Cell Phone-Based and Adherence Device Technologies for HIV Care and Treatment in Resource-Limited Settings: Recent Advances
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Numerous cell phone-based and adherence monitoring technologies have been developed to address barriers to effective HIV prevention, testing, and treatment. Because most people living with HIV and AIDS reside in resource-limited settings (RLS), it is important to understand the development and use of these technologies in RLS. Recent research on cell phone-based technologies has focused on HIV education, linkage to and retention in care, disease tracking, and antiretroviral therapy adherence reminders. Advances in adherence devices have focused on real-time adherence monitors, which have been used for both antiretroviral therapy and pre-exposure prophylaxis. Real-time monitoring has recently been combined with cell phone-based technologies to create real-time adherence interventions using short message service (SMS). New developments in adherence technologies are exploring ingestion monitoring and metabolite detection to confirm adherence. This article provides an overview of recent advances in these two families of technologies and includes research on their acceptability and cost-effectiveness when available. It additionally outlines key challenges and needed research as use of these technologies continues to expand and evolve.
KeywordsCell phones Electronic adherence monitoring Technology HIV antiretroviral therapy
Compliance with Ethics Guidelines
Conflict of Interest
Dr. Haberer reports grants from NIH, during the conduct of the study; personal fees from World Health Organization, personal fees from FHI 360, personal fees from NIH, outside the submitted work. Mr. Campbell reports grants from NIH, during the conduct of the study.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This study was supported from NIH grant numbers R21AI108329, R34H100940.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 1.Organization WH. Global update on the health sector response to HIV, 2014. WHO Press 2014; World Health Organization, Geneva. 2014. http://apps.who.int/iris/bitstream/10665/128494/1/9789241507585_eng.pdf?ua=1. Last accessed 18 July 2015.
- 2.Organization WH. Number of deaths due to HIV/AIDS. 2015. http://www.who.int/gho/hiv/epidemic_status/deaths_text/en/ Last accessed 31 May 2015
- 4.“Technology”. Merriam-Webster Dictionary. http://www.merriam-webster.com/dictionary/technology Last accessed 4 June 2015.
- 5.World Bank. Information and communication technologies, infoDev (Program), World Bank. Maximizing mobile: 2012 information and communications for development. Information and Communications for Development, vol. 2012. Washington, D.C.: World Bank: InfoDev; 2012.Google Scholar
- 6.Organization WH. mHealth: New horizons for health through mobile technologies: second global survey on eHealth. World Health Organization, Geneva, Switzerland. 2011. http://www.who.int/goe/publications/goe_mhealth_webpdf Last accessed 30 May 2015.
- 7.Center PR. Cell phones in Africa: communication lifeline. 2015. http://www.pewglobal.org/2015/04/15/cell-phones-in-africa-communication-lifeline/ Last accessed 4 June 2015.
- 8.Union IT. ICT facts and figures. International Telecommunication Union Geneva, Switzerland. 2015. http://www.itu.int/en/ITU-D/Statistics/Documents/facts/ICTFactsFigures2015pdf Last accessed 4 June 2015.
- 12.Consulting VW. mHealth for Development: the opportunity of mobile technology for healthcare in the developing world. Washington, DC and Berkshire, UK: UN Foundation-Vodafone Foundation Partnership. 2009. http://www.unpan1.un.org/intradoc/groups/public/documents/unpan/unpan037268pdf Last accessed 30 May 2015.
- 13.Mendoza G, Levine R, Kibuka T, Okoko L. mHealth compendium, volume 4. Arlington, VA: African Strategies for Health, Management Sciences for Health. 2014. http://www.africanstrategies4health.org/uploads/1/3/5/3/13538666/usaid_mhealth_compendium_vol_4_finalpdf Last accessed 30 May 2015.
- 17.Siedner MJ, Santorino D, Lankowski AJ, Kanyesigye M, Bwana MB, Haberer JE et al. A combination SMS and transportation reimbursement intervention to improve HIV care following abnormal CD4 test results in rural Uganda: an observational cohort study. BMC Med. 2015;13(160). doi: 10.1186/s12916-015-0397-1.
- 18.ClinicalTrials.gov. WelTel Retain: promoting engagement in pre-ART HIV care through SMS. 2015. https://clinicaltrials.gov/ct2/show/NCT01630304 Last accessed 31 May 2015.
- 20.Finocchario-Kessler S, Gautney BJ, Khamadi S, Okoth V, Goggin K, Spinler JK, et al. If you text them, they will come: using the HIV infant tracking system to improve early infant diagnosis quality and retention in Kenya. AIDS. 2014;28 Suppl 3:S313–21. doi: 10.1097/QAD.0000000000000332.PubMedCentralCrossRefPubMedGoogle Scholar
- 21.Bigna JJ, Noubiap JJ, Kouanfack C, Plottel CS, Koulla-Shiro S. Effect of mobile phone reminders on follow-up medical care of children exposed to or infected with HIV in Cameroon (MORE CARE): a multicentre, single-blind, factorial, randomised controlled trial. Lancet Infect Dis. 2014;14(7):600–8. doi: 10.1016/S1473-3099(14)70741-8.CrossRefPubMedGoogle Scholar
- 22.Schwartz SR, Clouse K, Yende N, Van Rie A, Bassett J, Ratshefola M, et al. Acceptability and feasibility of a mobile phone-based case management intervention to retain mothers and infants from an option B+ program in postpartum HIV care. Matern Child Health J. 2015. doi: 10.1007/s10995-015-1715-0.Google Scholar
- 23.Dryden-Peterson S, Bennett K, Hughes MD, Veres A, John O, Pradhananga R, et al. An augmented SMS intervention to improve access to antenatal CD4 testing and ART initiation in HIV-infected pregnant women: a cluster randomized trial. PLoS One. 2015;10(2):e0117181. doi: 10.1371/journal.pone.0117181.PubMedCentralCrossRefPubMedGoogle Scholar
- 24.Nsanzimana S, Ruton H, Lowrance DW, Cishahayo S, Nyemazi JP, Muhayimpundu R, et al. Cell phone-based and internet-based monitoring and evaluation of the National Antiretroviral Treatment Program during rapid scale-up in Rwanda: TRACnet, 2004-2010. J Acquir Immune Defic Syndr. 2012;59(2):e17–23. doi: 10.1097/QAI.0b013e31823e2278.CrossRefPubMedGoogle Scholar
- 26.•Finitsis DJ, Pellowski JA, Johnson BT. Text message intervention designs to promote adherence to antiretroviral therapy (ART): a meta-analysis of randomized controlled trials. PLoS One. 2014;9(2):e88166. doi: 10.1371/journal.pone.0088166. This recent meta-analysis summarizes a broad range of data from RLS and the developed world on the efficacy of SMS-based reminders.PubMedCentralCrossRefPubMedGoogle Scholar
- 27.Mbuagbaw L, van der Kop ML, Lester RT, Thirumurthy H, Pop-Eleches C, Ye C, et al. Mobile phone text messages for improving adherence to antiretroviral therapy (ART): an individual patient data meta-analysis of randomised trials. BMJ Open. 2013;3(12):e003950. doi: 10.1136/bmjopen-2013-003950.PubMedCentralCrossRefPubMedGoogle Scholar
- 28.Mills EJ, Lester R, Thorlund K, Lorenzi M, Muldoon K, Kanters S et al. Interventions to promote adherence to antiretroviral therapy in Africa: a network meta-analysis. Lancet HIV.1(3):e104-11. doi: 10.1016/S2352-3018(14)00003-4.
- 29.Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, de Walque D, et al. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS. 2011;25(6):825–34. doi: 10.1097/QAD.0b013e32834380c1.PubMedCentralCrossRefPubMedGoogle Scholar
- 34.Simoni JM, Montgomery A, Martin E, New M, Demas PA, Rana S. Adherence to antiretroviral therapy for pediatric HIV infection: a qualitative systematic review with recommendations for research and clinical management. Pediatrics. 2007;119(6):e1371–83. doi: 10.1542/peds.2006-1232.CrossRefPubMedGoogle Scholar
- 35.•Sabin LL, Bachman DeSilva M, Gill CJ, Zhong L, Vian T, Wubin X, et al. Improving adherence to antiretroviral therapy with triggered real time text message reminders: the China through technology study (CATS). J Acquir Immune Defic Syndr. 2015. doi: 10.1097/QAI.0000000000000651. This paper presents the first of two trials to combine electronic adherence monitoring and cell phone-based reminders, using a responsive reminder system based on detected non-adherence.Google Scholar
- 36.Mbuagbaw L, Thabane L, Ongolo-Zogo P, Lester RT, Mills EJ, Smieja M, et al. The Cameroon mobile phone SMS (CAMPS) trial: a randomized trial of text messaging versus usual care for adherence to antiretroviral therapy. PLoS One. 2012;7(12):e46909. doi: 10.1371/journal.pone.0046909.PubMedCentralCrossRefPubMedGoogle Scholar
- 38.Siedner MJ, Haberer JE, Bwana MB, Ware NC, Bangsberg DR. High acceptability for cell phone text messages to improve communication of laboratory results with HIV-infected patients in rural Uganda: a cross-sectional survey study. BMC Med Inform Decis Mak. 2012;12:56. doi: 10.1186/1472-6947-12-56.PubMedCentralCrossRefPubMedGoogle Scholar
- 41.da Costa TM, Barbosa BJ, Gomes e Costa DA, Sigulem D, de Fatima Marin H, Filho AC, et al. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform. 2012;81(4):257–69. doi: 10.1016/j.ijmedinf.2011.10.002.PubMedCentralCrossRefPubMedGoogle Scholar
- 42.Rana Y, Haberer J, Huang H, Kambugu A, Mukasa B, Thirumurthy H, et al. Short message service (SMS)-based intervention to improve treatment adherence among HIV-positive youth in Uganda: focus group findings. PLoS One. 2015;10(4):e0125187. doi: 10.1371/journal.pone.0125187.PubMedCentralCrossRefPubMedGoogle Scholar
- 43.Bigna JJ, Noubiap JJ, Plottel CS, Kouanfack C, Koulla-Shiro S. Barriers to the implementation of mobile phone reminders in pediatric HIV care: a pre-trial analysis of the Cameroonian MORE CARE study. BMC Health Serv Res. 2014;14:523. doi: 10.1186/s12913-014-0523-3.PubMedCentralCrossRefPubMedGoogle Scholar
- 45.Reid MJ, Dhar SI, Cary M, Liang P, Thompson J, Gabaitiri L, et al. Opinions and attitudes of participants in a randomized controlled trial examining the efficacy of SMS reminders to enhance antiretroviral adherence: a cross-sectional survey. J Acquir Immune Defic Syndr. 2014;65(2):e86–8. doi: 10.1097/QAI.0b013e3182a9c72b.PubMedCentralCrossRefPubMedGoogle Scholar
- 46.Nhavoto JA, Gronlund A, Chaquilla WP. SMSaude: design, development, and implementation of a remote/mobile patient management system to improve retention in care for HIV/AIDS and tuberculosis patients. JMIR mHealth uHealth. 2015;3(1):e26. doi: 10.2196/mhealth.3854.PubMedCentralCrossRefPubMedGoogle Scholar
- 55.van der Straten A, Montgomery E, Pillay D, Cheng H, Naidoo A, Cele Z, et al. Feasibility, performance, and acceptability of the Wisebag for potential monitoring of daily gel applicator use in Durban, South Africa. AIDS Behav. 2013;17(2):640–8. doi: 10.1007/s10461-012-0330-y.PubMedCentralCrossRefPubMedGoogle Scholar
- 57.•Orrell C, Cohen K, Mauff K, Bangsberg D, Maartens G, Wood R. A randomised controlled trial of real-time electronic adherence monitoring with text message dosing reminders in people starting first-line antiretroviral therapy. J Acquir Immune Defic Syndr. 2015. This paper is the second of two trials that linked SMS-based adherence reminders to non-adherence detected by real-time electronic monitoring.Google Scholar
- 58.Haberer J, Musinguzi N, Boum YI, Siedner J, Mocello A, Hunt P et al. Duration of antiretroviral therapy adherence interruption is associated with risk of virologic rebound as determined by real-time adherence monitoring in rural Uganda. J Acquir Immune Defic Syndr. 2015. doi: 10.1097/QAI.0000000000000737.