Know Your Audience: Predictors of Success for a @entity1 -Centered Texting XXXX to Augment Linkage to @entity645 Care in Rural Uganda.

@entity1 @entity851 @entity404 @entity7894 @entity645 @entity477
BACKGROUND: Despite investments in infrastructure and evidence for high acceptability, few mHealth interventions have been implemented in sub-Saharan Africa. OBJECTIVE: We sought to (1) identify predictors of uptake of an mHealth application for a low-literacy population of @entity1 living with @entity645 (PLWH) in rural Uganda and (2) evaluate the efficacy of various @entity851 ( @entity851 ) text message formats to optimize the balance between confidentiality and accessibility. METHODS: The trial evaluated the efficacy of a @entity851 text messaging @entity477 to notify PLWH of their laboratory results and request return to care for those with abnormal test results. @entity1 with a normal laboratory result received a single @entity851 text message indicating results were normal. @entity1 with an abnormal test result were randomized to 1 of 3 message formats designed to evaluate trade-offs between clarity and privacy: (1) an @entity851 text message that stated results were abnormal and requested return to clinic ("direct"), (2) the same message protected by a 4-digit PIN code (" @entity7894 ), and (3) the message "ABCDEFG" explained at enrollment to indicate abnormal results ("coded"). Outcomes of interest were (1) self-reported receipt of the @entity851 text message, (2) accurate identification of the message, and (3) return to care within 7 days (for abnormal results) or on the date of the scheduled appointment (for normal results). We fit regression models for each outcome with the following explanatory variables: sociodemographic characteristics, @entity404 count result, ability to read a complete sentence, ability to access a test message on enrollment, and format of @entity851 text message. RESULTS: Seventy-two percent (234/385) of @entity1 successfully receiving a message, 87.6% (219/250) correctly identified the message format, and 60.8% (234/385) returned to clinic at the requested time. Among @entity1 with abnormal tests results (138/385, 35.8%), the strongest predictors of reported message receipt were the ability to read a complete sentence and a demonstrated ability to access a test message on enrollment. @entity1 with an abnormal result who could read a complete sentence were also more likely to accurately identify the message format (AOR 4.54, 95% CI 1.42-14.47, P=.01) and return to clinic appropriately (AOR 3.81, 95% CI 1.61-9.03, P=.002). Those who were sent a PIN-protected message were less likely to identify the message (AOR 0.11, 95% CI 0.03-0.44, P=.002) or return within 7 days (AOR 0.26, 95% CI 0.10-0.66, P=.005). Gender, age, and socioeconomic characteristics did not predict any outcomes and there were no differences in outcomes between those receiving direct or coded messages. CONCLUSIONS: Confirmed literacy at the time of enrollment was a robust predictor of @entity851 text message receipt, identification, and appropriate response for PLWH in rural Uganda. PIN-protected messages reduced odds of clinic return, but coded messages were as effective as direct messages and might augment privacy. TRIAL REGISTRATION: Clinicaltrials.gov NCT 01579214; https://clinicaltrials.gov/ct2/show/NCT01579214 (Archived by WebCite at http://www.webcitation.org/6Ww8R4sKq).
