Joseph Davey Dvora, Nhavoto José António, Augusto Orvalho, Ponce Walter, Traca Daila, Nguimfack Alexandre, Palha de Sousa Cesar
*Ark, Maputo, Mozambique;†Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA;‡Department of Mathematics and Informatics, Eduardo Mondlane University, Maputo, Mozambique;§School of Business, Örebro University, Örebro, Sweden; and‖Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique.
J Acquir Immune Defic Syndr. 2016 Oct 1;73(2):e23-30. doi: 10.1097/QAI.0000000000001115.
We evaluated whether regular mobile phone text reminders improved patients' retention in antiretroviral therapy (ART) care in Mozambique.
SMSaúde was a randomized control trial of HIV-infected patients on ART who received regular text message reminder vs. standard of care at 3 public health facilities in Maputo Province, Mozambique. The primary outcome was retention in HIV care. Between November 2011 and March 2012, 830 eligible HIV-infected patients on ART were randomized 1:1 to the text reminder intervention or standard of care.
We used Kaplan-Meier estimators and log-rank tests to compare proportions of patients who received SMS reminders who were retained in HIV care compared to the control group who received standard of care. Post hoc analyses were performed using Cox proportional hazards models stratified by urban/rural facility and when initiated ART (≤3 months vs. >3 months). Hazard ratios and confidence intervals (CIs) are reported. Analysis was with intention to treat.
Patients who received text messages had lower attrition from HIV care at 12 months, though the difference was nonsignificant (RR: 0.68, 95% CI: 0.41 to 1.13). Among urban patients, text messages improved retention in HIV care (RR: 0.54, 95% CI: 0.31 to 0.95). Intervention patients newly initiated on ART (<3 months) had lower attrition than control patients (HR: 0.54; 95% CI: 0.23 to 0.91), especially urban newly initiated patients (HR: 0.20, 95% CI: 0.06 to 0.64). Text messages had no effect on retention among rural patients.
Text messages did not improve retention in HIV care for all patients on ART but improved retention in care of urban patients and those who recently started ART and received text reminders compared with standard of care.
我们评估了定期的手机短信提醒是否能提高莫桑比克接受抗逆转录病毒治疗（ART）患者的治疗依从性。
“短信健康”是一项针对莫桑比克马普托省3家公共卫生机构中接受ART治疗的HIV感染患者的随机对照试验，这些患者被随机分为定期接收短信提醒组和接受标准治疗组。主要结局是HIV治疗的依从性。在2011年11月至2012年3月期间，830名符合条件的接受ART治疗的HIV感染患者按1:1随机分为短信提醒干预组或标准治疗组。
我们使用Kaplan-Meier估计量和对数秩检验来比较接受短信提醒的患者与接受标准治疗的对照组在HIV治疗中的留存比例。使用Cox比例风险模型进行事后分析，按城市/农村医疗机构以及开始ART治疗的时间（≤3个月与>3个月）进行分层。报告风险比和置信区间（CI）。分析采用意向性治疗。
在12个月时，接收短信的患者在HIV治疗中的流失率较低，尽管差异不显著（RR：0.68，95%CI：0.41至1.13）。在城市患者中，短信提高了HIV治疗的依从性（RR：0.54，95%CI：0.31至0.95）。新开始接受ART治疗（<３个月）的干预组患者的流失率低于对照组患者（HR：0.54；95%CI：0.23至0.91），尤其是城市新开始接受治疗的患者（HR：0.20，95%CI：0.06至0.64）。短信对农村患者的治疗依从性没有影响。
短信提醒并未提高所有接受ART治疗患者的HIV治疗依从性，但与标准治疗相比，它提高了城市患者以及最近开始接受ART治疗并收到短信提醒患者的治疗依从性。
