A scoping review of mobile health for ART adherence in pregnant and breastfeeding women with HIV in sub-Saharan Africa: preferences, acceptability, and privacy concerns

BACKGROUND: Interventions involving Mobile Health (mHealth) have shown promise to improve retention in care and adherence to antiretroviral therapy (ART) among pregnant or breastfeeding women living with HIV (PBWLH). However, there are concerns surrounding the message preferences, acceptability, and confidentiality. This study aims to map and summarize the available evidence on the use of mHealth interventions in HIV care, especially ART adherence and retention in care, among PBWLH in sub-Saharan Africa, as well as their preferences, acceptability, and privacy concerns about these mHealth interventions. METHODOLOGY: This scoping review was conducted through a comprehensive search using PubMed, Google Scholar, Scopus, and AJOL following PRISMA-ScR guidelines. Search terms included combinations of “mHealth,” “telehealth,” “SMS,” “pregnant,” “HIV,” “Breastfeeding,” and “sub-Saharan Africa” using Boolean operators (AND, OR). Studies were assessed for eligibility, ensuring that only primary studies focusing on mHealth in PBWLH in sub-Saharan Africa were included. RESULTS: A total of 10 eligible studies were included, including randomized controlled trials (RCTs), qualitative studies, and mixed-methods research. The sample sizes ranged from 20 to 825 participants, focusing on PBWLH in sub-Saharan Africa. The mHealth tools included SMS-based texts and phone calls. Most participants preferred covert messages when compared with overt messages due to privacy concerns such as unintentional disclosure of status and phone sharing. Also, there was a high acceptability of mHealth interventions. For the studies on retention in care (nƒ_%=ƒ_%5), three studies showed positive impact of mHealth intervention compared to control whereas two studies were not statistically significant. The two studies had a long intervention length compared to the three which showed positive impact. CONCLUSION: The acceptability of mHealth interventions among PBLWH in sub-Saharan Africa is high, with a higher preference for covert messages. mHealth shows promise in improving retention in care and ART adherence, however, there are mixed results and insufficient evidence. More randomized controlled trials are needed in other sub-Saharan regions to provide more evidence. CLINICAL TRIAL NUMBER: Not applicable

• Population(s)
  • Women
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
• Engagement and Care Cascade
  • Retention in care
  • Treatment
• Health Systems
  • Delivery arrangements