Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria
ABSTRACT Context: Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is one of the world's most challenging pandemics. For treatment with Highly Active Anti-Retroviral Therapy (HAART) to be effective, high rate of adherence is essential. Aim: To demonstrate the effect of adherence counseling and text message reminders in improving patients' adherence to HAART. Settings and Design: A randomized control trial among non-adherents was carried out in a tertiary hospital in Nigeria between March and July, 2011. Materials and Methods: A total of 104 patients: 45 males (43.3%) and 59 females (56.7%) participated in the study. They were randomized into intervention and control groups. The intervention group received monthly adherence counseling and twice weekly short message reminders for four months, while the control group received only standard care. Self-reported adherence and CD4+ cell counts were measured pre- and post-intervention. Statistical Analysis Used: Data was analysed using Statistical Package for Social Sciences (SPSS) version 18. Risk rates, Chi-square, Mann-Whitney U test and Cohen's effect size were calculated. Level of significance was set at P = 0.05. Results: At post-intervention, 76.9% of the intervention group and 55.8% of the control group achieved adherence (χ2 = 5.211, P = 0.022, RR = 0.75 (0.55-0.96), Cohen's w = 0.224). Also, median CD4+ cell count of the intervention group increased from 193 cells/ml to 575.0 cells/ml against 131.0 cells/ml to 361.5 cells/ml in the control group (P = 0.007). Conclusion: Adherence counseling and text message reminders improved adherence among HIV patients. Its adoption for HIV patient management is advocated.
- The Lancet Infectious Diseases 06/2014; 14(7). DOI:10.1016/S1473-3099(14)70778-9 · 19.45 Impact Factor
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ABSTRACT: The purpose of this systematic review was to assess the quality of interventions using mHealth technology being developed for and trialed with HIV-infected African American (AA) women. We aimed to assess rigor and to ascertain if these interventions have been expanded to include the broad domain of self-management. After an extensive search using the PRISMA approach and reviewing 450 records (411 published studies and 39 on-going trials at clinicaltrials.gov), we found little completed research that tested mHealth HIV self-management interventions for AA women. At clinicaltrials.gov, we found several mHealth HIV intervention studies designed for women in general, forecasting a promising future. However, most studies were exploratory in nature and focused on a single narrow outcome, such as medication adherence. Given that cultural adaptation is the key to successfully implementing any effective self-management intervention, culturally relevant, gender specific mHealth interventions focusing on HIV-infected AA women are warranted for the future.Journal of the Association of Nurses in AIDS Care 08/2014; 26(2). DOI:10.1016/j.jana.2014.08.002 · 1.23 Impact Factor
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ABSTRACT: Mobile phone text messaging has been shown to improve adherence to antiretroviral therapy and to improve communication between patients and health care workers. It is unclear which strategies are most appropriate for scaling up text messaging programmes. We sought to investigate acceptability and readiness for ownership (community members designing, sending and receiving text messages) of a text message programme among a community of clients living with human immunodeficiency virus (HIV) in Yaoundé, Cameroon and to develop a framework for implementation. We used the mixed-methods sequential exploratory design. In the qualitative strand we conducted 7 focus group discussions (57 participants) to elicit themes related to acceptability and readiness. In the quantitative strand we explored the generalizability of these themes in a survey of 420 clients. Qualitative and quantitative data were merged to generate meta-inferences. Both qualitative and quantitative strands showed high levels of acceptability and readiness despite low rates of participation in other community-led projects. In the qualitative strand, compared to the quantitative strand, more potential service users were willing to pay for a text messaging service, preferred participation of health personnel in managing the project and preferred that the project be based in the hospital rather than in the community. Some of the limitations identified to implementing a community-owned project were lack of management skills in the community, financial, technical and literacy challenges. Participants who were willing to pay were more likely to find the project acceptable and expressed positive feelings about community readiness to own a text messaging project. Community ownership of a text messaging programme is acceptable to the community of clients at the Yaoundé Central Hospital. Our framework for implementation includes components for community members who take on roles as services users (demonstrating clear benefits, allowing a trial period and ensuring high levels of confidentiality) or service providers (training in project management and securing sustainable funding). Such a project can be evaluated using participation rate, clinical outcomes, satisfaction with the service, cost and feedback from users.BMC Health Services Research 09/2014; 14(1):441. DOI:10.1186/1472-6963-14-441 · 1.66 Impact Factor