Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Makerere University, Kampala, Uganda.
The Academy for Health Innovations, Infectious Diseases Institute, Makerere University, Kampala, Uganda.
JMIR Mhealth Uhealth. 2021 Feb 11;9(2):e22229. doi: 10.2196/22229.
Following the successful scale-up of antiretroviral therapy (ART), the focus is now on ensuring good quality of life (QoL) and sustained viral suppression in people living with HIV. The access to mobile technology in the most burdened countries is increasing rapidly, and therefore, mobile health (mHealth) technologies could be leveraged to improve QoL in people living with HIV. However, data on the impact of mHealth tools on the QoL in people living with HIV are limited to the evaluation of SMS text messaging; these are infeasible in high-illiteracy settings.
The primary and secondary outcomes were to determine the impact of interactive voice response (IVR) technology on Medical Outcomes Study HIV QoL scores and viral suppression at 12 months, respectively.
Within the Call for Life study, ART-experienced and ART-naïve people living with HIV commencing ART were randomized (1:1 ratio) to the control (no IVR support) or intervention arm (daily adherence and pre-appointment reminders, health information tips, and option to report symptoms). The software evaluated was Call for Life Uganda, an IVR technology that is based on the Mobile Technology for Community Health open-source software. Eligibility criteria for participation included access to a phone, fluency in local languages, and provision of consent. The differences in differences (DIDs) were computed, adjusting for baseline HIV RNA and CD4.
Overall, 600 participants (413 female, 68.8%) were enrolled and followed-up for 12 months. In the intervention arm of 300 participants, 298 (99.3%) opted for IVR and 2 (0.7%) chose SMS text messaging as the mode of receiving reminders and health tips. At 12 months, there was no overall difference in the QoL between the intervention and control arms (DID=0.0; P=.99) or HIV RNA (DID=0.01; P=.94). At 12 months, 124 of the 256 (48.4%) active participants had picked up at least 50% of the calls. In the active intervention participants, high users (received >75% of reminders) had overall higher QoL compared to low users (received <25% of reminders) (92.2 versus 87.8, P=.02). Similarly, high users also had higher QoL scores in the mental health domain (93.1 versus 86.8, P=.008) and better appointment keeping. Similarly, participants with moderate use (51%-75%) had better viral suppression at 12 months (80/94, 85% versus 11/19, 58%, P=.006).
Overall, there was high uptake and acceptability of the IVR tool. While we found no overall difference in the QoL and viral suppression between study arms, people living with HIV with higher usage of the tool showed greater improvements in QoL, viral suppression, and appointment keeping. With the declining resources available to HIV programs and the increasing number of people living with HIV accessing ART, IVR technology could be used to support patient care. The tool may be helpful in situations where physical consultations are infeasible, including the current COVID epidemic.
ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080.
随着抗逆转录病毒疗法（ART）的成功推广，现在的重点是确保艾滋病毒感染者的生活质量（QoL）和持续病毒抑制。在受影响最严重的国家，移动技术的普及程度正在迅速提高，因此，移动健康（mHealth）技术可以用来提高艾滋病毒感染者的生活质量。然而，关于 mHealth 工具对艾滋病毒感染者生活质量影响的数据仅限于短信文本消息的评估；在高文盲率的环境中，这些方法是不可行的。
主要和次要结局分别是确定交互式语音应答（IVR）技术对医疗结局研究 HIV 生活质量评分和 12 个月时病毒抑制的影响。
在“呼吁生命”研究中，接受过 ART 治疗的人和开始接受 ART 的未接受过 ART 治疗的艾滋病毒感染者被随机分为对照组（无 IVR 支持）或干预组（每日依从性和预约提醒、健康信息提示和报告症状的选项）（1:1 比例）。评估的软件是 Call for Life Uganda，这是一种基于移动技术社区健康开源软件的 IVR 技术。参与的资格标准包括有电话、精通当地语言并同意参加。计算了差异（DID），并根据基线 HIV RNA 和 CD4 进行了调整。
共有 600 名（413 名女性，68.8%）参与者符合条件并随访了 12 个月。在 300 名参与者的干预组中，298 名（99.3%）选择了 IVR，2 名（0.7%）选择了短信文本消息作为接收提醒和健康提示的方式。在 12 个月时，干预组和对照组之间的生活质量（DID=0.0；P=.99）或 HIV RNA（DID=0.01；P=.94）没有总体差异。在 12 个月时，256 名活跃参与者中有 124 名（48.4%）至少接听了 50%的电话。在积极参与干预的参与者中，高使用者（收到>75%的提醒）的生活质量总体上高于低使用者（收到<25%的提醒）（92.2 与 87.8，P=.02）。同样，高使用者在心理健康领域的生活质量评分也更高（93.1 与 86.8，P=.008），预约保持也更好。同样，中度使用者（51%-75%）在 12 个月时的病毒抑制效果更好（80/94，85%与 11/19，58%，P=.006）。
总的来说，IVR 工具的使用率和接受度都很高。虽然我们没有发现研究组之间生活质量和病毒抑制方面的总体差异，但使用工具的艾滋病毒感染者的生活质量、病毒抑制和预约保持方面有了更大的改善。随着艾滋病毒规划可用资源的减少和越来越多的艾滋病毒感染者接受抗逆转录病毒治疗，IVR 技术可以用于支持患者护理。在目前的 COVID 疫情期间，这种工具可能有助于无法进行物理咨询的情况。
ClinicalTrials.gov NCT02953080；https://clinicaltrials.gov/ct2/show/NCT02953080。
