AIDS Behav. 2010 Jun 8.
Challenges in Using Mobile Phones for Collection of Antiretroviral Therapy Adherence Data in a Resource-Limited Setting.
Haberer JE, Kiwanuka J, Nansera D, Wilson IB, Bangsberg DR. Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA, firstname.lastname@example.org.
Frequent antiretroviral therapy adherence monitoring could detect incomplete adherence before viral rebound develops and thus potentially prevent treatment failure. Mobile phone technologies make frequent, brief adherence interviews possible in resource-limited settings; however, feasibility and acceptability are unknown. Interactive voice response (IVR) and short message service (SMS) text messaging were used to collect adherence data from 19 caregivers of HIV-infected children in Uganda.
IVR calls or SMS quantifying missed doses were sent in the local language once weekly for 3-4 weeks. Qualitative interviews were conducted to assess participant impressions of the technologies. Participant interest and participation rates were high; however, weekly completion rates for adherence queries were low (0-33%), most commonly due to misunderstanding of personal identification numbers. Despite near ubiquity of mobile phone technology in resource-limited settings, individual level collection of healthcare data presents challenges. Further research is needed for effective training and incentive methods.
Am J Prev Med. 2010 Jul;39(1):78-80.
Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya.
Hoffman JA, Cunningham JR, Suleh AJ, Sundsmo A, Dekker D, Vago F, Munly K, Igonya EK, Hunt-Glassman J.
Danya International, Ltd., Silver Spring, Maryland, USA.
BACKGROUND: Growth in mobile phone penetration has created new opportunities to reach and improve care to underserved, at-risk populations including those with tuberculosis (TB) or HIV/AIDS.
PURPOSE: This paper summarizes a proof-of-concept pilot designed to provide remote Mobile Direct Observation of Treatment (MDOT) for TB patients. The MDOT model combines Clinic with Community DOT through the use of mobile phone video capture and transmission, alleviating the travel burden for patients and health professionals.
METHODS: Three healthcare professionals along with 13 patients and their treatment supporters were recruited from the Mbagathi District Hospital in Nairobi, Kenya. Treatment supporters were asked to take daily videos of the patient swallowing their medications. Patients submitted the videos for review by the health professionals and were asked to view motivational and educational TB text (SMS) and video health messages. Surveys were conducted at intake, 15 days, and 30 days. Data were collected in 2008 and analyzed in 2009.
RESULTS: All three health professionals and 11 patients completed the trial. All agreed that MDOT was a viable option, and eight patients preferred MDOT to clinic DOT or DOT through visiting Community Health Workers.
CONCLUSIONS: MDOT is technically feasible. Both patients and health professionals appear empowered by the ability to communicate with each other and appear receptive to remote MDOT and health messaging over mobile. Further research should be conducted to evaluate whether MDOT (1) improves medication adherence, (2) is cost effective, and (3) can be used to improve treatment compliance for other diseases such as AIDS.
AIDS Behav. 2010 Jun;14(3):716-20
Designing a mobile phone-based intervention to promote adherence to antiretroviral therapy in South India.
Shet A, Arumugam K, Rodrigues R, Rajagopalan N, Shubha K, Raj T, D’souza G, De Costa A. Department of Pediatrics, St John’s National Academy of Health Sciences, Bangalore, India.
Integration of mobile phone technology into HIV care holds potential, particularly in resource-constrained settings. Clinic attendees in urban and rural South India were surveyed to ascertain usage of mobile phones and perceptions of their use as an adherence aid. Mobile phone ownership was high at 73%; 26% reported shared ownership. A high proportion (66%) reported using phones to call their healthcare provider. There was interest in weekly telephonic automated voice reminders to facilitate adherence. Loss of privacy was not considered a deterrent. The study presents important considerations in the design of a mobile phone-based adherence intervention in India.