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The Acceptability and Perceived Usefulness of a Weekly Clinical SMS Program to Promote HIV Antiretroviral Medication Adherence in KwaZulu-Natal, South Africa

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Abstract

Short message service (SMS) text messages have been used to remind and encourage patients to take ART in research studies. However, few studies have assessed the feasibility and acceptability of SMS in routine clinical practice. We report patient perspectives on a weekly SMS adherence support program after implementation into clinical care at an HIV clinic in KwaZulu-Natal, South Africa. We conducted structured interviews with a cross-sectional convenience sample of 100 adult patients who were invited to join the program, 88 of whom had received a program SMS. Of these respondents, 81 (92 %) would recommend the program to a friend. Sixty-eight (77 %) felt the program helped them remember clinic appointments, a response associated with male gender [odds ratio (OR) 5.88, 95 % confidence interval (CI) 1.52–23.26, P = 0.011] and HIV disclosure outside the home [OR 3.40, 95 %CI 1.00–11.60, P = 0.050]. This clinical SMS adherence program was found to have high patient-perceived usefulness.

Resumen

Servicio de mensajes cortos (SMS) mensajes de texto se han utilizado para recordar y alentar a los pacientes a tomar ART en estudios de investigación. Sin embargo, pocos estudios han evaluado la viabilidad y aceptabilidad de los SMS en la práctica clínica habitual. Presentamos las perspectivas del paciente en un programa de apoyo a la adherencia de SMS semanal después de la implementación en la atención clínica en una clínica de VIH en KwaZulu -Natal, Sudáfrica. Hemos llevado a cabo entrevistas estructuradas con una muestra conveniencia transversal de 100 pacientes adultos que fueron invitados a participar en el programa, 88 de los cuales habían recibido un SMS del programa. De estos encuestados, 81 (92 %) recomendarían el programa a un amigo. Sesenta y ocho (77 %) considera el programa ayudó a recordar citas en la clínica, una respuesta asociada con el género masculino [odds ratio (OR) 5,88; intervalo de confianza del 95 % (IC) 1,52 a 23,26; p = 0,011] y la revelación del VIH fuera del casa [OR 3,40; IC del 95 % 1,00 a 11,60; p = 0,050]. Se encontró que este programa de adherencia SMS clínica para tener una alta utilidad percibida por el paciente.

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References

  1. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Conway B. The role of adherence to antiretroviral therapy in the management of HIV infection. JAIDS J Acquir Immune Defici Syndr. 2007;45:S14–8.

    Article  CAS  Google Scholar 

  3. Barth RE, van der Loeff MFS, Schuurman R, Hoepelman AIM, Wensing AMJ. Virological follow-up of adult patients in antiretroviral treatment programmes in Sub-Saharan Africa: a systematic review. Lancet Infect Dis. 2010;10(3):155–66.

    Article  CAS  PubMed  Google Scholar 

  4. Merten S, Kenter E, McKenzie O, Musheke M, Ntalasha H, Martin-Hilber A. Patient-reported barriers and drivers of adherence to antiretrovirals in Sub-Saharan Africa: a meta-ethnography. Trop Med Int Health. 2010;15:16–33.

    Article  PubMed  Google Scholar 

  5. Chesney M. Adherence to HAART regimens. AIDS Patient Care STDs. 2003;17(4):169–77.

    Article  PubMed  Google Scholar 

  6. Peltzer K, Friend-du Preez N, Ramlagan S, Anderson J. Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa. BMC Public Health. 2010;10(1):111.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mills EJ, Nachega JB, Buchan I, et al. Adherence to antiretroviral therapy in Sub-Saharan Africa and North America: a meta-analysis. JAMA. 2006;296(6):679–90.

    Article  CAS  PubMed  Google Scholar 

  8. Shet A, Arumugam K, Rodrigues R, et al. Designing a mobile phone-based intervention to promote adherence to antiretroviral therapy in South India. AIDS Behav. 2010;14(3):716–20.

    Article  PubMed  Google Scholar 

  9. Mbuagbaw L, Bonono-Momnougui RC, Thabane L. Considerations in using text messages to improve adherence to highly active antiretroviral therapy: a qualitative study among clients in Yaoundé, Cameroon. HIV/AIDS (Auckland, N.Z.). 2012;4:45–50.

    Google Scholar 

  10. Ware NC, Wyatt MA, Pisarski EE, et al. Meanings of SMS reminders for adherence support among adults taking ART in rural Southwestern Uganda. In: International conference on HIV prevention and treatment adherence. Miami, 2015 [abstract].

  11. Ware NC, Wyatt MA, Geng EH, et al. Toward an understanding of disengagement from HIV Treatment and care in Sub-Saharan Africa: a qualitative study. PLoS Med. 2013;10(1):e1001369.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lester RT, Ritvo P, Mills EJ, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet. 2010;376(9755):1838–45.

    Article  PubMed  Google Scholar 

  13. Pop-Eleches C, Thirumurthy H, Habyarimana JP, 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.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract. 2013;16(3):302–8.

    Article  CAS  PubMed  Google Scholar 

  15. Bigna JJR, Noubiap JJN, 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.

    Article  PubMed  Google Scholar 

  16. Mbuagbaw L, Thabane L, Ongolo-Zogo P, 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Shet A, Costa AD, Kumarasamy N, et al. Effect of mobile telephone reminders on treatment outcome in HIV: evidence from a randomised controlled trial in India. BMJ. 2014;349:g5978.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mbuagbaw L, van der Kop ML, Lester RT, 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mills EJ, Lester R, Thorlund K, et al. Interventions to promote adherence to antiretroviral therapy in Africa: a network meta-analysis. Lancet HIV. 2014;1(3):e104–11.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wald DS, Butt S, Bestwick JP. One-way versus two-way text messaging on improving medication adherence: meta-analysis of randomized trials. Am J Med. 2015;128(10):1139.e1131–5.

    Article  Google Scholar 

  22. Crankshaw T, Corless IB, Giddy J, Nicholas PK, Eichbaum Q, Butler LM. Exploring the patterns of use and the feasibility of using cellular phones for clinic appointment reminders and adherence messages in an antiretroviral treatment clinic, Durban, South Africa. AIDS Patient Care STDs. 2010;24(11):729–34.

    Article  PubMed  Google Scholar 

  23. Curioso WH, Alex Quistberg D, Cabello R, et al. “It’s time for your life”: How should we remind patients to take medicines using short text messages? In: AMIA annual symposium proceedings/AMIA symposium. AMIA symposium. 2009;2009:129–33.

  24. Rana Y, Haberer J, Huang 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.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rodrigues R, Shet A, Antony J, et al. Supporting adherence to antiretroviral therapy with mobile phone reminders: results from a Cohort in South India. PLoS One. 2012;7(8):e40723.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Reid MJA, Dhar SI, Cary M, 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. JAIDS J Acquir Immune Defici Syndr. 2014;65(2):e86–8.

    Article  Google Scholar 

  27. Mbuagbaw L, Thabane L, Ongolo-Zogo P. Opening communication channels with people living with HIV using mobile phone text messaging: insights from the CAMPS trial. BMC Res Notes. 2013;6(1):131.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bassett IV, Regan S, Chetty S, et al. Who starts antiretroviral therapy in Durban, South Africa?… not everyone who should. AIDS (London, England). 2010;24(Suppl 1):S37.

    Article  Google Scholar 

  29. Mills EJ, Beyrer C, Birungi J, Dybul MR. Engaging men in prevention and care for HIV/AIDS in Africa. PLoS Med. 2012;9(2):e1001167.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Brennan A, Maskew M, Sanne I, Fox M. The importance of clinic attendance in the first six months on antiretroviral treatment: a retrospective analysis at a large public sector HIV clinic in South Africa. J Int AIDS Soc. 2010;13(1):49.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  PubMed  Google Scholar 

  33. Siedner MJ, Santorino D, Haberer JE, Bangsberg DR. Know your audience: predictors of success for a patient-centered texting app to augment linkage to HIV care in rural Uganda. J Med Internet Res. 2015;17(3):e78.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Stirratt M, Remien R, Smith A, Copeland O, Dolezal C, Krieger D. The role of HIV serostatus disclosure in antiretroviral medication adherence. AIDS Behav. 2006;10(5):483–93.

    Article  PubMed  Google Scholar 

  35. Tuller D, Bangsberg D, Senkungu J, Ware N, Emenyonu N, Weiser S. Transportation costs impede sustained adherence and access to HAART in a clinic population in Southwestern Uganda: a qualitative study. AIDS Behav. 2010;14(4):778–84.

    Article  PubMed  Google Scholar 

  36. Hosmer DW, Lemeshow S. Multiple logistic regression. Applied logistic regression. New York: Wiley; 2005. p. 31–46.

    Book  Google Scholar 

  37. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med. 2007;45(4):247–51.

    Article  Google Scholar 

  38. Catz SL, McClure JB, Jones GN, Brantley PJ. Predictors of outpatient medical appointment attendance among persons with HIV. AIDS Care. 1999;11(3):361–73.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study received financial support from the Harvard Medical School Scholars in Medicine Program, NIH Grant K23 MH087228, K23 MH099916, T32 AI007433. This work was conducted with support from Harvard Catalyst. The Harvard Clinical and Translational Science Center (NCRR and NCATS, NIH Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The authors would like to thank the staff of Ethembeni clinic for welcoming and assisting the research team, the interview participants for their time and feedback, student volunteers (including Marco Grossi, Grace Hansen-Gilmour, April Kim, and Bessie Zhang) for assistance with data capture, and the leadership staff of Sawubona Health (including Majahonkhe Shabangu, Roy Zhang, Dario Sava, and Antony Bett) for their insights into the SMS program.

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Authors and Affiliations

  1. Harvard Medical School, Boston, MA, USA

    Nathan Georgette, Mark J. Siedner, Brian Zanoni & Jessica E. Haberer

  2. Center for Global Health, Massachusetts General Hospital, 100 Cambridge St, 15th Floor, Boston, MA, USA

    Mark J. Siedner, Brian Zanoni & Jessica E. Haberer

  3. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Mark J. Siedner, Brian Zanoni & Jessica E. Haberer

  4. University of KwaZulu-Natal, Durban, South Africa

    Thobekile Sibaya

  5. Boston Children’s Hospital, Boston, MA, USA

    Carter R. Petty

  6. Don McKenzie Hospital, Botha’s Hill, South Africa

    Stephen Carpenter

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  1. Nathan Georgette
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  7. Jessica E. Haberer
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Correspondence to Jessica E. Haberer.

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Conflict of Interest

Nathan Georgette and Stephen Carpenter were involved in the development and implementation of the Ethembeni SMS program. Georgette is the volunteer CEO of the non-profit Sawubona Health, which helped establish and supports the Ethembeni SMS program.

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Georgette, N., Siedner, M.J., Zanoni, B. et al. The Acceptability and Perceived Usefulness of a Weekly Clinical SMS Program to Promote HIV Antiretroviral Medication Adherence in KwaZulu-Natal, South Africa. AIDS Behav 20, 2629–2638 (2016). https://doi.org/10.1007/s10461-016-1287-z

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  • DOI: https://doi.org/10.1007/s10461-016-1287-z

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