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Mobile phone access and comfort: implications for HIV and tuberculosis care in India and South Africa

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SETTING: India and South Africa shoulder the greatest burden of tuberculosis (TB) and human immunodeficiency virus (HIV) infection respectively, but care retention is suboptimal.

OBJECTIVE: We conducted a study in Pune, India, and Matlosana, South Africa, 1) to identify the factors associated with mobile phone access and comfort of use, 2) to assess access patterns.

DESIGN: A cross-sectional study assessed mobile phone access, and comfort; a longitudinal study assessed access patterns.

RESULTS: We enrolled 261 participants: 136 in India and 125 in South Africa. Between 1 week and 6 months, participant contact decreased from 90% (n = 122) to 57% (n = 75) in India and from 93% (n = 116) to 70% (n = 88) in South Africa. In the latter, a reason for a clinic visit for HIV management was associated with 63% lower odds of contact than other priorities (e.g., diabetes mellitus, maternal health, TB). In India, 57% (n = 78) reported discomfort with texting; discomfort was higher in the unemployed (adjusted OR [aOR] 4.97, 95%CI 1.12–22.09) and those aged ≥35 years (aOR 1.10, 95%CI 1.04–1.16) participants, but lower in those with higher education (aOR 0.04, 95% CI 0.01–1.14). In South Africa, 91% (n = 114) reported comfort with texting.

CONCLUSION: Mobile phone contact was poor at 6 months. While mHealth could transform TB-HIV care, alternative approaches may be needed for certain subpopulations.

Keywords: cascade of care; mHealth; retention

Document Type: Research Article

Affiliations: 1: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 2: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA 3: Byramjee Jeejeebhoy Medical College (BJMC), Pune, India 4: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, Johns Hopkins School of Nursing, Baltimore, MD, USA 5: Perinatal HIV Research Unit, South Africa Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Soweto, South Africa 6: Johns Hopkins School of Medicine, Baltimore, MD, USA, BJMC-Johns Hopkins University Clinical Research Site, Pune, India 7: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, Johns Hopkins School of Medicine, Baltimore, MD, USA, BJMC-Johns Hopkins University Clinical Research Site, Pune, India 8: **Department of Medicine, Weill Cornell Medicine, Center for Global Health, New York, NY, USA

Publication date: July 1, 2019

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