“The messages gave me hope”

In Mombasa, viral suppression among women with HIV who sell sex improved thanks to a text-message service that motivated and supported them to keep taking medication. 

What is the research about? 

Motivation Matters!, a digital (or mhealth) intervention in Kenya for women with HIV who sell sex. The text-message service sends information about HIV, plus messages to motivate and support treatment adherence. Women are encouraged to respond to the messages or ask questions. Those who ask questions get a follow-up call from a nurse.  

A total of 119 women took part in the trial. All the women had recently been diagnosed with HIV, but 90% were not on antiretroviral treatment (ART). The remaining 10% were on treatment but it wasn’t working.  

All the women started (or swapped) treatment when they began the trial. Half got standard treatment support. The other half got standard support plus access to Motivation Matters! 

Why is this research important? 

More HIV programmes are using mobile phones to improve services. Due to their confidential nature, mhealth services can be particularly effective for people from stigmatised populations, but not many have been designed specifically for women who sell sex. This is despite the fact that globally female sex workers are 30 times more at risk of HIV than other women. 

What did they find out? 

After six months, 69% of women who used Motivation Matters! were virally suppressed (or undetectable) compared to 63% of women in the control group.  

By digging deeper into the data, researchers found Motivation Matters! had an even greater impact. When they removed data relating to women who were already undetectable when the trial began or had not sold sex recently, among the remaining women 74% of those in the Motivation Matters! group were undetectable after six months. But in the control group, only 46% of women were. 

Treatment adherence was also higher in the Motivation Matters! group than the control group every month during the six-month trial.  

The women who used Motivation Matters! got 50 text messages during the six-month study. All responded to at least one message and 60% asked at least one question. Overall, 55% of the messages got a response.  

Women felt Motivation Matters! was easy to use and had value. As one woman said: “The messages…gave me hope. I felt I was not alone.” 

Message content that mentioned religion, children and families and support from clinic staff were seen as the most meaningful. 

Around one in ten (12%) of women said they had difficulty responding to messages because they didn’t have phone credit. 

What does this mean for HIV services? 

Motivation Matters! (or a similar text-based service) could be an effective way to support sex workers with HIV to stay on ART. But text support must be co-designed with sex workers to ensure they trust the service and find it helpful.  

The Motivation Matters! messages were written to protect privacy (for example, some messages referred to antiretrovirals as blood pressure medication). Trial participants said this was very important to them. This privacy consideration also worked: around one-third of women said at least one person was curious about their text messages, but this did not lead to inadvertent disclosure of their HIV status. 

The finding that one in ten women could not respond due to a lack of credit suggests that paying for airtime could help some women get more out of the service.