elementary children from low-income urban households: Results from the project SWEAT study. Prev Med Rep 2023; 36:102475. [PMID: 37886725 PMCID: PMC10598049 DOI: 10.1016/j.pmedr.2023.102475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Food insecurity increases among marginalized children during the summer when school is out of session. Summer programming that offers access to healthy meals and snacks may reduce the risk. There is a national call in the US for more research to assure equitable access to summer programming. The objective of this prospective observational study was to characterize patterns of participation in summer programming among elementary children from low-income urban neighborhoods of metropolitan[Blinded]. Summer programming was broadly defined (e.g., church, school, recreation center, community center). Caregivers(n = 100) received weekly text messages via TextIt during the summer (Jun-Aug 2017). They were asked: "How many days this week did [ChildName] attend a summer program? Please respond with a number from 0 to 5, where 0 - no days, 2 - 2 days, etc." Weekly counts were summed. Stepwise logistic and linear regression models were conducted to examine differences in patterns of attendance according to key sociodemographic characteristics. Mean age was 7.03 ± 0.23. 52 % identified as female, 70 % were low-income, and 80.0 % identified as Black. 51 % attended summer programming at least once; 49 % never attended. Those who attended at least once vs. not at all were more likely to be male(p < 0.01); 62.75 % males vs. 37.25 % females attended summer programming at least once, whereas 67.35 % females compared to 32.65 % males never attended. Overall mean attendance was 10.40 ± 1.43 days(out of 50). Mean + SE attendance was lower for females (7.52 + 1.76) vs. males (13.52 + 2.21)(p < 0.05), and non-Black (4.30 + 1.97) vs. Black (11.93 + 1.67)(p = 0.01) children. Future research is needed to understand barriers to participation in summer programming.
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Affiliation(s)
- Laura Hopkins
- Department of Public Health and Prevention Science, College of Education and Health Sciences, Baldwin Wallace University, USA
| | - Heather Schier
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
| | - Leah May
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
| | - Miranda Westrick
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
| | - Devin O'Piela
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
| | - Bernadette Mazurek Melnyk
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
| | - Laureen Smith
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
| | - Carolyn Gunther
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
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Rothschild CW, Richardson BA, Guthrie BL, Kithao P, Omurwa T, Mukabi J, Callegari LS, Lokken EL, John-Stewart G, Unger JA, Kinuthia J, Drake AL. Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study. BJOG 2021; 129:926-937. [PMID: 34839583 PMCID: PMC9035040 DOI: 10.1111/1471-0528.17032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the contribution of specific contraceptive side effects to method switch and modern-method discontinuation among Kenyan women. DESIGN A prospective cohort study. SETTING Five counties in Western Kenya. PARTICIPANTS Women aged ≥18 years old and emancipated female minors ≥14 years old using modern, reversible contraception were recruited while attending 10 public health facilities. METHODS Patient-reported side effect symptoms, method switch, and discontinuation were reported through weekly text message-based surveys for 24 weeks. MAIN OUTCOME MEASUREMENTS Prevalence, hazards ratio (HR). RESULTS Among 825 women, 44% were using implants, 43% injectables, 7% intrauterine device, and 6% oral contraceptive pills at enrollment. Most (61%) women were continuing a method used in the previous month. During the 24-week follow-up, incidence of contraceptive switch was 61.3 per 100 person-years (95% confidence interval [CI] 52.4-71.8) and incidence of discontinuation was 38.5 per 100 person-years (95%CI 31.6-47.0). On average, one-quarter (prevalence [Pr] 0.24, 95%CI 0.22-0.26) of participants reported side effects or method problems weekly, with sexual side effects the most prevalent symptom (Pr 0.15, 95%CI 0.13-0.16). Lack of expected bleeding was associated with higher risk of method switch (adjusted hazard ratio [aHR] 2.36, 95%CI 1.22-4.57). Risk of all-modern method discontinuation was higher among women experiencing irregular bleeding (adjusted hazard ratio [aHR] 2.39, 95%CI 1.20-4.77), weight changes (aHR 2.72, 95%CI 1.47-4.68), and sexual side effects (aHR 2.42, 95%CI 1.40-4.20). CONCLUSIONS Addressing irregular bleeding, weight changes, and sexual side effects through development of new products that minimize these specific side effects and anticipatory counseling may reduce method-related discontinuation.
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Affiliation(s)
| | - Barbra A Richardson
- Departments of Biostatistics and Global Health, University of Washington, Seattle, USA, Division of Vaccine and Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Brandon L Guthrie
- Departments of Global Health and Epidemiology, University of Washington, Seattle, USA
| | | | | | | | - Lisa S Callegari
- Departments of Obstetrics & Gynecology and Health Services, University of Washington, Seattle, USA
| | - Erica L Lokken
- Department of Global Health, University of Washington, Seattle, USA
| | - Grace John-Stewart
- Departments of Global Health, Epidemiology, Medicine, and Pediatrics, University of Washington, Seattle, USA
| | - Jennifer A Unger
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, USA
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Janssen JM, McGrath A, Ereman R, Moonan PK, Oeltmann JE, Willis M, McCurdy SA. Use of SMS-linked electronic surveys for COVID-19 case investigation and contact tracing - Marin County, CA, USA. PUBLIC HEALTH IN PRACTICE 2021; 2:100170. [PMID: 34345874 PMCID: PMC8320401 DOI: 10.1016/j.puhip.2021.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/02/2021] [Indexed: 11/02/2022] Open
Abstract
Objectives We sought to quantify the proportion of contacts reported by persons with COVID-19 through a short message service (SMS)-linked survey in comparison to the proportion of contacts reported during a follow-up phone-interview. We also sought to assess improvement in contact tracing timeliness associated with sending SMS-linked surveys. Study design During December 4-15, 2020, persons identified as COVID-19 cases whose data was entered into Marin County's contact tracing database on even days received a SMS-linked survey and persons whose data was entered on odd days did not; all were called for case investigation and contact tracing. Chi-square test and Fisher's exact test were used to compare demographic data. Chi-square test was used to contrast categorical outcomes, and Wilcoxon's rank-sum test was used for continuous outcomes. Results Among 350 SMS-linked survey recipients, 85 (24%) responded and 4 (1%) reported contacts using the survey; an additional 303 contacts were reported during phone interviews. Without phone interviews, 99% of reported contacts would have been missed. There was no meaningful difference between study arms in the proportion of contacts notified within 48 h. Conclusions This SMS-linked survey had low participation and was not useful for identifying contacts. Phone interviews remained crucial for COVID-19 contact tracing.
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Affiliation(s)
- Julia M Janssen
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA
| | - Alana McGrath
- Marin County Department of Health and Human Services, 3240, Kerner Blvd, San Rafael, CA, USA
| | - Rochelle Ereman
- Marin County Department of Health and Human Services, 3240, Kerner Blvd, San Rafael, CA, USA
| | - Patrick K Moonan
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA
| | - John E Oeltmann
- COVID-19 Response Team, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA
| | - Matthew Willis
- Marin County Department of Health and Human Services, 3240, Kerner Blvd, San Rafael, CA, USA
| | - Stephen A McCurdy
- COVID-19 Case and Contact Investigation Unit, Marin County Department of Health and Human Services, 3240 Kerner Blvd, San Rafael, CA, USA
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Wirtz AL, Cooney EE, Stevenson M, Radix A, Poteat T, Wawrzyniak AJ, Cannon CM, Schneider JS, Haw JS, Case J, Althoff KN, Humes E, Mayer KH, Beyrer C, Rodriguez AE, Reisner SL. Digital Epidemiologic Research on Multilevel Risks for HIV Acquisition and Other Health Outcomes Among Transgender Women in Eastern and Southern United States: Protocol for an Online Cohort. JMIR Res Protoc 2021; 10:e29152. [PMID: 33900202 PMCID: PMC8111508 DOI: 10.2196/29152] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The HIV epidemic disproportionately impacts transgender women in the United States. Cohort studies identify unique risks for affected populations, but use of facility-based methods may bias findings towards individuals living in research catchment areas, more engaged in health services, or, in the case of transgender populations, those who are open about their transgender identity. Digital clinical trials and other online research methods are increasingly common, providing opportunity to reach those not commonly engaged in research. Simultaneously, there is a need to understand potential biases associated with digital research, how these methods perform, and whether they are accepted across populations. OBJECTIVE This study aims to assess the feasibility of developing and implementing an online cohort of transgender women to assess risks for HIV acquisition and other health experiences. Further, this study aims to evaluate how an online cohort compares to a site-based, technology-enhanced cohort for epidemiologic research. The overarching goal is to estimate incidence of HIV and other health outcomes among transgender women in eastern and southern United States. METHODS This substudy is part of a larger multisite prospective cohort (LITE) conducted among transgender women, which also includes a site-based, technology-enhanced cohort in 6 eastern and southern US cities. The online cohort was launched to enroll and follow participants across 72 cities in the same region and with similar demographic characteristics as the site-based cohort. Participants are followed for 24 months. Adult transgender women are recruited via convenience sampling (eg, peer referrals, social media, and dating apps). Participants reporting negative or unknown HIV status are enrolled in a baseline study visit, complete a sociobehavioral survey, and provide oral fluid specimens to test for HIV. Participants not living with HIV (lab-confirmed) at baseline are offered enrollment into the cohort; follow-up assessments occur every 6 months. RESULTS Enrollment into the online cohort launched in January 2019. Active recruitment stopped in May 2019, and enrollment officially closed in August 2020. A total of 580 participants enrolled into and are followed in the cohort. A recruitment-enrollment cascade was observed across screening, consent, and completion of study activities. Implementation experiences with HIV test kits highlight the need for heavy staff engagement to support participant engagement, visit completion, and retention, even with automated digital procedures. CONCLUSIONS This study is responsive to increasing research interest in digital observational and intervention research, particularly for populations who are most affected by the HIV epidemic and for those who may otherwise not participate in person. The progression across stages of the recruitment-enrollment cascade provides useful insight for implementation of cohort studies in the online environment. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/29152.
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Affiliation(s)
- Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Erin E Cooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Megan Stevenson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, United States
| | - Tonia Poteat
- Center for Health Equity Research, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Christopher M Cannon
- Research and Evaluation, Whitman-Walker Institute, Washington DC, DC, United States
| | | | - J Sonya Haw
- Emory University School of Medicine, Atlanta, GA, United States
| | - James Case
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, United States.,The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, United States.,Division of Endocrinology, Diabetes, and Hypertension, Brigham Women's Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Harvard University, Boston, MA, United States.,Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States
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- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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