Mobile (cell) phone communication has been suggested as a method to improve delivery of health services. However, data on the effects of mobile health technology on patient outcomes in resource-limited settings are limited. We aimed to assess whether mobile phone communication between health-care workers and patients starting antiretroviral therapy in Kenya improved drug adherence and suppression of plasma HIV-1 RNA load.
Viral load is a good predictor of treatment failure for patients on HAART. However, in
resource limited setting, viral load tests are not widely available. High adherence rates have been associated with
good treatment outcomes. Information on the use ofsimplified tools to measure adherence in the public sector
is scarce. We intend to demonstrate that a simple tool can be used routinely to monitor adherence in patients
Gjue ( know yourself) is a strategy developed by a consortium of youth organizations led by I Choose
Life- Africa, Liverpool treatment and services and National Organization of Peer Educators to provide HIV testing to over
1 million youth in Kenya. Going by the slogan, Gjue Niko sure Najijua ( I am sure I know my HIV status) , its
main attractiveness is the use of glow- in- the- dark wristbands for everyone who goes for testing under the campaign.
Each glow in dark wristband has a serial number to identify each wristband and to keep track of how many people have
been tested. It also has a toll free number inscribed on it which the youth can call to get information regarding
reproductive health and other post test services.
The purpose of this study is to evaluate the impact of two interventions - Inter-Personal
Communication [IPC] and Dedicated Service Outlets [DSOs] - in recruiting men aged 25-39 years for
Voluntary Medical Male Circumcision (VMMC) services.
The study, to be conducted in two phases, will examine procedural and clinical outcomes, as well as
participant and provider acceptability, of adaptations of the Shang Ring technique for male
circumcision that would simplify its use and increase its acceptability.
Phase I will be non-comparative for exploration of the no-flip technique for Shang Ring circumcision
(i.e. all participants will be circumcised using the no-flip Shang Ring technique). Historical data from
standard Shang Ring circumcisions conducted in Africa (Kenya, Uganda and Zambia) will be used
as the comparison group. Men will be randomized to removal at 7 days after circumcision vs.
delayed removal, to assess occurrence and safety of spontaneous detachments following
circumcision with the no-flip technique.
Phase 2 will compare the use of topical vs. injectable anesthesia for Shang Ring circumcision.
Participants will be randomized to topical vs. injectable anesthesia in a 2:1 ratio. The investigators
rationalize the 2:1 randomization scheme given that the investigators will have just completed Phase
I in which 200 men and boys will have been circumcised using the no-flip technique with injected
anesthesia. However, given the subjectivity associated with using reported pain as the primary
endpoint, the investigators believe it is critical to randomize participants in this phase of the study.
Although gains have been made in achieving the health-related Millennium Development Goals
(MDG), much is still needed in countries affected by high levels of HIV/AIDS. Prevention of motherto-child transmission (PMTCT) is a cornerstone strategy in reducing infant mortality from HIV. The
study will employ a cluster randomized control trial (cRCT) with 26 health facilities randomized to two
arms (intervention or control) to determine the effect of mobile phone technology on completion of
key PMTCT milestones from antenatal to six weeks postpartum. The study will examine the
acceptability, effectiveness, and cost of implementing a PMTCT-focused mHealth strategy among
HIV-infected pregnant women, health workers, and male partners.