There has been an explosive expansion in mobile phone ownership in Sub-Saharan Africa (SSA). Future mHealth interventions aiming to improve PMTCT care need to be targeted to attract the attention of women with lower education and younger age. The majority of those still enrolled at the end of the intervention reported that text-messaging had been helpful, mainly by improving access to healthcare providers. In this observational study, women of younger age, lower education, and who had not disclosed their HIV status were less likely to adhere to interactive text-messaging. In interviews with 176 women, 167 (95%) agreed or strongly agreed that the intervention had been helpful, mainly by improving access to and communication with their healthcare providers (43%). Women who had disclosed their HIV status had a lower rate of non-response (aRR:0.77 95%CI: 0.60–0.97). Women with higher than secondary education were less likely (aOR:0.28 95%CI: 0.13–0.64), to respond to < 50% of messages compared to women with primary education or less. Younger age (18–24 years) was associated with responding to < 50% of messages (aOR:2.20 95%CI: 1.03–4.72), compared to being 35–44 years. Having secondary education was associated with reporting a problem (aOR:1.88 95%CI: 1.08–3.27) compared to having primary education or less. Most reported problems were health related (84%). The proportion of non-responses increased with time and exceeded 50% around 14 months from enrolment. There were 16,017 (51%) instances of non-response. The 299 participants sent 15,183 (48%) okay-responses and 438 (1%) problem-responses. Perceptions of the intervention were evaluated through interviewer-administered follow-up questionnaires at 24 months postpartum. We used multivariable-adjusted logistic and negative binomial regression to estimate adjusted odds ratios (aORs), rate ratios (aRRs) and 95% confidence intervals (CIs) to assess associations between baseline characteristics and text responses. Healthcare workers phoned non-responders and problem-responders to manage any issue. They were instructed to text within 48 h stating that they were “okay” or had a “problem”. They received weekly text messages from their first antenatal care visit until 24 months postpartum asking “How are you?”. We conducted a cohort study nested within the WelTel PMTCT trial among 299 pregnant women living with HIV aged ≥ 18 years. We aimed to investigate how women in prevention of mother-to-child transmission of HIV (PMTCT) care in Kenya used, adhered to, and evaluated an interactive text-messaging intervention. To improve future mobile health (mHealth) interventions in resource-limited settings, knowledge of participants’ adherence to interactive interventions is needed, but previous studies are limited.
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