Designing a Mobile Phone-Based Intervention to Promote Adherence to Antiretroviral Therapy in South India

Department of Pediatrics, St John's National Academy of Health Sciences, Bangalore, India.
AIDS and Behavior (Impact Factor: 3.49). 06/2010; 14(3):716-20. DOI: 10.1007/s10461-009-9658-3
Source: PubMed


Integration of mobile phone technology into HIV care holds potential, particularly in resource-constrained settings. Clinic attendees in urban and rural South India were surveyed to ascertain usage of mobile phones and perceptions of their use as an adherence aid. Mobile phone ownership was high at 73%; 26% reported shared ownership. A high proportion (66%) reported using phones to call their healthcare provider. There was interest in weekly telephonic automated voice reminders to facilitate adherence. Loss of privacy was not considered a deterrent. The study presents important considerations in the design of a mobile phone-based adherence intervention in India.

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    • "This also concurred with an Indian study where high proportion (66%) reported using phones to call their healthcare provider to facilitate adherence with loss of privacy not considered a deterrent [14]. The anticipation of benefits from this cell phone communication by a greater proportion has been supported by most of the above studies where populations perceived that HIV information was important to their health. "
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    ABSTRACT: Clinical trials were conducted to assess the feasibility of using a cell phone text messaging-based system to follow up Human Immunodeficiency Virus (HIV) infected patients on antiretroviral (ARTs) and assess for improved adherence to their medication. However there is need to evaluate the perceptions of the HIV infected patients towards the use of these cell phones in an effort to better aid in the clinical management of their HIV infection. The objective of this study was therefore to determine the perceptions of HIV infected patients on the use of cell phone text messaging as a tool to support adherence to their ART medication. A cross sectional survey was conducted among patients receiving Highly Active Anti-Retroviral Therapy (HAART) at the Kenyatta National Hospital Comprehensive Care Clinic in Nairobi between May and July, 2011. Pre-tested questionnaires were used to collect the socio-demographic and perceptions data. The recruitment of the participants was done using the random probability sampling method and statistical analysis of data performed using Statistical Package for Social Sciences (SPSS) version 16.0. A total of 500 HIV infected patients (Male-107, Female-307) aged 19-72 years were interviewed. The majority of individuals (99%) had access to cell phones and 99% of the HIV infected patients interviewed supported the idea of cell phone use in management of their HIV infection. A large proportion (46%) claimed that they needed cell phone access for medical advice and guidance on factors that hinder their adherence to medication and only 3% of them needed it as a reminder to take their drugs. The majority (72%) preferred calling the healthcare provider with their own phones for convenience and confidential purposes with only 0.4% preferring to be called or texted by the health care provider. Most (94%), especially the older patients, had no problem with their confidentiality being infringed in the process of the conversation as per the bivariate analysis results. Cell phone communications are acceptable and in fact preferable over cell phone reminders.
    BMC Public Health 10/2013; 13(1):987. DOI:10.1186/1471-2458-13-987 · 2.26 Impact Factor
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    • "CD4 Screening: Although point-of-care CD4 diagnostic tools may be available in the future [32] and eHealth systems have been useful for HIV patient tracking across the continuum of care [33], there is not evidence to date on the use of mHealth tools explicitly for CD4 screening. In a more generic sense, several articles [20,31,32,35-37] found that mHealth tools were helpful for managing care by improving attendance to medical appointments, during some of which one would assume CD4 testing took place, through text reminders and community health worker support. However, further detail about the use of mHealth tools for rapid, accurate, and shared CD4 results reporting was not reported explicitly, although mHealth technologies to accomplish these goals are feasible and available. "
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    ABSTRACT: This systematic review assesses the published literature to describe the landscape of mobile health technology (mHealth) for HIV/AIDS and the evidence supporting the use of these tools to address the HIV prevention, care, and treatment cascade. The speed of innovation, broad range of initiatives and tools, and heterogeneity in reporting have made it difficult to uncover and synthesize knowledge on how mHealth tools might be effective in addressing the HIV pandemic. To do address this gap, a team of reviewers collected literature on the use of mobile technology for HIV/AIDS among health, engineering, and social science literature databases and analyzed a final set of 62 articles. Articles were systematically coded, assessed for scientific rigor, and sorted for HIV programmatic relevance. The review revealed evidence that mHealth tools support HIV programmatic priorities, including: linkage to care, retention in care, and adherence to antiretroviral treatment. In terms of technical features, mHealth tools facilitate alerts and reminders, data collection, direct voice communication, educational messaging, information on demand, and more. Studies were mostly descriptive with a growing number of quasi-experimental and experimental designs. There was a lack of evidence around the use of mHealth tools to address the needs of key populations, including pregnant mothers, sex workers, users of injection drugs, and men who have sex with men. The science and practice of mHealth for HIV are evolving rapidly, but still in their early stages. Small-scale efforts, pilot projects, and preliminary descriptive studies are advancing and there is a promising trend toward implementing mHealth innovation that is feasible and acceptable within low-resource settings, positive program outcomes, operational improvements, and rigorous study design
    The Open AIDS Journal 08/2013; 7(1):17-41. DOI:10.2174/1874613620130812003
    • "More patients can use this facility if the mobile phones and service providers offer Tamil language SMS facility. Pictorial messages could possibly obviate the problem of text messages if participants are trained to use the function.(6) "
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    ABSTRACT: Every year, a lot of Tuberculosis (TB) patients undergo Directly Observed Treatment Short-course (DOTS) in Salem city, one of the high TB districts in South India. Mobile phone usage among these patients and health workers is common. Mobile phone communication has a great potential in TB treatment. To analyze the mobile phone usage and its effectiveness in TB DOTS treatment. A cross-sectional survey with 150 TB patients was followed by a focus group discussion with treatment supervisors, DOTS providers, and health workers. Majority of patients use mobile phones to make calls to health workers to clarify their doubts on side effects, food, and symptoms of the disease. TB treatment supervisors effectively use mobile phones to counsel patients to adhere to the treatment regimen. Patients see mobile phones as a useful communication tool in TB treatment though they prefer direct interpersonal communication with health workers. Though the mobile ownership is 68% among the TB patients, many of them are not able to send text messages or read messages in English. Mobile phone possession and usage is high among the patients. Patients need to be trained to use mobile phone features such as alarm, voice mail, and interactive voice response. Incentives like free talk time and short message service (SMS) will encourage patients to communicate frequently with health workers, thereby, increasing the chances of better adherence to DOTS. SMS could be made available in the regional languages.
    Indian Journal of Community Medicine 03/2013; 38(4):229-233. DOI:10.4103/0970-0218.120158
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