Prevention Science

, Volume 20, Issue 1, pp 126–136 | Cite as

Using mHealth to Deliver a Home-Based Testing and Counseling Program to Improve Linkage to Care and ART Adherence in Rural South Africa

  • W. Scott ComuladaEmail author
  • Adriane Wynn
  • Heidi van Rooyen
  • Ruanne V. Barnabas
  • Rajeev Eashwari
  • Alastair van Heerden


Community-based HIV testing and counseling (HTC) programs have become an important part of the healthcare system in South Africa and other low- and middle-income countries with a high HIV prevalence and strained primary healthcare system. Current HTC programs excel at identifying people living with HIV (PLH) but leave gaps in linkage to care and antiretroviral therapy (ART) as most HTC programs do not have the capacity to ensure that linkage has occurred. This article presents the protocol for an mHealth study, that is, pilot testing a mobile platform in KwaZulu-Natal (KZN), South Africa, to improve linkage to care and ART adherence after home-based HTC. Testing data are shared with designated clinics. PLH are identified using fingerprint scans, mobile numbers, or South African IDs. If PLH do not present at a designated clinic after testing HIV positive, study field staff are sent SMS alerts to prompt follow-up visits. Similarly, if PLH do not refill ART prescriptions after their initial 1-month dose runs out, SMS alerts that are sent to field staff. This paper presents the mHealth study protocol and baseline sample characteristics (N = 101 PLH). Analyses will summarize rates of linkage to care and ART prescription refills. Cost-effectiveness analyses will examine the costs and benefits of linkage and ART adherence using our mHealth system. Linkage to care rates will be compared between our study and a historical control, that is, provided by a prior HTC program that was conducted in KZN without our mHealth system (n = 615).


HIV ART adherence mHealth Home visiting Linkage to care 



This research was supported by the National Institute of Mental Health (R21MH106351; P30MH58107).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The UCLA Institutional Review Board (IRB# 16-001207) and the HSRC Research Ethics Committee (REC 7/15/06/16) has approved and monitors the study protocol over time.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Society for Prevention Research 2018

Authors and Affiliations

  • W. Scott Comulada
    • 1
    Email author
  • Adriane Wynn
    • 2
  • Heidi van Rooyen
    • 3
  • Ruanne V. Barnabas
    • 4
  • Rajeev Eashwari
    • 5
  • Alastair van Heerden
    • 3
    • 6
  1. 1.Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Department of Health Policy ManagementUniversity of CaliforniaLos AngelesUSA
  3. 3.Human and Social Development Research ProgrammeHuman Sciences Research CouncilPretoriaSouth Africa
  4. 4.Global Health and MedicineUniversity of WashingtonSeattleUSA
  5. 5.eHealth DirectorateKwaZulu-Natal Provincial Department of HealthDurbanSouth Africa
  6. 6.Developmental Pathways to Health Research Unit, School of Community MedicineUniversity of the WitwatersrandJohannesburgSouth Africa

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