In Central Africa, vertical transmission of human immunodeficiency virus (HIV) infection from mother to child approaches 30%, reflecting in part inadequate implementation of postnatal preventive strategies, especially during breastfeeding [
1]. In Cameroon, the number of new pediatric HIV infections was increasing and reached 6,800 in 2011 [
2]. Recent estimates indicate that only 13% of children requiring antiretroviral HIV therapy (ART) actually receive it [
2]. Inadequate attendance at medical follow-up visits in infancy is a potentially reversible factor. Only 65% of infants born to seropositive mothers presented to the recommended six-weeks-of-age medical visit [
3]. Many factors underlie nonattendance at scheduled visits for HIV care and loss to medical follow-up. These include intrapersonal factors such as the cost of transportation, food availability, time constraints due to concomitant work, fear of disclosure of HIV status for mother and child, parental perception that the child is healthy, and personal religious beliefs. Interpersonal factors like male partner nonparticipation, familial stigmatization and conflicts play a role as well. Community factors include accepted cultural norms, changing community dynamics, and perceived stigma; these factors, along with health care system factors such as the clinic location, lack of patient-centered care, delays at the clinic, and different appointment scheduling for mother and child contribute to non-adherence with medical visits [
4].
Bastard
et al. have defined an adherence indicator based on timeliness of clinic attendance [
5]. The indicator is strongly predictive of virological response to ART and of the occurrence of drug resistance and identifies non-adherent patients in a timely manner in settings where viral load monitoring is not available [
5]. Mortality in HIV-infected infants has significantly decreased in the era of effective ART, yet infrequent or sporadic clinic attendance and poor compliance with cotrimoxazole prophylaxis and/or ART in infants born to HIV-infected women and late presentation of infants identified after birth are major contributors to persistent childhood mortality [
6]. Adherence with medical follow-up appointments is crucial for optimal treatment of chronic diseases, including pediatric HIV. The World Health Organization (WHO) encourages the use of new technologies to assist health delivery in resource-limited settings [
7]. The use of mobile phone text message (SMS) and voice phone calls to enhance attendance at medical appointments shows a favorable effect on clinic attendance in the general population as well as among adults with HIV/acquired immunodeficiency syndrome (AIDS) [
8]. There is also evidence from randomized controlled trials that mobile phone text-messaging at weekly intervals is efficacious in enhancing adherence to ART and in improving HIV viral load suppression [
9]. Some studies on attendance of medical appointment have been conducted among adults and adolescents [
10‐
17]. A recent Cochrane review concludes that appointment reminders sent via mobile phone text messaging (SMS) are as efficacious as voice phone call reminders in increasing patient attendance at medical visits and the effect is greater for both SMS and phone calls interventions as compared to no reminder [
17]. These findings are similar to those of Hasvold
et al. [
18]. To our knowledge, the effect in developing countries of medical appointment reminders delivered by SMS, by mobile phone call, or by both SMS and phone call on clinic attendance of babies and children requiring HIV-related care has not yet been studied. The proposed trial,
mo bile
re minders for
Ca meroonian children
re quiring (MORE CARE) HIV treatment, aims to determine the reminder method that most increases pediatric patient attendance at medical appointments for treatment of HIV-infected and HIV-exposed children, and to determine which is the most efficient related to working time and financial cost.