Study: Texting helps HIV patients adhere to treatment
A trial in Kenya has shown that text messages can help patients adhere to their treatment, and improved absolute adherence rates by 12 percent and viral load suppression by 9 percent.
The study, written by Richard T. Lester, MD, of the University of British Columbia in Vancouver, and colleagues, was released online Nov. 9 in the Lancet. It also will be presented later this month at the 2010 mHealth Summit in Washington, D.C.
The study assessed whether cellphone communication between healthcare workers and patients starting antiretroviral therapy (ART) in Kenya improved drug adherence and suppression of plasma HIV-1 RNA load. The randomized trial assessed HIV-infected adults initiating ART in three clinics in Kenya, where patients received a cellphone short message service (SMS) intervention or standard care.
Patients in the intervention group received weekly SMS messages from a clinic nurse and were required to respond within 48 hours. Patients in the control group received standard follow-up without text messages. Primary outcomes were self-reported ART adherence (greater than 95 percent of prescribed doses in the past 30 days at both six- and 12-month follow-up visits) and plasma HIV-1 viral RNA load suppression at 12 months.
The health workers used multiple recipient (bulk) messaging functions to improve efficiency. Patients in the intervention group were instructed to respond within 48h that either they were doing well or that they had a problem. The clinician then called patients who said they had a problem or who failed to respond within two days.
Between May 2007 and October 2008, 273 patients participated in the SMS intervention arm and 265 patients participated in the standard care arm. Adherence to ART was reported in 62 percent of those patients receiving the SMS intervention, compared with 50 percent in the control group. Suppressed viral loads were reported in 57 percent of patients in the SMS group and 48 percent in the control group.
“This study shows that mobile health innovations can improve HIV treatment outcomes. Patients who received the SMS support were more likely to report adherence to ART and were more likely to have their viral load suppressed below detection levels than patients who received the standard care alone,” the authors stated.
Only 3.3 percent of the weekly text messages identified a definitive requirement for follow-up, one nurse could potentially manage 1,000 patients by SMS and expect to call only 33 patients per week, the authors stated. SMS intervention is inexpensive (each SMS costs about 5 cents, equivalent to $20 per 100 patients per month, and follow-up voice calls averaged $3.75 per nurse per month) and the cellphone protocol used existing infrastructure.
“The applicability of this study to other countries and other diseases remains to be assessed,” the authors concluded. “Although the uptake of wireless telecommunication devices is becoming ubiquitous, introduction of mobile health initiatives is variable. We believe that the patient-centered communication effect, in particular the timely support of a patient by a health professional, is universal and can be improved by mobile telecommunication.”
An abstract of the study is available here.
The study, written by Richard T. Lester, MD, of the University of British Columbia in Vancouver, and colleagues, was released online Nov. 9 in the Lancet. It also will be presented later this month at the 2010 mHealth Summit in Washington, D.C.
The study assessed whether cellphone communication between healthcare workers and patients starting antiretroviral therapy (ART) in Kenya improved drug adherence and suppression of plasma HIV-1 RNA load. The randomized trial assessed HIV-infected adults initiating ART in three clinics in Kenya, where patients received a cellphone short message service (SMS) intervention or standard care.
Patients in the intervention group received weekly SMS messages from a clinic nurse and were required to respond within 48 hours. Patients in the control group received standard follow-up without text messages. Primary outcomes were self-reported ART adherence (greater than 95 percent of prescribed doses in the past 30 days at both six- and 12-month follow-up visits) and plasma HIV-1 viral RNA load suppression at 12 months.
The health workers used multiple recipient (bulk) messaging functions to improve efficiency. Patients in the intervention group were instructed to respond within 48h that either they were doing well or that they had a problem. The clinician then called patients who said they had a problem or who failed to respond within two days.
Between May 2007 and October 2008, 273 patients participated in the SMS intervention arm and 265 patients participated in the standard care arm. Adherence to ART was reported in 62 percent of those patients receiving the SMS intervention, compared with 50 percent in the control group. Suppressed viral loads were reported in 57 percent of patients in the SMS group and 48 percent in the control group.
“This study shows that mobile health innovations can improve HIV treatment outcomes. Patients who received the SMS support were more likely to report adherence to ART and were more likely to have their viral load suppressed below detection levels than patients who received the standard care alone,” the authors stated.
Only 3.3 percent of the weekly text messages identified a definitive requirement for follow-up, one nurse could potentially manage 1,000 patients by SMS and expect to call only 33 patients per week, the authors stated. SMS intervention is inexpensive (each SMS costs about 5 cents, equivalent to $20 per 100 patients per month, and follow-up voice calls averaged $3.75 per nurse per month) and the cellphone protocol used existing infrastructure.
“The applicability of this study to other countries and other diseases remains to be assessed,” the authors concluded. “Although the uptake of wireless telecommunication devices is becoming ubiquitous, introduction of mobile health initiatives is variable. We believe that the patient-centered communication effect, in particular the timely support of a patient by a health professional, is universal and can be improved by mobile telecommunication.”
An abstract of the study is available here.