Abstract
BACKGROUND: In Togo, men who have sex with men (MSM) experience disproportionately high rates of human immuno-deficiency virus (HIV), with prevalence at 13% compared to the countrywide general HIV prevalence of 2.5%. Mobile phone adoption has grown rapidly in West Africa in recent years and mobile health (mHealth) provides an opportunity to engage high-risk populations in HIV prevention, treatment and care (PTC). This study focuses on the text messaging component of a mHealth program and resulting linkages to PTC in Lomé, Togo. METHODS: We used a mixed-methods approach to collect information directly from a purposive sample of MSM to estimate the potential impact of the mHealth intervention on specific outcomes. A structured survey captured 503 MSM experiences with program activities to increase access to PTC through short message system (SMS), including data on socio-demographics, HIV knowledge and testing history, program awareness, use of services and referrals, use of mHealth, and experiences with and preferences for receiving HIV SMS messages. Twelve in-depth interviews captured qualitative data on MSM experiences and opinions related to the mHealth intervention, as well as barriers and facilitators to linkages between mHealth and clinic services. RESULTS: Predicted probabilities of MSM being reached by the program and linked to PTC is higher for those exposed to the program and significantly different (P<0.001). The probability of being linked to HIV prevention emerges as the highest among MSM exposed to SMS messages with 92% probability. MSM exposed to SMS had a 63% probability to be linked to treatment compared to only 40% among those not exposed to SMS. Program barriers and facilitators were identified through the thematic analysis of the qualitative data. Several facilitators to PTC were reported including: increased knowledge and awareness; convenient location of HIV testing coupled with distribution of products; ensuring individual confidentiality; and perceived care of providers. The main barriers to the program were lack of program awareness, program functionality and affordability for referral services, and peer educator training. CONCLUSIONS: The probability of being reached, and adhering to PTC is significantly higher among MSM exposed to HIV related SMS messages; however, the usefulness of SMS in HIV programs targeting MSM needs to be better understood.