Chuchu Veronicah M, Mutono Nyamai, Bichanga Philet, Kitala Philip M, Ksee Daniel, Muturi Mathew, Mwatondo Athman, Nasimiyu Carolyne, Akunga Lawrence, Amiche Amine, Hampson Katie, Thumbi Samuel M
Centre for Global Health Research, Kenya Medical Research Institute, Kisumu 1578-40100, Kenya.
Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi 29053-00625, Kenya.
Vaccines (Basel). 2023 Jun 18;11(6):1112. doi: 10.3390/vaccines11061112.
The prompt administration of post-exposure prophylaxis (PEP) is one of the key strategies for ending human deaths from rabies. A delay in seeking the first dose of rabies PEP, or failure to complete the recommended dosage, may result in clinical rabies and death. We assessed the efficacy of short message system (SMS) phone texts in improving the adherence to scheduled PEP doses among bite patients in rural eastern Kenya. We conducted a single-arm, before-after field trial that compared adherence among bite patients presenting at Makueni Referral Hospital between October and December 2018 (control) and between January and March 2019 (intervention). Data on their demographics, socio-economic status, circumstances surrounding the bite, and expenditures related to the bite were collected. A total of 186 bite patients were enrolled, with 82 (44%) in the intervention group, and 104 (56%) in the control group. The odds of PEP completion were three times (OR 3.37, 95% CI 1.28, 10.20) more likely among patients who received the SMS reminder, compared to the control. The intervention group had better compliance on the scheduled doses 2 to 5, with a mean deviation of 0.18 days compared to 0.79 days for the control group ( = 0.004). The main reasons for non-compliance included lack of funds (30%), and forgetfulness (23%) on days for follow-up treatment, among others. Nearly all (96%, = 179) the bite patients incurred indirect transport costs, at an average of USD 4 (USD 0-45) per visit. This study suggests that the integration of SMS reminders into healthcare service delivery increases compliance with PEP, and may strengthen rabies control and elimination strategies.
暴露后预防（PEP）的及时给药是终止狂犬病导致人类死亡的关键策略之一。延迟寻求首剂狂犬病PEP或未完成推荐剂量可能导致狂犬病临床发作和死亡。我们评估了短信系统（SMS）手机短信在提高肯尼亚东部农村地区咬伤患者按时接受PEP剂量的依从性方面的效果。我们进行了一项单组前后对照现场试验，比较了2018年10月至12月在马库埃尼转诊医院就诊的咬伤患者（对照组）和2019年1月至3月就诊的咬伤患者（干预组）的依从性。收集了他们的人口统计学、社会经济状况、咬伤相关情况以及与咬伤相关的支出数据。共纳入186名咬伤患者，干预组82名（44%），对照组104名（56%）。与对照组相比，收到短信提醒的患者完成PEP的几率高出三倍（比值比3.37，95%置信区间1.28，10.20）。干预组在第2至5剂预定剂量的依从性更好，平均偏差为0.18天，而对照组为0.79天（P = 0.004）。不依从的主要原因包括资金短缺（30%）以及随访治疗日的遗忘（23%）等。几乎所有（96%，n = 179）咬伤患者都产生了间接交通费用，每次就诊平均为4美元（0 - 45美元）。本研究表明，将短信提醒纳入医疗服务提供可提高对PEP的依从性，并可能加强狂犬病控制和消除策略。
