Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial

Abstract

BackgroundAdherence to treatment remains the cornerstone of long term viral suppression and successful treatment outcomes among patients receiving Antiretroviral Therapy (ART).Objective(s)Evaluate the effectiveness of mobile phone reminders and peer counseling in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia.MethodsA single-blind, parallel group RCT conducted in Hospital Sungai Buloh, Malaysia in which 242 adult Malaysian patients were randomized to intervention or control groups. Intervention consisted of a reminder module delivered through SMS and telephone call reminders by trained research assistants for 24 consecutive weeks (starting from date of ART initiation), in addition to adherence counseling at every clinic visit. The length of intended follow up for each patient was 6 months. Data on adherence behavior of patients was collected using specialized, pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires. Data on weight, clinical symptoms, CD4 count and viral load tests were also collected. Data was analyzed using SPSS version 22 and R software. Repeated measures ANOVA, Friedman’s ANOVA and Multivariate regression models were used to evaluate efficacy of the intervention.ResultsThe response rate after 6 months follow up was 93%. There were no significant differences at baseline in gender, employment status, income distribution and residential location of respondents between the intervention and control group. After 6 months follow up, the mean adherence was significantly higher in the intervention group (95.7; 95% CI: 94.39–96.97) as compared to the control group (87.5; 95% CI: 86.14–88.81). The proportion of respondents who had Good (>95%) adherence was significantly higher in the intervention group (92.2%) compared to the control group (54.6%). A significantly lower frequency in missed appointments (14.0% vs 35.5%) (p = 0.001), lower viral load (p = 0.001), higher rise in CD4 count (p = 0.017), lower incidence of tuberculosis (p = 0.001) and OIs (p = 0.001) at 6 months follow up, was observed among patients in the intervention group.ConclusionMobile phone reminders (SMS and telephone call reminders) and peer counseling are effective in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia. These findings may be of potential benefit for collaborative adherence planning between patients and health care providers at ART commencement.

Effect of enhanced reminders on postnatal clinic attendance in Addis Ababa, Ethiopia: a cluster randomized controlled trial

“…In the last 10 years growing evidence showed that mobile phone reminders (text messages and phone calls) can be used to improve attendance to healthcare appointments, increase access to health care, improve adherence to treatment, follow-up and rehabilitation and improves the efficiency of health service delivery [21][22][23]. Randomized trials indicated mobile phone reminder improves appointment compliance [20,23,24], adherence to ART and Tb medications [25,26]. In addition, it facilitates provision of health education, counseling [27,28] and behavioral change interventions [17,29].…”

Envío de mensajes de texto para mejorar la adherencia de pacientes en TARGA: ensayo aleatorizado controlado

“…Un método innovador y económico es el uso de las tecnologías de la información y comunicación (TIC), especialmente el envío de mensajes de texto (SMS) a los pacientes. Algunos ensayos aleatorizados controlados han demostrado que esta intervención es beneficiosa para los pacientes con VIH (9,10,11) . Sin embargo, hay otros estudios donde la intervención no mejoró la adherencia de los pacientes (12,13) .…”

Does Message-Based Communication Through Mobile Phones for Medication and Treatment Adherence Improve Health Outcomes? A Systematic Review

“…It is also inherently evident that most of the studies reviewed in this paper were undertaken over shorter periods of time (between 2 years and 4 days). Whereas this is a limitation beyond this paper, it is a calling for longitudinal studies and long term programmatic efforts that would provide more detailed evidence [40][41][42][43][44][45][46][47][48][49][50][51][52].…”