RESUMO
ABSTRACT: As access to human immunodeficiency virus treatment expands in Low to Middle Income Countries, it becomes critical to develop and test strategies to improve adherence and ensure efficacy. Text messaging improves adherence to antiretroviral treatment antiretroviral treatment in some patient populations, but data surrounding the use of these tools is sparse in pediatric and adolescent patients in low to middle income countries. We evaluated if a text message intervention can improve antiretroviral treatment adherence while accounting for cell phone access, patterns of use, and willingness to receive text messages.We carried out a cross sectional study to understand willingness of receiving text message reminders, followed by a randomized controlled trial to assess effectiveness of text message intervention.Enrolled participants were randomized to receive standard care with regular clinic visits, or standard care plus short message service reminders. Adherence was measured 3 times during the study period using a 4-day Recall Questionnaire. Outcome was measured based on differences in the average adherence between the intervention and control group at each time point (baseline, 3âmonths, 6âmonths).Most respondents were willing to receive text message adherence reminders (81.1%, nâ=â53). Respondent literacy, travel time to clinic, cell phone access, and patterns of use were significantly associated with willingness. In the randomized trial the intervention group (nâ=â50) experienced a small but significant mean improvement in adherence over the six-month period (4%, Pâ<â.01) whereas the control group (nâ=â50) did not (mean improvement: 0.8%, Pâ=â.64).Text message interventions effectively support antiretroviral adherence in pediatric patients living with human immunodeficiency virus. Studies designed to assess the impact of text messaging interventions must examine local context for cellular phone infrastructure and use and must account for potential loss to follow up when patients miss appointments and study assessments.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Soropositividade para HIV/tratamento farmacológico , Adesão à Medicação , Envio de Mensagens de Texto , Adolescente , Criança , Custos e Análise de Custo , Estudos Transversais , Países em Desenvolvimento , Guatemala , Humanos , Envio de Mensagens de Texto/economia , Adulto JovemRESUMO
In-person (face-to-face) data collection methods offer many advantages but can also be time-consuming and expensive, particularly in areas of difficult access. We take advantage of the increasing mobile phone penetration rate in rural areas to evaluate the feasibility of using cell phones to monitor the provision of key health and nutrition interventions linked to the first 1,000 days of life, a critical period of growth and development. We examine response rates to calendarized text messages (SMS) and phone calls sent to 1,542 households over a period of four months. These households have children under two years old and pregnant women and are located across randomly selected communities in Quiche, Guatemala. We find that the overall (valid) response rate to phone calls is over 5 times higher than to text messages (75.8% versus 14.4%). We also test whether simple SMS reminders improve the timely reception of health services but do not find any effects in this regard. Language, education, and age appear to be major barriers to respond to text messages as opposed to phone calls, and the rate of response is not correlated with a household's geographic location (accessibility). Moreover, response veracity is high, with an 84-91% match between household responses and administrative records. The costs per monitored intervention are around 1.12 US dollars using text messages and 85 cents making phone calls, with the costs per effective answer showing a starker contrast, at 7.76 and 1.12 US dollars, respectively. Our findings indicate that mobile phone calls can be an effective, low-cost tool to collect reliable information remotely and in real time. In the current context, where in-person contact with households is not possible due to the COVID-19 crisis, phone calls can be a valuable instrument for collecting information, monitoring development interventions, or implementing brief surveys.
Assuntos
Telefone Celular/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Monitorização Fisiológica/estatística & dados numéricos , Estado Nutricional/fisiologia , Pandemias , Pneumonia Viral/epidemiologia , População Rural/estatística & dados numéricos , Adulto , COVID-19 , Telefone Celular/economia , Pré-Escolar , Feminino , Guatemala/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Monitorização Fisiológica/economia , Gravidez , Sistemas de Alerta/economia , Sistemas de Alerta/estatística & dados numéricos , Inquéritos e Questionários , Telemedicina/economia , Telemedicina/estatística & dados numéricos , Envio de Mensagens de Texto/economia , Envio de Mensagens de Texto/estatística & dados numéricosRESUMO
Ensuring adherence and support during treatment of tuberculosis (TB) is a major public health challenge. Digital health technologies could help improve treatment outcomes. We considered their potential cost and impact on treatment for active or latent TB in Brazil.Decision analysis models simulated two adult cohorts with 1) drug-susceptible active TB, and 2) multidrug-resistant TB, and two cohorts treated with isoniazid for latent TB infection (LTBI): 1) close contacts of persons with active TB, and 2) others newly diagnosed with LTBI. We evaluated four digital support strategies: two different medication monitors, synchronous video-observed therapy (VOT), and two-way short message service (SMS). Comparators were standard directly observed treatment for active TB and self-administered treatment for LTBI. Projected outcomes included costs (2016 US dollars), plus active TB cases and disability-adjusted life years averted among persons with LTBI.For individuals with active TB, medication monitors and VOT are projected to lead to substantial (up to 58%) cost savings, in addition to alleviating inconvenience and cost to patients of supervised treatment visits. For LTBI treatment, SMS and medication monitors are projected to be the most cost-effective interventions. However, all projections are limited by the scarcity of published estimates of clinical effect for the digital technologies.