CSU 53/2011: SMS TEXTING AND ARV TREATMENT ADHERENCE IN KENYA

Tuesday, 15th of February 2011

Does this research have implications for other programmes, such as child vaccination, which have issues with dropout rates?

Good reading.

The Lancet, Volume 376, Issue 9755, Pages 1838 - 1845, 27 November 2010

Published Online: 10 November 2010

Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial

Original Text

Dr Richard T Lester MD a b c , Paul Ritvo PhD d, Edward J Mills PhD e, Antony Kariri BSc a, Sarah Karanja BSc a, Michael H Chung MD f, William Jack DPhil g, James Habyarimana PhD h, Mohsen Sadatsafavi MD i, Mehdi Najafzadeh MSc i, Carlo A Marra PharmD i, Benson Estambale MBChB j, Elizabeth Ngugi PhD a, T Blake Ball PhD b, Lehana Thabane PhD k, Lawrence J Gelmon MD a b, Joshua Kimani MBChB a b, Marta Ackers MD l, Prof Francis A Plummer MD b m

Summary

Background

Mobile (cell) phone communication has been suggested as a method to improve delivery of health services. However, data on the effects of mobile health technology on patient outcomes in resource-limited settings are limited. We aimed to assess whether mobile phone communication between health-care workers and patients starting antiretroviral therapy in Kenya improved drug adherence and suppression of plasma HIV-1 RNA load.

Methods

WelTel Kenya1 was a multisite randomised clinical trial of HIV-infected adults initiating antiretroviral therapy (ART) in three clinics in Kenya. Patients were randomised (1:1) by simple randomisation with a random number generating program to a mobile phone 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 h. Randomisation, laboratory assays, and analyses were done by investigators masked to treatment allocation; however, study participants and clinic staff were not masked to treatment. Primary outcomes were self-reported ART adherence (>95% of prescribed doses in the past 30 days at both 6 and 12 month follow-up visits) and plasma HIV-1 viral RNA load suppression (<400 copies per mL) at 12 months. The primary analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT00830622.

Findings

Between May, 2007, and October, 2008, we randomly assigned 538 participants to the SMS intervention (n=273) or to standard care (n=265). Adherence to ART was reported in 168 of 273 patients receiving the SMS intervention compared with 132 of 265 in the control group (relative risk [RR] for non-adherence 0·81, 95% CI 0·69—0·94; p=0·006). Suppressed viral loads were reported in 156 of 273 patients in the SMS group and 128 of 265 in the control group, (RR for virologic failure 0·84, 95% CI 0·71—0·99; p=0·04). The number needed to treat (NNT) to achieve greater than 95% adherence was nine (95% CI 5·0—29·5) and the NNT to achieve viral load suppression was 11 (5·8—227·3).

Interpretation

Patients who received SMS support had significantly improved ART adherence and rates of viral suppression compared with the control individuals. Mobile phones might be effective tools to improve patient outcome in resource-limited settings.

Funding

US President's Emergency Plan for AIDS Relief.

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a Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya

b Department of Medical Microbiology, University of Manitoba, Health Sciences Centre, Winnipeg, MB, Canada

c Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada

d School of Kinesiology and Health Sciences, Department of Psychology, York University, York, ON, Canada

e Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada

f Department of Global Health, University of Washington, Seattle, WA, USA

g Department of Economics, Georgetown University, Washington, DC, USA

h Georgetown Public Policy Institute, Georgetown University, Washington, DC, USA

i Collaboration for Outcome Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada

j University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya

k Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

l Global AIDS Program, US Centers for Disease Control and Prevention, Nairobi, Kenya

m National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada

Correspondence to: Dr Richard T Lester, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada

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