Dowshen Nadia, Kuhns Lisa M, Johnson Amy, Holoyda Brian James, Garofalo Robert
Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Med Internet Res. 2012 Apr 5;14(2):e51. doi: 10.2196/jmir.2015.
For youth living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), nonadherence to antiretroviral therapy (ART) can lead to poor health outcomes and significantly decreased life expectancy.
To evaluate the feasability, acceptability, and preliminary efficacy of short message service (SMS) or text message reminders to improve adherence to ART for youth living with HIV/AIDS.
We conducted this prospective pilot study using a pre-post design from 2009 to 2010 at a community-based health center providing clinical services to youth living with HIV/AIDS. Eligibility criteria included HIV-positive serostatus, age 14-29 years, use of a personal cell phone, English-speaking, and being on ART with documented poor adherence. During the 24-week study period, participants received personalized daily SMS reminders and a follow-up message 1 hour later assessing whether they took the medication, and asking participants to respond via text message with the number 1 if they took the medication and 2 if they did not. Outcome measures were feasibility, acceptability, and adherence. Self-reported adherence was determined using the visual analog scale (VAS) and AIDS Clinical Trial Group (ACTG) questionnaire 4-day recall. Viral load and CD4 cell count were followed as biomarkers of adherence and disease progression at 0, 12, and 24 weeks.
Participants (N = 25) were mean age 23 (range 14-29) years, 92% (n = 23) male, 60% (n = 15) black, and 84% (n = 21) infected through unprotected sex. Mean VAS scores significantly increased at 12 and 24 weeks in comparison with baseline (week 0: 74.7, week 12: 93.3, P < .001; week 24: 93.1, P < .001). ACTG questionnaire 4-day recall also improved (week 0: 2.33, week 12: 3.24, P = .002; week 24: 3.19, P = .005). There was no significant difference in CD4 cell count or viral load between baseline and 12- or 24-week follow-up, although there was a trend toward improvement of these biomarkers and a small to moderate standardized effect size (range of Cohen d: -0.51 to 0.22). Of 25 participants, 21 (84%) were retained, and 20 of the 21 (95%) participants who completed the study found the intervention helpful to avoid missing doses.
In this pilot study, personalized, interactive, daily SMS reminders were feasible and acceptable, and they significantly improved self-reported adherence. Larger controlled studies are needed to determine the impact of this intervention on ART adherence and other related health outcomes for youth living with HIV/AIDS.
对于感染人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征（AIDS）的年轻人来说，不坚持抗逆转录病毒疗法（ART）会导致健康状况不佳，并显著缩短预期寿命。
评估短信服务（SMS）或文本消息提醒对提高HIV/AIDS青年坚持ART治疗的可行性、可接受性和初步疗效。
我们于2009年至2010年在一家为HIV/AIDS青年提供临床服务的社区卫生中心，采用前后对照设计进行了这项前瞻性试点研究。纳入标准包括HIV阳性血清学状态、年龄14 - 29岁、使用个人手机、讲英语且正在接受ART治疗但记录显示依从性差。在为期24周的研究期间，参与者每天收到个性化的短信提醒，并在1小时后收到一条跟进消息，询问他们是否服药，要求参与者通过短信回复，若服药回复数字1，未服药回复数字2。观察指标为可行性、可接受性和依从性。采用视觉模拟量表（VAS）和艾滋病临床试验组（ACTG）问卷4天回忆法来确定自我报告的依从性。在第0、12和24周时，跟踪病毒载量和CD4细胞计数作为依从性和疾病进展的生物标志物。
参与者（N = 25）的平均年龄为23岁（范围14 - 29岁），92%（n = 23）为男性，60%（n = 15）为黑人，84%（n = 21）通过无保护性行为感染。与基线相比，第12周和第24周时VAS平均得分显著提高（第0周：74.7，第12周：93.3，P <.001；第24周：93.1，P <.001）。ACTG问卷4天回忆法结果也有所改善（第0周：2.33，第12周：3.24，P =.002；第24周：3.19，P =.005）。基线与12周或24周随访之间，CD4细胞计数或病毒载量无显著差异，尽管这些生物标志物有改善趋势，且标准化效应大小为小到中度（Cohen d范围：-0.51至0.22）。25名参与者中，21名（84%）坚持下来，完成研究的21名参与者中有20名（95%）认为该干预有助于避免漏服药物。
在这项试点研究中，个性化、交互式的每日短信提醒是可行且可接受的，并且显著提高了自我报告的依从性。需要开展更大规模的对照研究来确定该干预措施对HIV/AIDS青年ART依从性及其他相关健康结局的影响。
