Clinical trial NCT01746758: Mobile Phone Text Messaging Referral
Official title: Establishing a Community Referral System to Improve Uptake of Adolescent Sexual Reproductive Health Services in Mwanza, Tanzania
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: HIV
Sexually Transmitted Infections
Contraception
Pregnancy
Keywords: Reproductive health, mHealth, Cluster randomised trial
Lead sponsor: Liverpool School of Tropical Medicine
Sponsor class: OTHER
Collaborators: name: National Institute for Medical Research, Tanzania
name: Ministry of Health and Social Welfare, Tanzania
First posted: 2012-12-11
Enrollment: 700
Sex: ALL
Minimum age (years): 15
Maximum age (years): 19
Standard ages: CHILD
ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The study hypothesis is that managed referral of patients at community level (from drug stores) increases uptake of reproductive health (RH) services at dispensary and health centre levels.

The intervention is currently being implemented in 2 districts (Magu and Sengerema) in Mwanza Region on the northwest shore of Lake Victoria. It is nested within the IntHEC Community Randomised Trial which aims to evaluate the impact of a complex RH intervention on the uptake and integration of reproductive health services in 2 Regions in Tanzania (Mwanza and Iringa) and Niger (Say and Aguie) respectively. 18 wards per region were stratified according to geographical and economic criteria and randomly assigned to intervention or comparison wards. The SMS intervention is being implemented in 9 intervention wards in Mwanza Region only. 9 wards are followed for comparison.

Detailed description: The SMS intervention was developed in 2 phases: (i) stakeholder consultation and (ii) technical design. Twenty-three consultation meetings were held with 78 drug store owners and attendants, 45 dispensary and health centre clinical officers and nurses, and 148 adolescents in communities. These stakeholders prioritised key deficiencies in existing RH provision and preferred strategies to address them. Detailed methods and results of these consultations are presented elsewhere (Consultation Paper in preparation). In brief government health facilities wanted an intervention that allows dispensaries and health centres to take charge of STI treatment and provide skilled service for other RH needs. Drug stores wanted an intervention that recognises and integrates their contribution to the health system, while adolescents wanted an intervention that promotes accessibility, confidentiality and trust of service providers. Through subsequent meetings, an SMS intervention strategy was identified because all clinical officers and drug store attendants demonstrated use mobile phones on a day-to-day basis.

The intervention design prioritised patients' ease of access to service: when a patient comes to a drug store to buy medicines for a RH related problem that may require a prescription drug, the drug store explains the referral system. If the patient accepts, the drug store sends a text message with the patient details to a toll-free number connected to a web-system. The system processes and forwards the patient details including a password to a dispensary matched with the referrer drug store. At the same time, that password is sent back to the referrer drug store so that it can be passed on to the patient. While at dispensary, patients with a password are received, matched with details received in text messages, and given fast track RH service, after which the dispensary sends a text message to the toll-free number confirming the completeness of patient treatment. This intervention is implemented in all 9 intervention wards in Mwanza. No intervention is implemented in the 9 comparison wards.

Eligibility criteria: Inclusion Criteria:

Only patients attending services at the drug store. Only patients seeking reproductive health care services. Only resident in study wards.

Exclusion Criteria:

Patients non-residence in study wards. Patients seeking non-reproductive health care services.

The primary and secondary outcomes will be measured in people aged 15-19 (our definition of adolescent), but the intervention accepts all age-groups during implementation.

Primary outcomes:
measure: Increase the number of patients receiving reproductive health services at dispensary and health centre level after referral from a drug store.
timeFrame: 12 months
Secondary outcomes:
measure: Referred number of patients attending HIV, STI, pregnancy prevention (including numbers of condoms, VCT, and post-abortion care) and treatment
timeFrame: 12 months
measure: Referred number of patients attending other contraceptives (the pill, intra-uterine devices, injection, female condom and sterilisation where available)
timeFrame: 12 months
measure: Referred number of patients testing HIV positive (where there is a testing service)
timeFrame: 12 months
measure: Referred number of patients diagnosed with STIs (syndromic diagnosis)
timeFrame: 12 months
measure: Prevalence of HIV and STIs in the data from study areas
timeFrame: 12 months
Other outcomes:
Locations:
city: Mwanza
country: Tanzania
facility: National Institute for Medical Research Tanzania
Study officials:
affiliation: Liverpool School of Tropical Medicine
name: John N Dusabe, MSc BSc
role: PRINCIPAL_INVESTIGATOR
affiliation: Liverpool School of Tropical Medicine
name: Angela IN Obasi, MSc PhD MRCP
role: PRINCIPAL_INVESTIGATOR
References: