Challenges in Using Mobile Phones for Collection of Antiretroviral Therapy Adherence Data in a Resource-Limited Setting

Abstract

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 three to four 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.

The Integrated Model for e-Health Data Collection and Sharing under Distributed Environments in Tanzania

“…For those countries with no vital registration, VA is a reliable method that is commonly used to study the pattern of cause of death. Regardless of the methodology and tool used, the process of collecting, interpreting and processing VA data is very involving and uncertain [8,22,23]. It is pinpointed in [22] that rigorous validation of VA procedure is needed to establish confidence in the data collection.…”

“…Even though there is much innovation on hardware devices [5,6], building software application for collecting e-Health data remains a challenge to information system developers [7][8][9]. Many health system software applications are often developed without specifying how they will interact with existing or future health information systems [2,5].…”

The Path to Scale: Navigating Design, Policy, and Infrastructure

“…Not all users such as care providers and patients own a personal mobile device and often share mobile phones with family members or access the phones available to them in their community (Chang et al, 2011;Haberer, Kiwanuka, Nansera, Wilson & Bangsberg, 2010). Moreover, phone ownership rates vary significantly based on gender particularly in the developing world.…”

“…Given the variance in skill sets and levels of literacy among CHWs, there is a need for continuous support and training to maintain their effective contribution not only in their healthcare knowledge but also in technology and its use (Lehmann & Sanders, 2007). Refresher mHealth training for CHWs have been effective in addressing observed technology usability gaps and improving impact during an intervention and can also contribute significantly to long-term project sustainability and scale (Modi et al, 2015;Haberer et al, 2010). mHealth training is not only essential for users such as healthcare providers but also for other key actors in an mHealth ecosystem such as project managers, application developers, and information technology specialists who require training in the development and maintenance of platforms including software and hardware to support mHealth implementations locally (Chetley, Davies, Trude, McConnell & Ramirez, 2006;Aranda-Jan et al, 2014).…”

Utility of an Interactive Voice Response System to Assess Antiretroviral Pharmacotherapy Adherence Among Substance Users Living with HIV/AIDS in the Rural South

“…19 However, the few studies that have used IVR systems to assess or promote medication adherence employed international samples that limit generalization to IVR applications in the rural South. 20,21 Other studies have piloted cell phone-based interventions to measure and increase ARV medication adherence. Text-message reminders were found superior to beeper reminders, 22 and unannounced biweekly pill counts with counseling via cell phone increased adherence more so than unannounced biweekly pill counts alone.…”