Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Stockholm, Sweden; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Amref Health Africa, Langata Road, Nairobi, Kenya.
Lancet Public Health. 2018 Mar;3(3):e143-e152. doi: 10.1016/S2468-2667(17)30239-6. Epub 2018 Jan 30.
BACKGROUND: Retention of patients in HIV care is crucial to ensure timely treatment initiation, viral suppression, and to avert AIDS-related deaths. We did a randomised trial to determine whether a text-messaging intervention improved retention during the first year of HIV care. METHODS: This unmasked, randomised parallel-group study was done at two clinics in informal settlements in Nairobi, Kenya. Eligible participants were aged 18 years or older, HIV-positive, had their own mobile phone or access to one, and were able to use simple text messaging (or have somebody who could text message on their behalf). Participants were randomly assigned (1:1), with random block sizes of 2, 4, and 6, to the intervention or control group. Participants in the intervention group received a weekly text message from the automated WelTel service for 1 year and were asked to respond within 48 h. Participants in the control group did not receive text messages. Participants in both groups received usual care, which comprised psychosocial support and counselling; patient education; CD4 cell count; treatment; screening for tuberculosis, opportunistic infections, and sexually transmitted infections; prevention of mother-to-child transmission and family planning services; and up to two telephone calls for missed appointments. The primary outcome was retention in care at 12 months (ie, clinic attendance 10-14 months after the first visit). Participants who did not attend this 12-month appointment were traced, and we considered as retained those who were confirmed to be active in care elsewhere. The data analyst and clinic staff were masked to the group assignment, whereas participants and research nurses were not. We analysed the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01630304. FINDINGS: Between April 4, 2013, and June 4, 2015, we screened 1068 individuals, of whom 700 were recruited. 349 people were allocated to the intervention group and 351 to the control group. Participants were followed up for a median of 55 weeks (IQR 51-60). At 12 months, 277 (79%) of 349 participants in the intervention group were retained, compared with 285 (81%) of 351 participants in the control group (risk ratio 0·98, 95% CI 0·91-1·05; p=0·54). There was one mild adverse event related to the intervention, a domestic dispute that occurred when a participant's partner became suspicious of the weekly messages and follow-up calls. INTERPRETATION: This weekly text-messaging service did not improve retention of people in early HIV care. The intervention might have a modest role in improving self-perceived health-related quality of life in individuals in HIV care in similar settings. FUNDING: National Institutes of Health and Canadian Institutes of Health Research Canadian HIV Trials Network.
背景:确保及时开始治疗、病毒抑制以及避免艾滋病相关死亡,使艾滋病病毒感染者留在护理中至关重要。我们进行了一项随机试验,以确定短信干预是否可以改善艾滋病病毒护理的第一年中的保留率。
方法:这是一项在肯尼亚内罗毕非正规住区的两个诊所进行的未蒙面、随机平行组研究。合格的参与者年龄在 18 岁或以上,HIV 阳性,拥有自己的手机或可以使用简单的短信(或有人可以代表他们发短信),并且能够使用简单的短信(或有人可以代表他们发短信)。参与者被随机分配(1:1),随机分组大小为 2、4 和 6,分为干预组或对照组。干预组每周从 WelTel 自动服务收到一条短信,要求在 48 小时内回复。对照组的参与者未收到短信。两组的参与者均接受常规护理,包括心理社会支持和咨询;患者教育;CD4 细胞计数;治疗;筛查结核病、机会性感染和性传播感染;预防母婴传播和计划生育服务;以及最多两次预约错过的电话。主要结局是 12 个月时的保留率(即在首次就诊后 10-14 个月就诊)。未参加 12 个月预约的参与者将被追踪,我们认为那些在其他地方确认正在积极接受护理的人被保留。数据分析师和诊所工作人员对分组分配保持遮罩,而参与者和研究护士则没有。我们对意向治疗人群进行了分析。这项试验在 ClinicalTrials.gov 注册,编号为 NCT01630304。
结果:在 2013 年 4 月 4 日至 2015 年 6 月 4 日之间,我们筛查了 1068 人,其中 700 人被招募。349 人被分配到干预组,351 人被分配到对照组。参与者的中位随访时间为 55 周(IQR 51-60)。在 12 个月时,干预组的 277(79%)名参与者与对照组的 285(81%)名参与者(风险比 0·98,95%CI 0·91-1·05;p=0·54)。干预组仅有 1 例轻度不良事件,涉及一对夫妇对每周的短信和后续电话产生怀疑,导致家庭纠纷。
解释:每周的短信服务并未改善早期 HIV 护理中人们的保留率。该干预措施可能在改善类似环境中接受 HIV 护理的个体的自我感知健康相关生活质量方面发挥适度作用。
资助:美国国立卫生研究院和加拿大卫生研究院加拿大艾滋病病毒试验网络。
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