Pilot Trial of Quarterly Text-Based Patient Contacts to Increase Engagement in HIV Care Postpartum: Lessons Learned

Abstract

Introduction: In South Carolina, there is a high prevalence of pregnant and postpartum individuals with HIV not engaged in medical care, potentially resulting in higher rates of perinatal transmission. Innovative patient-centered approaches are needed to improve care access and engagement. The purpose of this study was to determine if text-based communication during the postpartum period would result in increased HIV care engagement and HIV viral suppression after delivery. Methods: We conducted a 21-month prospective pilot study. Postpartum people with HIV were texted a quarterly message following the delivery of a viable infant. Texts were in the form of a brief survey to inquire about their well-being and if they desired antiviral medication refills, contraceptive services, or an appointment. We evaluated the number of postpartum people who had a HIV care visit and/or HIV RNA tests within 12 months postpartum. One-year postpartum, participants were offered phone interviews to collect feedback on program quality. Results: Twenty-nine people with HIV delivered viable infants. Eight (28%) responded to at least one text message postpartum. Twenty (69%) were 1-year postpartum and eligible for analysis, and four (20%) agreed to phone interviews. Less than half of 1-year postpartum people had an HIV care visit (n = 9, 45%). More than half had an HIV RNA test (n = 13, 65%), but only 69% were virally suppressed (n = 9). Discussion: Although interviewed participants provided positive feedback, fewer postpartum people with HIV utilized text communications than expected (28%). Postpartum engagement in HIV care and ongoing viral suppression were lower than desired (52% and 80%), and text responders were not more engaged or more likely to be suppressed. Strategies to improve ongoing postpartum care engagement are still needed.