Researchers find text messages to HIV patients improve adherence, health outcomes in Kenya trial

Nov 10 2010

"Using mobile-phone text messages to remind HIV patients to take their dose of life-saving medications can give a major boost to drug adherence, according to an innovative trial in Kenya unveiled on Tuesday," Agence France-Presse reports.

For the study, which was published online in the Lancet Wednesday, researchers describe how "[b]etween May 2007 and October 2009, 538 patients [initiating antiretroviral therapy (ART)] were enrolled in the WelTel Kenya1 study from three clinics that provided care for HIV/AIDS patients - one in a low-income section of Nairobi, another in a higher-income section of the city, and a third in a rural district. Half of the patients were randomly selected to receive text message support, while the others did not," according to a University of British Columbia press release (11/9).

"Patients in the intervention group received weekly SMS messages from a clinic nurse" with "the slogan 'Mambo?' …  which is Kiswahili for 'How are you?'," the study authors write. "The health workers used multiple recipient (bulk) messaging functions to improve efficiency. Patients in the intervention group were instructed to respond within 48 h that either they were doing well ('Sawa') or that they had a problem ('Shida'). The clinician then called patients who said they had a problem or who failed to respond within 2 days," they report (Lester et al., 11/10).

"The phone messages helped 12 percent of patients better stay with their treatment, compared with a group that did not have mobile follow-up, according to the research," Bloomberg reports. "About 9 percent more patients saw the amount of virus in their blood drop," the news service adds (von Schaper, 10/9).

"It's not actually reminders, per se, it's actually the support that they seek, and timely triggers to be able to report on any problems that they have," the University of British Columbia's Richard Lester, lead author of the study, explained, during a presentation of the findings at the mHealth Alliance Summit in Washington, D.C., the Canadian Press/Winnipeg Free Press reports. "It's a weekly check-in, and it provides them the chance to report on any problems they have with their medications very early, and then the nurse or clinical officer would actually call them back and sort out those problems and triage them," Lester added (Tobin, 11/9).

"About three percent of participants in the text messaging group reported a need for followup," leading "the researchers [to] estimat[e] one nurse could potentially manage 1,000 patients by text messaging and expect to call 33 patients per week" CBC News reports. (11/9).

With the cost of each SMS "around five U.S. cents," AFP adds "the SMS system could be a sure-fire winner compared to personal visits by a nurse, the researchers say. It could be less expensive just measured on travel costs alone" (11/9).

"Overall, this study has implications for policy makers and global funders of ART programmes," the study authors report in the Lancet. "First, this is one of the first adherence interventions to confer a reduction in virologic failures. ART needs to be taken lifelong, thus optimal adherence is crucial to the prevention of antiretroviral drug resistance. Instances of drug resistance make future treatment options more challenging and progressively more expensive to deliver. Additionally, reducing viral replication through ART can decrease transmission of HIV-1 to new partners and thus can play a preventive role at the population level to reduce the number of new infections," they conclude (11/10).

In an accompanying Lancet Comment, Benjamin Chi of the Centre for Infectious Disease Research in Zambia and Jeffrey Stringer of the University of Alabama School of Medicine write, "As policy makers consider bringing the SMS intervention to scale - which we think they should - some questions remain," such as whether or not the findings could be replicated in other settings and the potential cost associated with such intervention (11/10).

Leaders Address mHealth Summit

In a keynote address at the mHealth Summit on Tuesday Bill Gates, co-chair of the Bill & Melinda Gates Foundation, emphasized the potential for mobile technology to "improve global health with cheap diagnostic tools, patient reminders and making immunization programs more efficient," AFP reports in a separate article (11/9).

"'The mobile phone is pretty interesting for lots of things,' Gates said in his keynote address at the mobile health event," AFP/TechRadar reports. "'There's a whole lot of opportunities. I think we have to approach these things with some humility though,' added Gates, noting that much of the developing world still has no internet or data connections" (Hartley, 11/10).

AFP writes that Gates noted mobile technology's ability to provide a link between trained health care professionals and patients in limited resourced clinics as well as other benefits of the technology for making improvements to TB diagnostics. "I do think there's absolutely a role (for mobile technology to impact global health) but I think we have to hold ourselves to some pretty tough metrics to see if it's really making a difference or not," Gates said (11/9).

allAfrica.com, also reporting on the mHealth Summit, writes of why health experts believe mobile phones present an opportunity to improve health outcomes in developing countries.   

"The fastest growing cell phone markets, in fact, are in the developing countries where the disease burdens are also the highest. There are five billion subscribers today, almost 70 percent of them in the developing world," said Kathy Calvin, CEO of the United Nations Foundation, according to the news service. "We believe that through wireless networks we can connect patients, families and practitioners with a speed and breadth never before possible. We have the ability to get the right information into the hands of the people who need it, when and where they need it - messages, reminders, checklists, access to information, calls for emergency help in a difficult birth, are all improved with the use of cell and mobile technology," Calvin said.

The article outlines several topics to be addressed during the mHealth Summit - including what the news service refers to as "the first organizing meeting of the maternal mHealth initiative" - and names several keynote speakers at the summit, including Aneesh Chopra, White House chief technology officer; Ted Turner, chairman of the U.N. Foundation; and Judith Rodin, president of the Rockefeller Foundation (Shiner, 11/10).