主动、互动、双向短信对马拉维利隆圭地区抗逆转录病毒治疗 12 个月保持率的影响：一项准实验研究的结果。

The effect of proactive, interactive, two-way texting on 12-month retention in antiretroviral therapy: Findings from a quasi-experimental study in Lilongwe, Malawi.

机构信息

Department of Global Health, University of Washington, Seattle, WA, United States of America.

International Training and Education Center for Health (I-TECH), Seattle, WA, United States of America.

出版信息

PLoS One. 2024 Aug 29;19(8):e0298494. doi: 10.1371/journal.pone.0298494. eCollection 2024.

BACKGROUND

Retaining clients on antiretroviral therapy (ART) is challenging, especially during the first year on ART. Mobile health (mHealth) interventions show promise to close retention gaps. We aimed to assess reach (who received the intervention?) and effectiveness (did it work?) of a hybrid two-way texting (2wT) intervention to improve ART retention at a large public clinic in Lilongwe, Malawi.

METHODS

Between August 2021-June 2023, in a quasi-experimental study, outcomes were compared between two cohorts of new ART clients: 1) those opting into 2wT who received automated, weekly motivation short messaging service (SMS) messages and response-requested appointment reminders; and 2) a matched historical cohort receiving standard of care (SoC). Reach was defined as "the proportion clients ≤6 months of ART initiation eligible for 2wT". 2wT effectiveness was assessed in time-to-event analysis. Retention was presented in a Kaplan-Meier plot and compared between 2wT and SoC using a log-rank test. The effect of 2wT on ART dropout (lost to follow-up or stopped ART) was estimated using Fine-Gray competing risk regression models, adjusting for sex, age and WHO HIV stage at ART initiation.

RESULTS

Of 1,146 clients screened, 501 were eligible for 2wT, a reach of 44%. Lack of phone (393/645; 61%) and illiteracy (149/645; 23%) were the most common ineligibility reasons. Among 468 participants exposed to 2wT, 12-month probability of ART retention was 91% (95% CI: 88% - 94%) compared to 76% (95% CI: 72% - 80%) among 468 SoC participants (p<0.001). Compared to SoC, 2wT participants had a 65% lower hazard of ART dropout at any timepoint (sub-distribution hazard ratio 0.35, 95% CI: 0.24-0.51; p<0.001).

CONCLUSIONS

2wT did not reach all clients. For those who opted-in, 2wT significantly increased 12-month ART retention. Expansion of 2wT as a complement to other retention interventions should be considered in other low-resource, routine ART settings.

背景

在抗逆转录病毒疗法（ART）中，保留患者的治疗依从性是一项挑战，尤其是在开始治疗的第一年。移动医疗（mHealth）干预措施显示出缩小保留差距的潜力。我们旨在评估在马拉维利隆圭的一家大型公立诊所中，一种混合双向短信（2wT）干预措施在提高 ART 保留率方面的可及性（哪些人接受了干预？）和效果（它是否有效？）。

方法

在 2021 年 8 月至 2023 年 6 月期间，采用准实验研究，在两组新接受 ART 的患者中比较了结果：1）选择加入 2wT 的患者，他们接受自动化的每周动机短消息服务（SMS）消息和请求回复的预约提醒；2）一组匹配的历史队列接受标准护理（SoC）。可及性定义为“≤6 个月 ART 起始时符合 2wT 条件的患者比例”。2wT 的效果通过时间事件分析进行评估。保留率在 Kaplan-Meier 图中呈现，并通过对数秩检验比较 2wT 和 SoC。使用 Fine-Gray 竞争风险回归模型估计 2wT 对 ART 停药（失访或停止 ART）的影响，调整了性别、年龄和开始 ART 时的世卫组织 HIV 阶段。

结果

在筛查的 1146 名患者中，有 501 名符合 2wT 的条件，可及性为 44%。最常见的不合格原因是没有手机（393/645；61%）和不识字（149/645；23%）。在接受 2wT 暴露的 468 名参与者中，与接受 SoC 的 468 名参与者相比，12 个月的 ART 保留率为 91%（95%CI：88% - 94%），而接受 SoC 的 468 名参与者为 76%（95%CI：72% - 80%）（p<0.001）。与 SoC 相比，2wT 参与者在任何时间点的 ART 停药风险降低了 65%（亚分布风险比 0.35，95%CI：0.24-0.51；p<0.001）。