Division of Global Health, Karolinska Institutet, Stockholm, Sweden.
PLoS One. 2012;7(8):e40723. doi: 10.1371/journal.pone.0040723. Epub 2012 Aug 27.
Adherence is central to the success of antiretroviral therapy. Supporting adherence has gained importance in HIV care in many national treatment programs. The ubiquity of mobile phones, even in resource-constrained settings, has provided an opportunity to utilize an inexpensive, contextually feasible technology for adherence support in HIV in these settings. We aimed to assess the influence of mobile phone reminders on adherence to antiretroviral therapy in South India. Participant experiences with the intervention were also studied. This is the first report of such an intervention for antiretroviral adherence from India, a country with over 800 million mobile connections.
Quasi-experimental cohort study involving 150 HIV-infected individuals from Bangalore, India, who were on antiretroviral therapy between April and July 2010. The intervention: All participants received two types of adherence reminders on their mobile phones, (i) an automated interactive voice response (IVR) call and (ii) A non-interactive neutral picture short messaging service (SMS), once a week for 6 months. Adherence measured by pill count, was assessed at study recruitment and at months one, three, six, nine and twelve. Participant experiences were assessed at the end of the intervention period.
The mean age of the participants was 38 years, 27% were female and 90% urban. Overall, 3,895 IVRs and 3,073 SMSs were sent to the participants over 6 months. Complete case analysis revealed that the proportion of participants with optimal adherence increased from 85% to 91% patients during the intervention period, an effect that was maintained 6 months after the intervention was discontinued (p = 0.016). Both, IVR calls and SMS reminders were considered non-intrusive and not a threat to privacy. A significantly higher proportion agreed that the IVR was helpful compared to the SMS (p<0.001).
Mobile phone reminders may improve medication adherence in HIV infected individuals in this setting, the effect of which was found to persist for at least 6 months after cessation of the intervention.
依从性是抗逆转录病毒疗法成功的关键。在许多国家的治疗方案中，支持依从性对于艾滋病毒护理变得越来越重要。即使在资源有限的情况下，手机的普及也为利用一种廉价且符合当地情况的技术来支持艾滋病毒患者的依从性提供了机会。我们旨在评估在印度南部使用手机提醒对接受抗逆转录病毒治疗的艾滋病患者的依从性的影响。同时也研究了参与者对干预措施的体验。这是印度首例关于利用手机提醒来提高抗逆转录病毒治疗依从性的报告，印度拥有超过 8 亿手机用户。
这是一项在印度班加罗尔进行的准实验性队列研究，涉及 2010 年 4 月至 7 月期间接受抗逆转录病毒治疗的 150 名艾滋病毒感染者。干预措施：所有参与者都在手机上收到两种类型的依从性提醒，（i）自动交互式语音应答（IVR）电话和（ii）每周一次的非交互式中性图片短信服务（SMS），持续 6 个月。通过药物计数来衡量依从性，在研究招募时以及第 1、3、6、9 和 12 个月进行评估。在干预结束时评估参与者的体验。
参与者的平均年龄为 38 岁，27%为女性，90%为城市居民。在 6 个月期间，共向参与者发送了 3895 次 IVR 电话和 3073 条 SMS。完整病例分析显示，在干预期间，依从性最佳的参与者比例从 85%增加到 91%，并且在干预停止后 6 个月仍保持这一效果（p=0.016）。IVR 电话和短信提醒都被认为是非侵入性的，不会威胁到隐私。与短信相比，有更高比例的参与者认为 IVR 很有帮助（p<0.001）。
在这种情况下，手机提醒可能会提高感染艾滋病毒的个体对药物的依从性，并且这种效果在干预停止后至少持续 6 个月。
