SMS text messaging helps HIV patients reduce viral load

Mobile-based communication between HIV patients and doctors can help reinforce observance to drug treatment and reduce the viral load, a new study by WelTel Kenya, a non-profit non-governmental mHealth organization, reveals.

The study, which was conducted in Kenya between 2007 and 2009, found that SMS text messaging supported improved adherence to antiretroviral therapy (ART) and suppression of the most common strain of HIV — HIV-1 RNA load.

The WelTel Kenya1 intervention involved sending text messages every Monday morning to patients to inquire of their health status or whether they had trouble with the treatment. Upon failure to respond, medical personnel would call the patient to find out why and give assistance where necessary.

According to WelTel, non-response was defined as not responding within 48 hours of the message. The report shows that cellphone problems were commonly named as reasons for not responding at 22 percent, “mostly due to lack of network credit.”

The majority of the problems reported in the final trial were related to either drug effects or social stigma.

Adherence trials started in 2005, when ARVs were first distributed in Kenya’s hospitals for free access to the patients.

Speaking to SciDev.Net, a major science online publisher, Sarah Karanja, an HIV/sexually transmitted infection prevention officer for the Kenya AIDS Control Project run by the University of Manitoba, Canada, and one of the researchers involved in the study, said: “Patient clinician cell phone communication provided constant interaction between the drug providers and the patients. If a patient had a problem, they were able to contact the clinician, who would, in turn, provide immediate assistance.”

Karanja further comments that a majority of people at that time had acquired mobile phones prompting the intervention to be mobile based.

WelTel Kenya reported that between 2007 and 2009, 271 participants generated 11,873 responses, 377 of which indicated a problem.

Judy Gichoya of the Regional East African Center for Health Informatics told the SciDev.Net that several randomized “controlled trials have provided enough scientific evidence about SMS’s role in improving adherence to treatment.”

She said that the text message reminders applied in the study were “further proof that they can boost adherence to long-term medication regimes for chronic illness.”

“There is a role for cell phone technology in HIV prevention, through promoting adherence to preventive measures,” she said. “Patients may use the cell phones for their own personalized initiatives, such as the use of alarms for medication reminders.”

Gichoya however warns that the possibility of disclosure of status, loss of privacy and technical difficulties have to be addressed prior to using text messaging on large-scale for health initiatives.

“There are no studies describing the use of cell phones to improve adherence to HIV/AIDS treatment guidelines and studies addressing [their use in bringing about] behavior change [in other health areas] cite difficulty in outcome measurement and high costs as hampering their scalability,” she added.

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