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Kwena ZA, Oketch BA, Beres LK, Lewis-Kulzer J, Akama EO, Sang NM, Adhiambo HF, Iguna S, Ontuga GM, Nyandieka E, Shade S, Bukusi EA, Geng E, Abuogi LL. User-informed tailoring of electronic and in-person peer navigation strategies to improve retention in HIV care for adolescents and young adults: a qualitative inquiry. AIDS Care 2024:1-9. [PMID: 38838007 DOI: 10.1080/09540121.2024.2361821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
Poor adherence and retention in HIV care remain a major challenge among adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA). Strategies are urgently required to support AYA to remain in care for better health outcomes. We explored AYA preferences regarding the format and delivery of electronic and in-person peer navigation to improve HIV care outcomes. This formative qualitative study was conducted among AYA enrolled in HIV care at three clinics in western Kenya. We conducted two focus group discussions (FGDs) each with 8-9 participants (n = 17) purposively selected based on age, gender and clinic where they received care. The characteristics desired of a navigator are a person of the same age group and HIV status who has a good memory and is friendly and able to maintain confidentiality. AYA want the content of their interaction with the navigator to center on sharing motivational messages and also educating them on matters of HIV care, sexual and reproductive health and mental health. The preferred navigation formats for electronic communication are platforms considered confidential. AYA preferred interventions delivered through secure communication platforms by navigators with whom they have commonalities. The navigation interventions that prioritize confidentiality and holistic content will likely be most highly valued by AYA. Furthermore, electronic mechanisms can help support the relationship building that is at the core of our navigation approach and a fundamental aspect of social work in general.
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Affiliation(s)
- Zachary Arochi Kwena
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Bertha Akinyi Oketch
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Laura K Beres
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jayne Lewis-Kulzer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Eliud Omondi Akama
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Norton Mutai Sang
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Sarah Iguna
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Gladys Moraa Ontuga
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Everlyne Nyandieka
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Starley Shade
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | | | - Elvin Geng
- School of Medicine, Washington University, St. Louis, MO, USA
| | - Lisa L Abuogi
- Department of Pediatrics, University of Colorado, Denver, CO, USA
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Laban M, Nakku EJ, Nangendo J, Muramuzi D, Akello F, Bakeera SK, Semitala FC, Semeere AS, Karamagi C. Acceptability of short message service reminders as the support tool for PrEP adherence among young women in Mukono district, Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002492. [PMID: 38165833 PMCID: PMC10760663 DOI: 10.1371/journal.pgph.0002492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/17/2023] [Indexed: 01/04/2024]
Abstract
Adolescent girls and young women (AGYW) have a disproportionately high incidence of HIV compared to males of the same age in Uganda. AGYW are a priority sub-group for daily oral Pre-Exposure Prophylaxis (PrEP), but their adherence has consistently remained low. Short Message Service (SMS) reminders could improve adherence to PrEP in AGYW. However, there is paucity of literature about acceptability of SMS reminders among AGYW using PrEP. We assessed the level of acceptability of SMS reminders as a PrEP adherence support tool and the associated factors, among AGYW in Mukono district, Central Uganda. We consecutively enrolled AGYW using PrEP in Mukono district in a cross sectional study. A structured pre-tested questionnaire was administered to participants by three trained research assistants. Data were analyzed in STATA 17.0; continuous variables were summarized using median and interquartile range (IQR) while categorical variables were summarized using frequencies and percentages. Acceptability of SMS was defined as willingness to accept SMS reminders to support PrEP adherence and was assessed using the seven constructs of the theoretical framework of acceptability. The relationship between the outcome and independent variables was assessed using a modified Poisson regression with robust standard errors. During the month of August 2022, 142 AGYW with median age 22 years (IQR; 18, 24) of whom 80.3% owned a personal mobile phone were assessed. SMS reminders were highly acceptable [90.9%, 95% Confidence Interval (CI) [84.9, 95.0]]. Rural residence was negatively associated with acceptability of SMS reminders (aPR: 0.92, 95% CI (0.84, 0.99)) and having belief that SMS cannot breach individual's privacy (aPR: 1.40, 95% CI (1.07, 1.84)) was positively associated with acceptability of SMS reminders. The acceptability of SMS reminders was high in this sub-population. SMS reminder can be leveraged to support AGYW to adhere to PrEP but should be designed in a way that maintains confidentiality, and supports AGYW living in rural settings.
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Affiliation(s)
- Muteebwa Laban
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edith Joloba Nakku
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joan Nangendo
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dan Muramuzi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Faith Akello
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sabrina Kitaka Bakeera
- Department of Pediatrics and Child health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fred Collins Semitala
- Makerere University Joint AIDS Program, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Aggrey S. Semeere
- Department of Prevention, Care and Treatment, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Karamagi
- Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Musanje K, Kamya MR, Kasujja R, Vanderplasschen W, Sinclair DL, Baluku MM, Odokonyero RF, Namisi CP, Mukisa J, White RG, Camlin CS. The Effect of a Group-Based Mindfulness and Acceptance Training on Psychological Flexibility and Adherence to Antiretroviral Therapy Among Adolescents in Uganda: An Open-Label Randomized Trial. J Int Assoc Provid AIDS Care 2024; 23:23259582241236260. [PMID: 38446992 PMCID: PMC10919136 DOI: 10.1177/23259582241236260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Adherence to antiretroviral therapy (ART) is lower in adolescents with HIV (AWH) than in any other age group, partly due to self-regulatory challenges during development. Mindfulness and acceptance training have been shown to support psychological flexibility, a self-regulatory skill that potentially improves adolescent adherence to medication. We assessed the effect of weekly group-based mindfulness and acceptance training sessions on ART adherence among older adolescents (15-19 years) in Kampala, Uganda. One hundred and twenty-two AWH (median age 17, range 15-19 years, 57% female) receiving care at a public health facility in Kampala were randomized 1:1 to receive 4 weekly 90-min group sessions facilitated by experienced trainers or standard-of-care ART services. The training involved (Session 1) clarifying values, (Session 2) skillfully relating to thoughts, (Session 3) allowing and becoming aware of experiences non-judgmentally, and (Session 4) exploring life through trial and error. At baseline, postintervention, and 3-month follow-up, psychological flexibility was measured using the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8), and self-reported ART adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). At baseline, the intervention and standard-of-care arms had similar psychological flexibility (AFQ-Y8 score:15.45 ± 0.82; 15.74 ± 0.84) and ART adherence (MMAS-8 score: 5.32 ± 0.24; 5.13 ± 0.23). Retention through the study was moderate (71%). Completion of mindfulness and acceptance training was associated with a significant reduction in psychological inflexibility at the 3-month follow-up (AFQ-Y8 score: 12.63 ± 1.06; 14.05 ± 1.07, P = .006). However, no significant differences were observed in self-reported adherence to ART at the 3-month follow-up (MMAS-8 score: 5.43 ± 0.23; 4.90 ± 0.33, P = .522). Group-based mindfulness and acceptance training improved psychological flexibility in this population of adolescents on ART in Uganda but did not significantly improve ART adherence. Future research should explore integrated approaches that combine behavioral management training with other empowerment aspects to improve ART adherence among AWH.
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Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Rosco Kasujja
- Department of Mental Health and Community Psychology, Makerere University, Kampala, Uganda
| | | | | | - Martin M. Baluku
- Department of Educational, Social and Organizational Psychology, Makerere University, Kampala, Uganda
| | | | - Charles P. Namisi
- Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda
| | - John Mukisa
- Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda
| | - Ross G. White
- School of Psychology, Queens University, Belfast, Northern Ireland
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
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Tizie SB, Shiferaw AM, Beshir MA, Mengistie MB, Degualem SM, Assaye BT. Perceptions of HIV patients on the use of cell phones as a tool to improve their antiretroviral adherence in Northwest, Ethiopia: a cross-sectional study. BMC Public Health 2023; 23:2508. [PMID: 38097970 PMCID: PMC10722756 DOI: 10.1186/s12889-023-17452-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Human immuno deficiency virus (HIV) is one of the most infectious diseases that cause death. A Medication non-adherence in HIV patient has been caused by factors such as not taking medications as prescribed by a physician, withdrawing from medication, missing appointments, and forgetfulness. To improve patients' antiretroviral adherence, supporting them with mobile phone applications is advisable. This study aimed to assess HIV patients' perceptions towards the use of cell phones to improve antiretroviral adherence. METHODS AND MATERIALS An institutional-based cross-sectional study was conducted among 423 HIV patients at a comprehensive specialized hospital in northwest Ethiopia from June to July 2022. Study participants were selected using systematic random sampling techniques and the data collection tool was adopted and modified for different literatures. Data were collected through an online data collection tool, and STATA-14 software was used for analysis. Descriptive statistics and binary logistic regression were used. The variables with a P-value equal to or less than 0.2 in bivariable logistic regression were entered into a multivariable logistic regression, and model fitness was assessed. RESULTS A total of 410 study subjects have participated, making a response rate of 97%. In this study, 62% (95% CI: 57-67%) of HIV patients had a positive perception regarding the use of mobile phones to improve antiretroviral adherence. Perceived usefulness of mobile phones [AOR = 4.5, (95% CI: 2.2-9.1)], perceived ease of mobile phone use [AOR = 3.9, (95% CI: 2.0-7.5), age [AOR = 3.0, (95% CI: 1.5-6.2)], and educational status [AOR = 5.0, (95% CI: 2.3-10.0)] were significantly associated with HIV patients' perception of mobile phones' use to improve antiretroviral adherence. CONCLUSIONS More than half of the respondents had positive perception regarding the use of mobile phones to enhance their adherence to treatment. Perceived usefulness, perceived ease of use, age, and educational status was significantly associated with perception of mobile phone use to enhance antiretroviral therapy adherence. Therefore, the government have to encourage and support patients in incorporating mobile phones into their antiretroviral therapy (ART) follow-up through training.
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Affiliation(s)
- Sefefe Birhanu Tizie
- Department of Health Informatics, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Atsede Mazengia Shiferaw
- Department of Health Informatics College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Miftah Abdella Beshir
- Department of Health Informatics College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Muluken Belachew Mengistie
- Department of Health Informatics, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Sayih Mehari Degualem
- School of Nursing, college of Medicine and Health science, Arbaminch University, Arbaminch, Ethiopia
| | - Bayou Tilahun Assaye
- Department of Health Informatics, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
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Akama EO, Beres LK, Kulzer JL, Ontuga G, Adhiambo H, Bushuru S, Nyagesoa E, Osoro J, Opondo I, Sang N, Oketch B, Nyanga J, Osongo CO, Nyandieka E, Ododa E, Omondi E, Ochieng F, Owino C, Odeny T, Kwena ZA, Eshun-Wilson I, Petersen M, Bukusi EA, Geng EH, Abuogi LL. A youth-centred approach to improving engagement in HIV services: human-centred design methods and outcomes in a research trial in Kisumu County, Kenya. BMJ Glob Health 2023; 8:e012606. [PMID: 38030226 PMCID: PMC10689376 DOI: 10.1136/bmjgh-2023-012606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/01/2023] [Indexed: 12/01/2023] Open
Abstract
IntroductionInnovative interventions are needed to improve HIV outcomes among adolescents and young adults (AYAs) living with HIV. Engaging AYAs in intervention development could increase effectiveness and youth acceptance, yet research is limited. We applied human-centred design (HCD) to refine adherence-support interventions pretrial and assessed HCD workshop acceptability. METHODS We applied an iterative, four-phased HCD process in Kenya that included: (1) systematic review of extant knowledge, (2) prioritisation of design challenges, (3) a co-creation workshop and (4) translation tables to pair insights with trial intervention adaptations. The co-creation workshop was co-led by youth facilitators employing participatory activities to inform intervention adaptations. Iterative data analysis included rapid thematic analysis of visualised workshop outputs and notes using affinity mapping and dialogue to identify key themes. We conducted a survey to assess workshop acceptability among participants. RESULTS Twenty-two participants engaged in the 4-day workshop. Co-creation activities yielded recommendations for improving planned interventions (eg, message frequency and content; strategies to engage hard-to-reach participants), critical principles to employ across interventions (eg, personalisation, AYA empowerment) and identification of unanticipated AYA HIV treatment priorities (eg, drug holidays, transition from adolescent to adult services). We revised intervention content, peer navigator training materials and study inclusion criteria in response to findings. The youth-led HCD workshop was highly acceptable to participants. CONCLUSIONS Research employing HCD among youth can improve interventions preimplementation through empathy, youth-led inquiry and real-time problem solving. Peer navigation may be most influential in improving retention when engagement with young people is based on mutual trust, respect, privacy and extends beyond HIV-specific support. Identifying opportunities for personalisation and adaptation within intervention delivery is important for AYAs. Patient engagement interventions that target young people should prioritise improved transition between youth and adult services, youth HIV status disclosure, AYA empowerment and healthcare worker responsiveness in interactions and episodic adherence interruptions.
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Affiliation(s)
- Eliud Omondi Akama
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Laura K Beres
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jayne Lewis Kulzer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Gladys Ontuga
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Harriet Adhiambo
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Sarah Bushuru
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Edwin Nyagesoa
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Joseph Osoro
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Isaya Opondo
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Norton Sang
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Bertha Oketch
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - James Nyanga
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Cirilus Ogollah Osongo
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
- Family AIDS Care and Education Services (FACES) Clinic, Kisumu, Kenya
| | - Evelyn Nyandieka
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Evelyn Ododa
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Eunice Omondi
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Felix Ochieng
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Clinton Owino
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Thomas Odeny
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Zachary Arochi Kwena
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Ingrid Eshun-Wilson
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Maya Petersen
- Biostatistics and Epidemiology, University of California, Berkeley, California, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Elvin H Geng
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lisa L Abuogi
- Department of Pediatrics, University of Colorado, Denver, Colorado, USA
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Paolino M, Sánchez Antelo V, Kohler RE, Viswanath K, Arrossi S. Implementation of an mHealth intervention to increase adherence to triage among HPV positive women with HPV-self-collection (ATICA study): post-implementation evaluation from the women's perspective. BMC Womens Health 2023; 23:332. [PMID: 37353835 PMCID: PMC10288763 DOI: 10.1186/s12905-023-02475-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/10/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Low adherence to triage after positive screening is a widespread problem for cervical cancer screening programs in Low- and Middle-income Countries. Adherence to cytology-based triage can be challenging, especially among women with self-collected tests. SMS-based interventions are accepted by women and can increase screening uptake. The ATICA study was an effectiveness-implementation hybrid type I trial, combining a cluster randomized controlled trial (RCT) with a mixed-methods implementation evaluation involving quantitative and qualitative methods. Although the RCT provided evidence regarding the effectiveness of the SMS-based intervention, less is known about its acceptability, relevance, and usefulness from the women´s perspective. METHODS We carried out a cross-sectional study based on a structured questionnaire among HPV-positive women who were enrolled in ATICA's intervention group. We measured acceptability, appropriateness, and message content comprehension. Also, we evaluated if the SMS message was considered a cue to encourage women to pick up their HPV test results and promote the triage. RESULTS We interviewed 370 HPV-positive women. Acceptability of SMS messages among women who had received at least one message was high (97%). We found high levels of agreement in all appropriateness dimensions. More than 77% of women showed high comprehension of the content. Among women who received at least one SMS message, 76% went to the health center to pick up their results. Among those who got their results, 90% reported that the SMS message had influenced them to go. We found no significant differences in acceptability, appropriateness or message comprehension between women who adhered to triage and those who did not adhere after receiving the SMS messages. CONCLUSION The intervention was highly acceptable, and women reported SMS was an appropriate channel to be informed about HPV test results availability. SMS was also a useful cue to go to the health center to pick up results. The implementation did not encounter barriers associated with the SMS message itself, suggesting the existence of other obstacles to triage adherence. Our results support the RCT findings that scaling up SMS is a highly acceptable intervention to promote cervical screening triage adherence.
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Affiliation(s)
- Melisa Paolino
- Centre for the Study of State and Society, National Council for Scientific and Technical Research AR, Buenos Aires, Argentina.
| | - Victoria Sánchez Antelo
- Centre for the Study of State and Society, National Council for Scientific and Technical Research AR, Buenos Aires, Argentina
| | - Racquel E Kohler
- Cancer Health Equity, Cancer Institute of New Jersey, Rutgers - the State University of New Jersey, New Jersey, USA
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - Silvina Arrossi
- Centre for the Study of State and Society, National Council for Scientific and Technical Research AR, Buenos Aires, Argentina
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Sewak A, Yousef M, Deshpande S, Seydel T, Hashemi N. The effectiveness of digital sexual health interventions for young adults: a systematic literature review (2010-2020). Health Promot Int 2023; 38:7033126. [PMID: 36757346 DOI: 10.1093/heapro/daac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
There has been a proliferation of digital sexual health interventions targeting adolescents; however, limited evaluative reviews have compared the effectiveness of multiple digital tools for sexual health literacy and behaviour change. This study conducted a systematic literature review, screened 9881 records and analysed 61 studies. Findings suggest that websites and mobile phones dominate digital sexual health interventions, with a majority effectively delivering cognitive (e.g. awareness and attitudes about sexual and reproductive health) and behavioural outcomes (e.g. abstinence and use of contraception). The most popular sexual health promotion mechanisms were interactive websites, text messaging and phone calls, and online education programmes, followed by mobile applications-fewer studies in this review utilized social media, games and multimedia. Previous reviews focused on single outcome measures (e.g. sexually transmitted infection testing) to assess interventions' effectiveness. The current review moves beyond single outcome measures to cover a wider range of behavioural and non-behavioural sexual health issues and contexts covered in the literature. Four main categories were analysed as outcomes: cognitive perceptions, promoting sexual health-related behaviours, promoting sexual health-related products and services, and impact (viral load). Seventy-nine per cent of interventions focused on preventive sexual health behaviours and products (e.g. condoms) and services (e.g. HIV testing). Overall, 75% of studies effectively changed sexual health behaviour and cognitive perceptions. However, the digital-only tools did not vary from the blended formats, in influence outcomes, even after categorizing them into behavioural or non-behavioural outcomes. Compared to previous systematic reviews, more studies from the last decade used rigorous research design in the form of randomized controlled trials, non-randomized control trials, and quasi-experiments and lasted longer.
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Affiliation(s)
- Aarti Sewak
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Queensland 4111, Australia
| | - Murooj Yousef
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Queensland 4111, Australia
| | - Sameer Deshpande
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Queensland 4111, Australia
| | - Tori Seydel
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Queensland 4111, Australia
| | - Neda Hashemi
- School of Medicine, Griffith University, Gold Coast Campus, Building G01, Gold Coast, Queensland 4215, Australia
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Kajubi P, Parkes-Ratanshi R, Twimukye A, Bwanika Naggirinya A, Nabaggala MS, Kiragga A, Castelnuovo B, King R. Perceptions and Attitudes Toward an Interactive Voice Response Tool (Call for Life Uganda) Providing Adherence Support and Health Information to HIV-Positive Ugandans: Qualitative Study. JMIR Form Res 2022; 6:e36829. [PMID: 36472904 PMCID: PMC9768667 DOI: 10.2196/36829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The continuing decline in AIDS-related deaths in the African region is largely driven by the steady scale-up of antiretroviral therapy. However, there are challenges to retaining people living with HIV on treatment. Call for Life Uganda (CFLU) is an interactive voice response tool using simple analogue phones. CFLU supports patients with daily pill reminders, preappointment reminders, symptom reporting and management, and weekly health promotion tips. Mobile health tools are being increasingly used in resource-limited settings but are often adopted without rigorous evaluation. OBJECTIVE This qualitative study conducted at 12 months after enrollment assessed patients' experiences, perceptions, and attitudes regarding CLFU. METHODS We conducted a qualitative substudy within an open-label randomized controlled trial titled "Improving outcomes in HIV patients using mobile phone based interactive software support." Data were collected through 6 focus group discussions with participants sampled based on proportion of calls responded to-<25%, between 25% and 50%, and >50%-conducted at the Infectious Diseases Institute, Mulago, and the Kasangati Health Centre IV. NVivo (version 11; QSR International) was used in the management of the data and in the coding of the emerging themes. The data were then analyzed using content thematic analysis. RESULTS There was consensus across all groups that they had more positive than negative experiences with the CFLU system. Participants who responded to >50% of the calls reported more frequent use of the specific elements of the CFLU tool and, consequently, experienced more benefits from the system than those who responded to calls less frequently. Irrespective of calls responded to, participants identified pill reminders as the most important aspect in improved quality of life, followed by health promotion tips. The most common challenge faced was difficulty with the secret personal identification number. CONCLUSIONS Findings showed participants' appreciation, high willingness, and interest in the intervention, CFLU, that demonstrated great perceived potential to improve their access to health care; adherence to treatment; health awareness; and, consequently, quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080.
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Affiliation(s)
- Phoebe Kajubi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rosalind Parkes-Ratanshi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Public Health & Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Adelline Twimukye
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Agnes Bwanika Naggirinya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Internal Medicine, College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
| | - Maria Sarah Nabaggala
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rachel King
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Institute for Global Health Sciences,, University of California, San Francisco, San Francisco, CA, United States
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Adong J, Fatch R, Emenyonu N, Muyindike W, Ngabirano C, Cheng D, Hahn J. Cell Phone Availability and Usage for mHealth and Intervention Delivery to Persons Living With HIV in a Low-Resource Setting: Cross-sectional Study. JMIR Form Res 2022; 6:e35631. [PMID: 35998023 PMCID: PMC9449822 DOI: 10.2196/35631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 07/15/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND HIV/AIDS is now a manageable chronic illness owing to effective antiretroviral therapy (ART), which involves routine follow-up care, including regular physical visits to the clinic. In the recent past, and in wake of the COVID-19 pandemic, there has been increased need for virtual care and intervention delivery, a modality known as mobile health (mHealth), which includes cell phone-delivered services for medical and public health practice. OBJECTIVE Here we describe cell phone use and its relationship with alcohol use in a cohort of persons living with HIV and latent tuberculosis (TB). METHODS We performed a cross-sectional analysis of baseline data from a cohort of persons living with HIV and latent TB in HIV care in southwestern Uganda. We estimated proportions of cell phone and text message use and evaluated their associations with alcohol use-a common modifiable behavior among persons living with HIV. Cell phone use (primary outcome) was defined as owning a cell phone that is turned on at least half of the day. Any alcohol use was defined as any self-reported alcohol use in the prior 3 months or a phosphatidylethanol (an alcohol biomarker) level of ≥8 ng/mL. RESULTS A total of 300 participants (median age 40 years; n=146, 48.7% male) were included in the analysis. Most (n=267, 89.0%) participants had access to a phone and of them, 26 (9.7%) shared the phone with someone else. In total, 262/300 (87.3%) of participants owned a cell phone that is turned on at least half of the time; the majority (n=269, 89.7%) rarely or never sent text messages, and over two-thirds (n=200, 66.9%) rarely or never received text messages. Most (n=214, 71.3%) had any alcohol use in the prior 3 months. In adjusted analyses, any alcohol use was not significantly associated with cell phone use (adjusted odds ratio [aOR] 0.48, 95% CI 0.18-1.25; P=.13) or sending (aOR 0.82, 95% CI 0.28-2.37; P=.71) or receiving (aOR 1.31, 95% CI 0.70-2.47; P=.40) text messages. CONCLUSIONS There is hope that mHealth interventions in this population can be carried out using cell phones owing to their popularity; however, the interventions may need to employ methods that do not rely on the sending and receiving of text messages only.
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Affiliation(s)
- Julian Adong
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Nneka Emenyonu
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Winnie Muyindike
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Christine Ngabirano
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Debbie Cheng
- Boston University School of Public Health, Boston, MA, United States
| | - Judith Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Soepnel LM, McKinley MC, Klingberg S, Draper CE, Prioreschi A, Norris SA, Ware LJ. Evaluation of a Text Messaging Intervention to Promote Preconception Micronutrient Supplement Use: Feasibility Study Nested in the Healthy Life Trajectories Initiative Study in South Africa. JMIR Form Res 2022; 6:e37309. [PMID: 35980731 PMCID: PMC9437786 DOI: 10.2196/37309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Social messaging strategies such as SMS text messaging and radio are promising avenues for health promotion and behavior change in low- to middle-income settings. However, evidence of their acceptability, feasibility, and impact in the context of young women’s health and micronutrient deficiencies is lacking. Objective This study aimed to evaluate the feasibility of an automated 2-way text messaging intervention nested in an ongoing preconception health trial, the Healthy Life Trajectories Initiative (HeLTI; HeLTI Bukhali) in Soweto, South Africa. Second, we aimed to evaluate the acceptability of a health promotion radio serial, which aired concurrently in the region. Methods In this feasibility study, 120 participants enrolled in HeLTI Bukhali between November 2020 and February 2021 received the 6-month 2-way text messaging intervention. Quantitative and qualitative data on intervention acceptability, usability, interaction, perceived benefit, and fidelity were collected during 5 focus group discussions (FGDs) and from study data logs. During the FGDs, data were collected on the acceptability of the radio serial. Following the text messaging intervention, capillary hemoglobin levels were assessed, and a participant questionnaire provided information on adherence and attitudes toward supplements. The text messaging control group comprised the first 120 women recruited from November 2019 to February 2020, who received the Bukhali intervention but not the text messages. Statistical significance testing and a linear mixed model were used for indicative effect comparisons between the text message–receiving and control groups. Results The text messaging intervention was found to be acceptable and to have perceived benefits, including being reminded to take supplements, gaining knowledge, and feeling supported by the study team. The use of the 2-way text messaging reply function was limited, with only a 10.8% (13/120) response rate by week 24. Barriers to replying included a lack of interest or phone credit and technical issues. Regarding the indicative effect, participants receiving the text messages had higher self-reported adherence at follow-up than the text messaging control group (42/63, 67% vs 33/85, 39% taking supplements every time; P=.02), and altitude-adjusted hemoglobin increased more between baseline and follow-up in the SMS text message–receiving group than in the text messaging control group (1.03, 95% CI 0.49-1.57; P<.001). The radio serial content was acceptable, although few participants reported exposure before the FGD. Conclusions Women reported that the text messaging intervention was useful and described the benefits of receiving the messages. Examination of hemoglobin status indicated a promising beneficial effect of text messaging support on adherence to micronutrient supplementation, requiring further exploration through randomized controlled studies. Health promotion through radio and text messages were both found to be acceptable, although more research into the radio serial reach among young women is needed. Trial Registration Pan African Clinical Trials Registry (PACTR) PACTR201903750173871; https://tinyurl.com/4x6n32ff
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Affiliation(s)
- Larske M Soepnel
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle C McKinley
- Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Human Development, University of Southampton, Southampton, United Kingdom
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
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11
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Tarantino N, Lartey M, Arnold T, Brown L, Kwara A, Guthrie K. Preferences for a Game-Based SMS Adherence Intervention Among Young People Living with HIV in Ghana: A Qualitative Study. AIDS Behav 2022; 26:2169-2181. [PMID: 35066732 PMCID: PMC9167246 DOI: 10.1007/s10461-021-03562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/01/2022]
Abstract
Young people living with HIV (YPLH) are at risk for poor treatment adherence. Short message service (SMS) interventions can improve adherence, yet few exist for YPLH. Our study investigated preferences for a game-based SMS intervention among YPLH in Ghana. Thirty-two YPLH, ages 18 to 24, were recruited from an HIV clinic to complete in-depth interviews. Content analysis of interview data revealed areas of technology use relevant to intervention implementation, including mobile communication preferences, internet access, and mobile game use. Participants reported high perceived utility towards intervention features: treatment reminders, gamification components, and involvement of supportive individuals (e.g., providers). Issues with privacy, literacy, and cultural/developmental appropriateness were among concerns raised. Suggestions were made for strengthening basic SMS features (e.g., using code words to protect privacy) and incorporating advanced features (e.g., simplifying game interactions). This novel approach may help engage YPLH in HIV care if carefully developed with attention towards its mechanisms and user preferences.
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Affiliation(s)
- Nicholas Tarantino
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | | | - Trisha Arnold
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Larry Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Awewura Kwara
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Kate Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Miriam Hospital, Center for Behavioral and Preventive Medicine, Providence, RI, USA
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12
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Lalla-Edward ST, Mashabane N, Stewart-Isherwood L, Scott L, Fyvie K, Duncan D, Haile B, Chugh K, Zhou Y, Reimers J, Pan M, Venkatraman M, Stevens W. Implementation of an mHealth App to Promote Engagement During HIV Care and Viral Load Suppression in Johannesburg, South Africa (iThemba Life): Pilot Technical Feasibility and Acceptability Study. JMIR Form Res 2022; 6:e26033. [PMID: 35107427 PMCID: PMC8851337 DOI: 10.2196/26033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/30/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND South Africa has the largest HIV treatment program worldwide. Retention in care and medication adherence remain problematic necessitating innovative solutions for improving HIV care. The increasing availability and use of mobile technology can support positive clinical outcomes for persons living with HIV. iThemba Life is a mobile health app designed with input from South African health professionals and patients, promoting engagement with HIV care through access to medical results. OBJECTIVE This study aimed to test the feasibility and acceptability of receiving HIV viral load (VL) results through the app and compare the time to HIV VL result return for study participants before and after app use. METHODS Using convenience sampling, adults having routine VL phlebotomy were recruited from 2 Johannesburg health facilities. After signed consent, the app was downloaded on their Android smartphones, phlebotomy was performed, and the sample barcode was scanned through their phone to link the sample and app. Participants received a notification of the result availability and logged into the app to view results, their explanation and recommended action. RESULTS Overall, 750 people were screened to enroll 500 participants. Of 750, 113 (15.1%) failed eligibility screening. 21.5% (137/637) had smartphone technical limitations preventing enrollment. Results were released to 92.2% (461/500) of participants' phones. App technical issues and laboratory operational issues limited the number of released results. Approximately 78.1% (360/461) results were viewed in the app. Median time from notification of availability to result viewed being 15.5 hours (0.6; range 0-150 days). Turnaround time from phlebotomy to the result being received was 6 (range 1-167) days for users versus 56 days (range 10-430 days; P<.001) before app use. Overall, 4% (20/500) of participants received unsuppressed results (VL>1000 copies/mL). Turnaround time for unsuppressed results was 7 days for participants versus 37.5 days before app use (P<.001). The difference before and after app use in the suppressed and unsuppressed users for time from sample collection to result delivery was statistically significant. Of 20 participants, 12 (60%) returned for a confirmatory VL during the study period. The time from an unsuppressed VL to a confirmatory VL was 106 days for app users versus 203 days before app use (P<.001). Overall, 52.4% (262/500) of participants completed an exit survey; 23.2% (58/250) reported challenges in viewing their VL results. Moreover, 58% (35/60) reported that they overcame challenges with technical assistance from others, and 97.3% (255/262) wanted to continue using the app for VL results. CONCLUSIONS Using iThemba Life for VL results was well-received despite limited smartphone access for some participants. App users received results 10 times sooner than before the app and 5 times sooner if their VL >1000 copies/mL. This increased notification speed led to participants wanting to continue using iThemba Life.
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Affiliation(s)
| | - Nonkululeko Mashabane
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | | | - Lesley Scott
- Molecular Medicine & Haematology, University of the Witwatersrand, Parktown, South Africa
| | - Kyle Fyvie
- Molecular Medicine & Haematology, University of the Witwatersrand, Parktown, South Africa
| | - Dana Duncan
- Roche Molecular Systems, Inc, Pleasanton, CA, United States
| | - Betiel Haile
- Roche Molecular Systems, Inc, Pleasanton, CA, United States
| | - Kamal Chugh
- Roche Molecular Systems, Inc, Pleasanton, CA, United States
| | - Yiyong Zhou
- Roche Molecular Systems, Inc, Pleasanton, CA, United States
| | | | - Matteus Pan
- Roche Molecular Systems, Inc, Pleasanton, CA, United States
| | | | - Wendy Stevens
- Molecular Medicine & Haematology, University of the Witwatersrand, Parktown, South Africa.,National Priorities Programme, National Health Laboratory Systems, Parktown, South Africa
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13
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Somefun OD, Casale M, Haupt Ronnie G, Desmond C, Cluver L, Sherr L. Decade of research into the acceptability of interventions aimed at improving adolescent and youth health and social outcomes in Africa: a systematic review and evidence map. BMJ Open 2021; 11:e055160. [PMID: 34930743 PMCID: PMC8689197 DOI: 10.1136/bmjopen-2021-055160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/04/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Interventions aimed at improving adolescent health and social outcomes are more likely to be successful if the young people they target find them acceptable. However, no standard definitions or indicators exist to assess acceptability. Acceptability research with adolescents in low-and-middle-income countries (LMICs) is still limited and no known reviews systhesise the evidence from Africa. This paper maps and qualitatively synthesises the scope, characteristics and findings of these studies, including definitions of acceptability, methods used, the type and objectives of interventions assessed, and overall findings on adolescent acceptability. DESIGN We conducted a systematic review of peer-reviewed studies assessing intervention acceptability with young adults (aged 10-24) in Africa, published between January 2010 and June 2020. DATA SOURCES Web of Science, Medline, PsycINFO, SociIndex, CINAHL, Africa-wide, Academic Search Complete and PubMed were searched through July 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Papers were selected based on the following inclusion criteria: if they (1) reported primary research assessing acceptability (based on the authors' definition of the study or findings) of one or more intervention(s) with adolescents and young adults 10-24; (2) assessed acceptability of intervention(s) aimed at positively influencing one or more development outcome(s), as defined by sustainable development goal (SDG) indicators; (3) reported on research conducted in Africa; (4) were in the English Language; (5) were peer-reviewed and and (6) were published between 1 January 2010 and 30 June 2020. DATA EXTRACTION AND SYNTHESIS Abstracts were reviewed independently by the two first authors to determine relevance. Full text of potentially eligible studies were retrieved and independently examined by the same two authors; areas of disagreement or lack of clarity were resolved through discussion by the two authors and-where necessary-the assessment of a third author. RESULTS 55 studies were considered eligible for inclusion in the review. Most studies were conducted in Southern Africa, of which 32 jointly in South Africa and Uganda. The majority of interventions assessed for acceptability could be classified as HIV or HPV vaccine interventions (10), E-health (10), HIV testing interventions (8), support group interventions (7) and contraceptive interventions (6). The objectives of most interventions were linked to SDG3, specifically to HIV and sexual and reproductive health. Acceptability was overall high among these published studies. 22 studies provided reasons for acceptability or lack thereof, some specific to particular types of interventions and others common across intervention types. CONCLUSIONS Our review exposes considerable scope for future acceptability research and review work. This should include extending acceptability research beyond the health (and particularly HIV) sector and to regions in Africa where this type of research is still scarce; including adolescents earlier, and potentially throughout the intervention process; further conceptualising the construct of acceptability among adolescents and beyond; and examining the relationship between acceptability and uptake.
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Affiliation(s)
- Oluwaseyi Dolapo Somefun
- UKRI GCRF Accelerating Achievement for Africa's Adolescents, School of Public Health, , University of the Western Cape, Cape Town, South Africa
| | - Marisa Casale
- UKRI GCRF Accelerating Achievement for Africa's Adolescents, School of Public Health, , University of the Western Cape, Cape Town, South Africa
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | | | - Chris Desmond
- Centre for Rural Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Dept of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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14
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Bezabih AM, Gerling K, Abebe W, Abeele VV. Behavioral Theories and Motivational Features Underlying eHealth Interventions for Adolescent Antiretroviral Adherence: Systematic Review. JMIR Mhealth Uhealth 2021; 9:e25129. [PMID: 34890353 PMCID: PMC8709919 DOI: 10.2196/25129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/06/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background eHealth systems provide new opportunities for the delivery of antiretroviral therapy (ART) adherence interventions for adolescents. They may be more effective if grounded in health behavior theories and behavior change techniques (BCTs). Prior reviews have examined the effectiveness, feasibility, and acceptability of these eHealth systems. However, studies have not systematically explored the use of health behavior theories and BCTs in the design of these applications. Objective The purpose of this review was to explore whether health behavior theories and BCTs were considered to ground designs of eHealth systems supporting adolescents’ (10-24 years) ART adherence. More specifically, we examined which specific theories and BCTs were applied, and how these BCTs were implemented as design features. Additionally, we investigated the quality and effect of eHealth systems. Methods A systematic search was performed on IEEE Xplore, ACM, ScienceDirect, PubMed, Scopus, and Web of Science databases from 2000 to 2020. Theory use and BCTs were coded using the Theory Coding Scheme and the Behavior Change Technique Taxonomy version 1 (BCTTv1), respectively. Design features were identified using the lenses of motivational design for mobile health (mHealth). The number of BCTs and design features for each eHealth system and their prevalence across all systems were assessed. Results This review identified 16 eHealth systems aiming to support ART adherence among adolescents. System types include SMS text message reminders (n=6), phone call reminders (n=3), combined SMS text message and phone call reminders (n=1), electronic adherence monitoring devices (n=3), smartphone apps (n=1), smartphone serious games (n=1), gamified smartphone apps (n=1), leveraging existing social media (n=2), web-based applications (n=1), videoconferencing (n=1), and desktop applications (n=1). Nine were grounded in theory, of which 3 used theories extensively. The impact of adolescent developmental changes on ART adherence was not made explicit. A total of 42 different BCTs and 24 motivational design features were used across systems. Ten systems reported positive effects on 1 or more outcomes; however, of these ten systems, only 3 reported exclusively positive effects on all the outcomes they measured. As much as 6 out of 16 reported purely no effect in all the outcomes measured. Conclusions Basic applications (SMS text messaging and phone calls) were most frequent, although more advanced systems such as mobile apps and games are also emerging. This review indicated gaps in the use of theory and BCTs, and particularly the impact of developmental changes on ART adherence was not adequately considered. Together with adopting a developmental orientation, future eHealth systems should effectively leverage health theories and consider developing more advanced systems that open the door to using BCTs more comprehensively. Overall, the impact of eHealth systems on adolescent ART adherence and its mediators is promising, but conclusive evidence on effect still needs to be provided.
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Affiliation(s)
- Alemitu Mequanint Bezabih
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kathrin Gerling
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Vero Vanden Abeele
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
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15
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Sekandi JN, Murray K, Berryman C, Davis-Olwell P, Hurst C, Kakaire R, Kiwanuka N, Whalen CC, Mwaka ES. Ethical, Legal and Sociocultural Issues in the Use of Mobile Technologies and Call Detail Records Data for Public Health Research in the East African Region: A Scoping Review (Preprint). Interact J Med Res 2021; 11:e35062. [PMID: 35533323 PMCID: PMC9204580 DOI: 10.2196/35062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/17/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Juliet Nabbuye Sekandi
- Global Health Institute, College of Public Health, University of Georgia, Athens, GA, United States
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Kenya Murray
- Global Health Institute, College of Public Health, University of Georgia, Athens, GA, United States
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Corinne Berryman
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, United States
| | - Paula Davis-Olwell
- Global Health Institute, College of Public Health, University of Georgia, Athens, GA, United States
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Caroline Hurst
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, United States
| | - Robert Kakaire
- Global Health Institute, College of Public Health, University of Georgia, Athens, GA, United States
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Christopher C Whalen
- Global Health Institute, College of Public Health, University of Georgia, Athens, GA, United States
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Erisa Sabakaki Mwaka
- Department of Anatomy, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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16
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Mehra N, Tunje A, Hallström IK, Jerene D. Effectiveness of mobile phone text message reminder interventions to improve adherence to antiretroviral therapy among adolescents living with HIV: A systematic review and meta-analysis. PLoS One 2021; 16:e0254890. [PMID: 34293033 PMCID: PMC8297901 DOI: 10.1371/journal.pone.0254890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Poor adherence to antiretroviral therapy in adolescents living with HIV is a global challenge. One of the key strategies to improve adherence is believed to be the use of digital adherence tools. However, evidence is limited in this area. Our objective was to investigate the effectiveness of mobile phone text message reminders in improving ART adherence for adolescents. Methods The preferred reporting item for systematic review and meta-analysis guideline was followed. A literature search was done in five databases (PubMed, Web of Science, Embase, Global Health and Cochrane) in August 2020. Additional searches for studies and grey literature were performed manually. We included studies with quantitative design exploring the effectiveness of text message reminders, targeting adolescents aged 10–19 years. Studies were excluded if the intervention involved phone calls, phone-based applications, or other complex tech services. Mean differences between intervention and standard of care were computed using a random effects model. Subgroup analyses were performed to identify sources of heterogeneity between one-way and two-way text messages. Results Of 2517 study titles screened, seven eligible studies were included in the systematic review. The total number of participants in the included studies was 987, and the study sample varied from 14 to 332. Five studies showed a positive impact of text messaging in improving adherence, while no significant difference was found between the intervention and the control (standard of care) group in the remaining two studies. The pooled mean difference between the intervention and the control group was 0.05 (95% CI: –0.08 to 0.17). There was considerable heterogeneity among the studies (I2 = 78%). Conclusion and recommendation The meta-analysis of text message reminder interventions did not show a statistically significant difference in the improvement of ART adherence among adolescents living with HIV. The included studies were heterogeneous in the reported clinical outcomes, where the effectiveness of the intervention was identified in small studies which had a short follow-up period. Studies with bigger sample size and a longer follow-up period are needed.
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Affiliation(s)
- Nishant Mehra
- Child and Family Health Unit, Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
- * E-mail:
| | - Abayneh Tunje
- Child and Family Health Unit, Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Inger Kristensson Hallström
- Child and Family Health Unit, Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Degu Jerene
- KNCV Tuberculosis Foundation, The Hague, Netherlands
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17
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Twimukye A, Bwanika Naggirinya A, Parkes-Ratanshi R, Kasirye R, Kiragga A, Castelnuovo B, Wasswa J, Nabaggala MS, Katabira E, Lamorde M, King RL. Acceptability of a Mobile Phone Support Tool (Call for Life Uganda) for Promoting Adherence to Antiretroviral Therapy Among Young Adults in a Randomized Controlled Trial: Exploratory Qualitative Study. JMIR Mhealth Uhealth 2021; 9:e17418. [PMID: 34121665 PMCID: PMC8240800 DOI: 10.2196/17418] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 10/19/2020] [Accepted: 05/07/2021] [Indexed: 12/16/2022] Open
Abstract
Background Adherence to treatment is critical for successful treatment outcomes. Although factors influencing antiretroviral therapy (ART) adherence vary, young adults are less likely to adhere owing to psychosocial issues such as stigma, ART-related side effects, and a lack of access to treatment. The Call for Life Uganda (CFLU) mobile health (mHealth) tool is a mobile phone–based technology that provides text messages or interactive voice response functionalities through a web interface and offers 4 modules of support. Objective This study aims to describe the acceptability and feasibility of a mobile phone support tool to promote adherence to ART among young adults in a randomized controlled trial. Methods An exploratory qualitative design with a phenomenological approach at 2 study sites was used. A total of 17 purposively selected young adults with HIV infection who had used the mHealth tool CFLU from 2 clinics were included. In total, 11 in-depth interviews and 1 focus group discussion were conducted to examine the following topics: experience with the CFLU tool (benefits and challenges), components of the tool, the efficiency of the system (level of comfort, ease, or difficulty in using the system), how CFLU resolved adherence challenges, and suggestions to improve CFLU. Participants belonged to 4 categories of interest: young adults on ART for the prevention of mother-to-child transmission, young adults switching to or on the second-line ART, positive partners in an HIV-discordant relationship, and young adults initiating the first-line ART. All young adults had 12 months of daily experience using the tool. Data were analyzed using NVivo version 11 software (QSR International Limited) based on a thematic approach. Results The CFLU mHealth tool was perceived as an acceptable intervention; young adults reported improvement in medication adherence, strengthened clinician-patient relationships, and increased health knowledge from health tips. Appointment reminders and symptom reporting were singled out as beneficial and helped to address the problems of forgetfulness and stigma-related issues. HIV-related stigma was reported by a few young people. Participants requested extra support for scaling up CFLU to make it more youth friendly. Improving the tool to reduce technical issues, including network outages and a period of software failure, was suggested. They suggested that in addition to digital solutions, other support, including the promotion of peer support meetings and the establishment of a designated space and staff members for youth, was also important. Conclusions This mHealth tool was an acceptable and feasible strategy for improving ART adherence and retention among young adults in resource-limited settings. Trial Registration ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080
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Affiliation(s)
- Adelline Twimukye
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Rosalind Parkes-Ratanshi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,Department of Public Health & Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Ronnie Kasirye
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jacob Wasswa
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maria Sarah Nabaggala
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elly Katabira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
| | - Mohammed Lamorde
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rachel Lisa King
- Institute for Global Health Sciences, University of California, San Francisco, CA, United States
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Linnemayr S, Zutshi R, Shadel W, Pedersen E, DeYoreo M, Tucker J. Text Messaging Intervention for Young Smokers Experiencing Homelessness: Lessons Learned From a Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e23989. [PMID: 33792551 PMCID: PMC8050749 DOI: 10.2196/23989] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/04/2021] [Accepted: 02/23/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Smoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. OBJECTIVE This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. METHODS Homeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. RESULTS Participants had widespread (smart)phone ownership-16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention. CONCLUSIONS The TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13722-020-00187-6.
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Affiliation(s)
| | | | | | - Eric Pedersen
- University of Southern California, Los Angeles, CA, United States
| | | | - Joan Tucker
- RAND Corporation, Santa Monica, CA, United States
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19
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Sánchez SA, Ramay BM, Zook J, de Leon O, Peralta R, Juarez J, Cocohoba J. Toward improved adherence: a text message intervention in an human immunodeficiency virus pediatric clinic in Guatemala City. Medicine (Baltimore) 2021; 100:e24867. [PMID: 33725842 PMCID: PMC7969223 DOI: 10.1097/md.0000000000024867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/30/2021] [Indexed: 01/05/2023] Open
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, 3 months, 6 months).Most respondents were willing to receive text message adherence reminders (81.1%, n = 53). 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 (n = 50) experienced a small but significant mean improvement in adherence over the six-month period (4%, P < .01) whereas the control group (n = 50) did not (mean improvement: 0.8%, P = .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.
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Affiliation(s)
| | - Brooke M. Ramay
- Department of pharmaceutical Chemistry
- Center for Health Studies, Universidad del Valle de Guatemala 18 Avenida 11-95, Guatemala City, Guatemala
| | - Jessica Zook
- Department of Clinical Pharmacy, University of California San Francisco 533 Parnassus Ave Ste U503, San Francisco CA
| | - Oscar de Leon
- Center for Health Studies, Universidad del Valle de Guatemala 18 Avenida 11-95, Guatemala City, Guatemala
| | - Ricardo Peralta
- Integrated HIV and Chronic Infectious Disease Clinic “Dr. Carlos Mejia” at the Roosevelt Hospital, Pediatric division, Guatemala City, Guatemala. Calzada Roosevelt, Guatemala City, Guatemala
| | - Julio Juarez
- Integrated HIV and Chronic Infectious Disease Clinic “Dr. Carlos Mejia” at the Roosevelt Hospital, Pediatric division, Guatemala City, Guatemala. Calzada Roosevelt, Guatemala City, Guatemala
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California San Francisco 533 Parnassus Ave Ste U503, San Francisco CA
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Suarez EB, Logie C, Arocha JF, Sanchez H, Shokirova T. Contesting everyday violence: Resilience pathways of gay and transgender youth in Peru. Glob Public Health 2020; 16:706-728. [DOI: 10.1080/17441692.2020.1856397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Eliana Barrios Suarez
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Kitchener,Canada
| | - Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Jose F. Arocha
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | | | - Takhmina Shokirova
- Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier University, Kitchener,Canada
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21
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Atreya S, Kumar G, Samal J, Bhattacharya M, Banerjee S, Mallick P, Chakraborty D, Gupta S, Sarkar S. Patients'/Caregivers' Perspectives on Telemedicine Service for Advanced Cancer Patients during the COVID-19 Pandemic: An Exploratory Survey. Indian J Palliat Care 2020; 26:S40-S44. [PMID: 33088085 PMCID: PMC7535001 DOI: 10.4103/ijpc.ijpc_145_20] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction: Novel coronavirus disease 2019 (COVID 19) has usurped human peace and mobility. The confinement of the population and the rising epidemic has disrupted the routine care for non-COVID-19 patients. Telehealth is a growing field, and its application in palliative care is seen as a solution to serve the population in this difficult crisis. Methodology: A exploratory survey was designed to assess the changes in the hospital-based practice of palliative care in the COVID-19 pandemic and patient/caregiver's perception about the provision of telehealth services to palliative care patients of a tertiary care cancer hospital of eastern India. Results: There was a dramatic reduction in the outpatient clinic footfalls by 51% with teleconsultation. Although there was no change in the number of emergency visits, the inpatient admissions reduced by 44%. Nearly 82% of patient/caregivers gave a positive feedback about telemedicine care provided by the department and mentioned that the service provided them with support and connectedness. Almost 64% of the patients and caregivers reported that the service helped allay the fear and reassured them that there was a someone to support them. As high as 76% of the participants felt that they would prefer teleconsultation in future and were ready to pay for teleconsultations if charges were to be applied in the future. Conclusion: Telemedicine is an important tool and an essential service to care for palliative care patients in the community especially when the patient and health-care professionals are separated by a pandemic or natural disaster.
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Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Gaurav Kumar
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Jyotiprakash Samal
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Moitri Bhattacharya
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Shabnam Banerjee
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Pallab Mallick
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Debratna Chakraborty
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sunipa Gupta
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Saswati Sarkar
- Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, India
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Fisher CB, Bragard E, Bloom R. Ethical Considerations in HIV eHealth Intervention Research: Implications for Informational Risk in Recruitment, Data Maintenance, and Consent Procedures. Curr HIV/AIDS Rep 2020; 17:180-189. [PMID: 32358768 PMCID: PMC7263316 DOI: 10.1007/s11904-020-00489-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Along with the benefits of eHealth HIV interventions are challenges to participant privacy and confidentiality inherent in the use of online strategies. This paper reviews current guidelines and recent publications to identify ethical issues and suggested solutions in recruitment, data management, and informed consent. RECENT FINDINGS Across eHealth HIV research, recruitment, data collection, and storage efforts to protect informational risk highlight the tension between the investigators' ability to protect participant confidentiality and the evolving informational risk posed by the online platforms on which they are operating. Adequately addressing these challenges requires updating technical competencies and educating participants on their own responsibilities to guard against privacy violations. Additional protections are required when interventions involve peer or community support, especially with minors. The rapid progression of technology presents challenges in solidifying best practices for future interventions. This article draws on published works describing investigator experiences to contribute to the ongoing development of guidance in this area.
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Affiliation(s)
- Celia B Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, 117 Dealy Hall, Rose Hill Campus, 441 E. Fordham Road, Bronx, NY, 10458, USA.
| | - Elise Bragard
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Rachel Bloom
- Department of Psychology, Fordham University, Bronx, NY, USA
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Geldof M, Thiombiano BA, Wagner N. "When I receive the message, it is a sign of love": symbolic connotations of SMS messages for people living with HIV in Burkina Faso. AIDS Care 2020; 33:810-817. [PMID: 32449365 DOI: 10.1080/09540121.2020.1769832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Mobile health (mHealth) has gained considerable interest recently due to its potential to improve health outcomes in developing countries with high outreach yet low costs. Several studies have explored the use of short message service (SMS) reminders to improve antiretroviral (ARV) retention and adherence, with mixed results. The majority of these studies has a quantitative nature and employs randomized designs, which do not provide further qualitative insights about other possible impacts of the messages. Based on the qualitative assessment of an SMS intervention in Burkina Faso, which complemented a (quantitative) Randomized Controlled Trial (RCT), we show that beyond the functional role of improving ARV retention and adherence, SMS messages can also play important symbolic roles in offering psychosocial support to people living with HIV (PLHIV) and improving their perception of life. Concomitantly, we show that sufficient (ICT) literacy skills cannot be taken for granted in resource-poor settings. Yet, regardless of (ICT) literacy skills, the symbolism of care was perceived. Furthermore, we highlight the importance of complementing quantitative evidence of mHealth interventions with qualitative assessments.
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Affiliation(s)
- Marije Geldof
- International Institute of Social Studies, Erasmus University Rotterdam, The Hague, The Netherlands
| | - Boundia Alexandre Thiombiano
- Institut du Développement Rural (IDR), Université Nazi Boni (former Université Polytechnique de Bobo-Dioulasso), Bobo-Dioulasso, Burkina Faso
| | - Natascha Wagner
- International Institute of Social Studies, Erasmus University Rotterdam, The Hague, The Netherlands
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MacCarthy S, Mendoza-Graf A, Saya U, Samba C, Birungi J, Okoboi S, Linnemayr S. Lessons learned from a mobile technology-based intervention informed by behavioral economics to improve ART adherence among youth in Uganda. AIDS Care 2020; 32:616-622. [PMID: 31137959 PMCID: PMC6999852 DOI: 10.1080/09540121.2019.1622630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 05/14/2019] [Indexed: 12/12/2022]
Abstract
Evidence suggests that simple text messaging interventions may not suffice to improve ART adherence among youth in low-resource settings. To address this shortcoming, we developed an intervention that shared weekly real-time adherence feedback to youth in Uganda using short message services (SMS), based on information tracked by an electronic device (Wisepill). We present results from 7 formative and 6 exit focus groups (FGs) in Mulago and Entebbe, Uganda with youth ages 15-24, providers, and Community Advisory Board members. Participants consistently conveyed positive impressions of Wisepill, noting that it helped store their medications, facilitated travel, served as a reminder, and motivated adherence. Participants raised phone-related issues before the study; most were addressed but some remained (e.g., limited network access, electricity for powering phones). Further, they highlighted the importance of carefully crafting text messages (e.g., use slang rather than potentially stigmatizing words) and viewed personalizing messages favorably but were divided on the desirability of including their name in study-related texts. Exit FGs confirmed that sharing group adherence levels with participants tapped into the competitive spirit common among youth. Our results suggest future mobile technology-based interventions can be improved by providing messages that go beyond simple reminders to provide individual and group-level adherence feedback.
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Affiliation(s)
- Sarah MacCarthy
- RAND Corporation, Behavioral and Policy Sciences, Santa Monica, CA, USA
| | | | - Uzaib Saya
- Pardee RAND Graduate School, Santa Monica, CA, USA
| | | | | | - Stephen Okoboi
- Infectious Diseases Institute, Makerere University Kampala, Uganda
| | - Sebastian Linnemayr
- RAND Corporation, Economics, Sociology, and Statistics, Santa Monica, CA, USA
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Cell Phones, Sexual Behaviors and HIV Prevalence in Rakai, Uganda: A Cross Sectional Analysis of Longitudinal Data. AIDS Behav 2020; 24:1574-1584. [PMID: 31520238 DOI: 10.1007/s10461-019-02665-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cell phones have increased communication and connection across the globe and particularly in sub-Saharan Africa-with potential consequences for the HIV epidemic. We examined the association among ownership of cell phones, sexual behaviors (number of sexual partners, alcohol use before sex, inconsistent condom use), and HIV prevalence. Data were from four rounds (2010-2016) of the Rakai Community Cohort Study (N = 58,275). Sexual behaviors and HIV prevalence were compared between people who owned a cell phone to people who did not own a cell phone. We stratified analysis by younger (15-24 years) and older (25+ years) age groups and by gender. Using logistic regression and after adjusting for sociodemographic characteristics, we found cell phone ownership was independently associated with increased odds of having two or more sexual partners in the past 12 months across age and gender groups (young men AOR 1.67, 95% CI 1.47-1.90; young women AOR 1.28 95% CI 1.08-1.53; older men AOR 1.54 95% CI 1.41-1.69; older women AOR 1.44 95% CI 1.26-1.65). Interestingly, young men who owned cell phones had decreased odds of using condoms inconsistently (AOR 0.66, 95% CI 0.57-0.75). For young women, cell phone ownership was associated with increased odds of using alcohol before sex (AOR 1.38 95% CI 1.17-1.63) and increased odds of inconsistent condom use (AOR 1.40, 95% 1.17-1.67). After adjusting for sociodemographic characteristics, only young women who owned cell phones had increased odds of being HIV positive (AOR 1.27 95% CI 1.07-1.50). This association was not mediated by sexual behaviors (Adjusted for sociodemographic characteristics and sexual behaviors AOR 1.24, 95% CI 1.05-1.46). While cell phone ownership appears to be associated with increased HIV risk for young women, we also see a potential opportunity for future cell phone-based health interventions.
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Shrestha R, Altice FL, DiDomizio E, Sibilio B, Ranjit YS, Copenhaver MM. Feasibility and Acceptability of an mHealth-Based Approach as an HIV Prevention Strategy Among People Who Use Drugs on Pre-Exposure Prophylaxis. Patient Prefer Adherence 2020; 14:107-118. [PMID: 32021122 PMCID: PMC6971384 DOI: 10.2147/ppa.s236794] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/07/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There has been increasing interest in the use of mHealth technology in health care. To our knowledge, however, there is a lack of empirical evidence on the utilization of text messaging services (short message service; SMS) for HIV prevention among opioid-dependent people who use drugs (PWUD). As part of our formative work, we conducted an in-depth feasibility and acceptability study on the use of SMS reminders for HIV prevention in this risk group. METHODS Forty HIV-negative, opioid-dependent PWUD who are currently taking pre-exposure prophylaxis (PrEP) were enrolled in the study. Participants received daily PrEP text reminders and weekly HIV risk reduction-related messages, which were developed using a user-centered approach. Participants were assessed at baseline and immediately post-intervention. Following the post-intervention assessment, participants completed an in-depth qualitative interview. RESULTS Feasibility of text messaging service was high, as assessed by participants' willingness to receive text messages (100%), retention (95%), and successful delivery of text messages (97%). Results further showed that participants were satisfied and perceived the use of daily PrEP reminder text messages as valuable and acceptable [mean: 75.0 (range 0-100)]. Whereas, acceptability for the weekly text messages on HIV risk reduction was 60.3 (±15.6), with 58.3% recommending them for future use. Thematic data exploration revealed important information for understanding and refining SMS content as well as logistical preferences. CONCLUSION Our findings provide preliminary evidence of the feasibility and acceptability of a text messaging-based approach as a potential tool for primary HIV prevention to improve PrEP adherence and HIV risk reduction among this underserved population. HIV risk reduction text messages need further modifications to become more appealing, with participant feedback taken into consideration.
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Affiliation(s)
- Roman Shrestha
- Aasaman Nepal, HIV Prevention Group, Lalitpur, Nepal
- Correspondence: Roman Shrestha Asaman Nepal, HIV Prevention Group, Ring Road, Lalitpur44700, NepalTel +977-9849783132 Email
| | - Frederick L Altice
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Elizabeth DiDomizio
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Brian Sibilio
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Yerina S Ranjit
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael M Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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Endebu T, Deksisa A, Dugasa W, Mulu E, Bogale T. Acceptability and feasibility of short message service to improve ART medication adherence among people living with HIV/AIDS receiving antiretroviral treatment at Adama hospital medical college, Central Ethiopia. BMC Public Health 2019; 19:1315. [PMID: 31638936 PMCID: PMC6805404 DOI: 10.1186/s12889-019-7687-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 09/25/2019] [Indexed: 12/01/2022] Open
Abstract
Background People living with HIV/AIDS are facing sub-optimal adherence to antiretroviral therapy. Short message service innovative strategies have been recommended by the national strategy to support medication adherence among HIV positive people. Thus, this study was conducted to examine the feasibility and acceptability of a short message service to improve medication adherence among people living with HIV/AIDS receiving Antiretroviral Treatment. Methods We conducted a cross-sectional survey, from February 5 to 30, 2018, among 422 randomly selected adults living with HIV/AIDS receiving antiretroviral treatment at Adama Hospital. Interviewer administered structured questionnaire was used to collect quantitative data on the feasibility and acceptability of short message services, socio-demographic and clinical characteristics of participants. Qualitative data were also collected from two focus groups to supplement the quantitative findings. Logistic regression analysis was performed to identify factors associated with the feasibility and acceptability of short message services. Results Of 420 participants responded to our questionnaire, about nine of ten patients (93.8%) possessed had a mobile phone. Most of the patients (90.9%) were willing to accept SMS to improve their medication adherence. Patients who were in young age, early adult, disclosed their HIV status, having cell phone always and believe short message service aid adherence were more likely to accept short messages on adherence. On the other hand, frequent ART Clinic visit and perceived low confidentiality of short message service were negatively associated with acceptability of short message service. Conclusion The acceptability of short message service on adherence to antiretroviral therapy was high among people living with HIV/AIDS central Ethiopia. Authors recommend further studies, piloting or experimenting, that validate the acceptability, feasibility, effectiveness, and scalability of the intervention.
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Affiliation(s)
- Tamrat Endebu
- Department of Public Health, Adama Hospital and Medical College, Adama, Ethiopia
| | - Alem Deksisa
- Department of Public Health, Adama Hospital and Medical College, Adama, Ethiopia
| | - Warku Dugasa
- Department of Public Health, Adama Hospital and Medical College, Adama, Ethiopia
| | - Ermiyas Mulu
- Department of Public Health, College of Medicine & Health Sciences, Ambo University, Ambo, Ethiopia.
| | - Tilahun Bogale
- Department of Public Health, Adama Hospital and Medical College, Adama, Ethiopia.,Department of Public Health, College of Medicine & Health Sciences, Ambo University, Ambo, Ethiopia
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Ames HMR, Glenton C, Lewin S, Tamrat T, Akama E, Leon N. Clients' perceptions and experiences of targeted digital communication accessible via mobile devices for reproductive, maternal, newborn, child, and adolescent health: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 10:CD013447. [PMID: 31608981 PMCID: PMC6791116 DOI: 10.1002/14651858.cd013447] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Governments and health systems are increasingly using mobile devices to communicate with patients and the public. Targeted digital client communication is when the health system transmits information to particular individuals or groups of people, based on their health or demographic status. Common types of targeted client communication are text messages that remind people to go to appointments or take their medicines. Other types include phone calls, interactive voice response, or multimedia messages that offer healthcare information, advice, monitoring, and support. OBJECTIVES To explore clients' perceptions and experiences of targeted digital communication via mobile devices on topics related to reproductive, maternal, newborn, child, or adolescent health (RMNCAH). SEARCH METHODS We searched MEDLINE (OvidSP), MEDLINE In-Process & Other Non-Indexed Citations (OvidSP), Embase (Ovid), World Health Organization Global Health Library, and POPLINE databases for eligible studies from inception to 3-6 July 2017 dependant on the database (See appendix 2). SELECTION CRITERIA We included studies that used qualitative methods for data collection and analysis; that explored clinets' perceptions and experiences of targeted digital communication via mobile device in the areas of RMNCAH; and were from any setting globally. DATA COLLECTION AND ANALYSIS We used maximum variation purposive sampling for data synthesis, employing a three-step sampling frame. We conducted a framework thematic analysis using the Supporting the Use of Research Evidence (SURE) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether potential implementation barriers identified in our synthesis had been addressed in the trials included in the related Cochrane Reviews of effectiveness. MAIN RESULTS We included 35 studies, from a wide range of countries on six continents. Nineteen studies were conducted in low- and middle-income settings and sixteen in high-income settings. Some of the studies explored the views of people who had experienced the interventions, whereas others were hypothetical in nature, asking what people felt they would like from a digital health intervention. The studies covered a range of digital targeted client communication, for example medication or appointment reminders, prenatal health information, support for smoking cessation while pregnant, or general sexual health information.Our synthesis showed that clients' experiences of these types of programmes were mixed. Some felt that these programmes provided them with feelings of support and connectedness, as they felt that someone was taking the time to send them messages (moderate confidence in the evidence). They also described sharing the messages with their friends and family (moderate confidence).However, clients also pointed to problems when using these programmes. Some clients had poor access to cell networks and to the internet (high confidence). Others had no phone, had lost or broken their phone, could not afford airtime, or had changed their phone number (moderate confidence). Some clients, particularly women and teenagers, had their access to phones controlled by others (moderate confidence). The cost of messages could also be a problem, and many thought that messages should be free of charge (high confidence). Language issues as well as skills in reading, writing, and using mobile phones could also be a problem (moderate confidence).Clients dealing with stigmatised or personal health conditions such as HIV, family planning, or abortion care were also concerned about privacy and confidentiality (high confidence). Some clients suggested strategies to deal with these issues, such as using neutral language and tailoring the content, timing, and frequency of messages (high confidence).Clients wanted messages at a time and frequency that was convenient for them (moderate confidence). They had preferences for different delivery channels (e.g. short message service (SMS) or interactive voice response) (moderate confidence). They also had preferences about message content, including new knowledge, reminders, solutions, and suggestions about health issues (moderate confidence). Clients' views about who sent the digital health communication could influence their views of the programme (moderate confidence).For an overview of the findings and our confidence in the evidence, please see the 'Summary of qualitative findings' tables.Our matrix shows that many of the trials assessing these types of programmes did not try to address the problems we identified, although this may have been a reporting issue. AUTHORS' CONCLUSIONS Our synthesis identified several factors that can influence the successful implementation of targeted client communication programmes using mobile devices. These include barriers to use that have equity implications. Programme planners should take these factors into account when designing and implementing programmes. Future trial authors also need to actively address these factors and to report their efforts in their trial publications.
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Affiliation(s)
- Heather MR Ames
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
| | - Claire Glenton
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
| | - Simon Lewin
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070Cape TownSouth Africa7505
| | - Tigest Tamrat
- World Health OrganizationDepartment of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerlandCH‐1211
| | - Eliud Akama
- University of WashingtonSeattleWashingtonUSA
| | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070Cape TownSouth Africa7505
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Cele MA, Archary M. Acceptability of short text messages to support treatment adherence among adolescents living with HIV in a rural and urban clinic in KwaZulu-Natal. South Afr J HIV Med 2019; 20:976. [PMID: 31616573 PMCID: PMC6779962 DOI: 10.4102/sajhivmed.v20i1.976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/16/2019] [Indexed: 01/04/2023] Open
Abstract
Background The use of mobile communication technologies (mHealth) has improved adherence and viral suppression among HIV-infected adults. Adolescents have disproportionally lower levels of adherence and viral suppression compared with adults, potentially impacting the goal of 90% viral suppression by 2030. Objectives The aim of this study was to evaluate the acceptability of using short message service (SMS)-based mHealth interventions as a tool to improve adherence in HIV-infected adolescents in a rural and urban clinic in KwaZulu-Natal (KZN). Method A cross-sectional study with a sample size of 100 participants was conducted in a rural and urban clinic in KZN, from January 2018 to June 2019. Fifty participants were sequentially enrolled from each clinic. A questionnaire was self-administered with the assistance of the treating clinician depending on the adolescent's level of understanding. Informed consent was obtained from guardians and questionnaires were anonymised. Appropriate descriptive and comparative statistics were used. Results The mean age of participants was 15 years, with 88% having access to a mobile device (MOD). There was no significant difference in MOD ownership between rural and urban participants. Majority of participants (65%) were willing to receive SMS-based adherence support with no difference between rural and urban area. Conclusion With high rates of MOD ownership and acceptability (willingness to use mHealth to improve health status), SMS-based mHealth interventions have the potential to improve adherence and viral suppression in adolescents living with HIV in both rural and urban KZN. Further studies with a larger sample size need to be conducted to further explore these findings.
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Affiliation(s)
- Mthokozisi A Cele
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Moherndran Archary
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
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Santos VDF, Costa AKB, Lima ICVD, Alexandre HDO, Gir E, Galvão MTG. Use of the telephone for accessing people living with HIV/AIDS to antiretroviral therapy: systematic review. CIENCIA & SAUDE COLETIVA 2019; 24:3407-3416. [PMID: 31508759 DOI: 10.1590/1413-81232018249.31112017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/20/2018] [Indexed: 11/21/2022] Open
Abstract
This paper aims to evaluate the effectiveness of telephone use for the adherence of people with HIV/AIDS to antiretroviral therapy. A systematic review was carried out in the following databases: Latin American and Caribbean Literature in Health Sciences (Lilacs/ Bireme), SCOPUS, Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Web of Science; and in the Scientific Electronic Library Online (SciELO) and Cochrane libraries, using the following descriptors: "HIV", "Cell Phones", "Acquired Immunodeficiency Syndrome" and "Antiretroviral Therapy, Highly Active". We gathered a sample of 17 papers. The proposed cellphone interventions were the use of cellular applications, Short Message Service, and telephone calls. In most studies, telephone use has had a significant impact on adherence to treatment. The evaluation of the studies showed good methodological quality and adequate allocation secrecy. Self-reported adherence emerged among the adherence measuring methods. Cellphone use was effective in improving adherence to antiretroviral therapy for people living with HIV.
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Affiliation(s)
- Vanessa da Frota Santos
- Departamento de Enfermagem, Universidade Federal do Ceará. R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
| | - Ana Karoline Bastos Costa
- Departamento de Enfermagem, Universidade Federal do Ceará. R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
| | - Ivana Cristina Vieira de Lima
- Departamento de Enfermagem, Universidade Federal do Ceará. R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
| | | | - Elucir Gir
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto SP Brasil
| | - Marli Teresinha Gimeniz Galvão
- Departamento de Enfermagem, Universidade Federal do Ceará. R. Alexandre Baraúna 1115, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
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Ggita JM, Ojok C, Meyer AJ, Farr K, Shete PB, Ochom E, Turimumahoro P, Babirye D, Mark D, Dowdy D, Ackerman S, Armstrong-Hough M, Nalugwa T, Ayakaka I, Moore D, Haberer JE, Cattamanchi A, Katamba A, Davis JL. Patterns of usage and preferences of users for tuberculosis-related text messages and voice calls in Uganda. Int J Tuberc Lung Dis 2019; 22:530-536. [PMID: 29663958 DOI: 10.5588/ijtld.17.0521] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little information exists about mobile phone usage or preferences for tuberculosis (TB) related health communications in Uganda. METHODS We surveyed household contacts of TB patients in urban Kampala, Uganda, and clinic patients in rural central Uganda. Questions addressed mobile phone access, usage, and preferences for TB-related communications. We collected qualitative data about messaging preferences. RESULTS We enrolled 145 contacts and 203 clinic attendees. Most contacts (58%) and clinic attendees (75%) owned a mobile phone, while 42% of contacts and 10% of clinic attendees shared one; 94% of contacts and clinic attendees knew how to receive a short messaging service (SMS) message, but only 59% of contacts aged 45 years (vs. 96% of contacts aged <45 years, P = 0.0001) did so. All contacts and 99% of clinic attendees were willing and capable of receiving personal-health communications by SMS. Among contacts, 55% preferred detailed messages disclosing test results, while 45% preferred simple messages requesting a clinic visit to disclose results. CONCLUSIONS Most urban household TB contacts and rural clinic attendees reported having access to a mobile phone and willingness to receive TB-related personal-health communications by voice call or SMS. However, frequent phone sharing and variable messaging abilities and preferences suggest a need to tailor the design and monitoring of mHealth interventions to target recipients.
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Affiliation(s)
- J M Ggita
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - C Ojok
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - A J Meyer
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - K Farr
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
| | - P B Shete
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
| | - E Ochom
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - P Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Babirye
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Mark
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Dowdy
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - S Ackerman
- Department of Social & Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - M Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - T Nalugwa
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - I Ayakaka
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Moore
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda; London School of Hygiene & Tropical Medicine, London, England, UK
| | - J E Haberer
- Massachusetts General Hospital Global Health, Boston, Massachusetts, USA, Harvard Medical School, Boston, Massachusetts, USA
| | - A Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda; Clinical Epidemiology Unit, Department of Medicine, Makerere University, Kampala, Uganda
| | - J L Davis
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA; Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA
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Abstract
PURPOSE OF REVIEW Multiple reviews have examined eHealth/mHealth interventions to address treatment adherence, including those focusing on youth living with HIV (YLWH). This review synthesizes results of prior reviews and recent studies (last 5 years) to provide a path forward for future research, acknowledging both lessons learned and gaps to be addressed. RECENT FINDINGS Recent studies provide further evidence for the feasibility and acceptability of technology-based HIV interventions. Formative research of more comprehensive smartphone applications and pilot studies of computer-delivered interventions provide additional guidance on YLWH's preferences for intervention components and show promising preliminary efficacy for impacting treatment adherence. Expanding access to technology among YLWH, in the United States (US) and globally, supports the continued focus on eHealth/mHealth interventions as a means to reduce disparities in clinical outcomes. Future research should lend greater focus to implementation and scale-up of interventions through the use of adaptive treatment strategies that include costing analyses, measuring and maximizing engagement, fostering information sharing between researchers, and building upon sustainable platforms.
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Moore HA, Metcalf CA, Cassidy T, Hacking D, Shroufi A, Steele SJ, Duran LT, Ellman T. Investigating the addition of oral HIV self-tests among populations with high testing coverage - Do they add value? Lessons from a study in Khayelitsha, South Africa. PLoS One 2019; 14:e0215454. [PMID: 31048859 PMCID: PMC6497254 DOI: 10.1371/journal.pone.0215454] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/03/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction HIV self-testing (HIVST) offers a useful addition to HIV testing services and enables individuals to test privately. Despite recommendations to the contrary, repeat HIV testing is frequent among people already on anti-retroviral treatment (ART) and there are concerns that oral self-testing might lead to false negative results. A study was conducted in Khayelitsha, South Africa, to assess feasibility and uptake of HIVST and linkage-to-care following HIVST. Methods Participants were recruited at two health facilities from 1 March 2016 to 31 March 2017. People under 18 years, or with self-reported previously-diagnosed HIV infection, were excluded. Participants received an OraQuick Rapid HIV-1/2 Antibody kit, and reported their HIVST results by pre-paid text message (SMS) or by returning to the facility. Those not reporting within 7 days were contacted by phone. Electronic and paper-based clinical and laboratory records were retrospectively examined for all participants to identify known HIV outcomes, after matching for name, date of birth, and sex. These findings were compared with self-reported HIVST results where available. Results Of 639 participants, 401 (62.8%) self-reported a negative HIVST result, 27 (4.2%) a positive result, and 211 (33.0%) did not report. The record search identified that of the 401 participants self-reporting a negative HIVST result, 19 (4.7%) were already known to be HIV positive; of the 27 self-reporting positive, 12 (44%) were known HIV positive. Overall, records showed 57/639 (8.9%) were HIV positive of whom 39/57 (68.4%) had previously-diagnosed infection and 18/57 (31.6%) newly-diagnosed infection. Of the 428 participants who self-reported a result, 366 (85.5%) reported by SMS. Conclusions HIVST can improve HIV testing uptake and linkage to care. SMS is acceptable for reporting HIVST results but negative self-reports by participants may be unreliable. Use of HIVST by individuals on ART is frequent despite recommendations to the contrary and its implications need further consideration.
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Affiliation(s)
- Hazel Ann Moore
- Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
- * E-mail:
| | - Carol A. Metcalf
- Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Tali Cassidy
- Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Damian Hacking
- Médecins Sans Frontières, Khayelitsha Project, Cape Town, South Africa
| | - Amir Shroufi
- Médecins Sans Frontières, Cape Town, South Africa
| | | | | | - Tom Ellman
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
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Kerrigan A, Kaonga NN, Tang AM, Jordan MR, Hong SY. Content guidance for mobile phones short message service (SMS)-based antiretroviral therapy adherence and appointment reminders: a review of the literature. AIDS Care 2019; 31:636-646. [PMID: 30497271 PMCID: PMC6408301 DOI: 10.1080/09540121.2018.1549723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
Abstract
Mobile phones are increasingly being used to support health activities, including the care and management of people living with HIV/AIDS. Short message service (SMS) has been explored as a means to optimize and support behaviour change. However, there is minimal guidance on messaging content development. The purpose of this review was to inform the content of SMS messages for mobile health (mHealth) initiatives designed to support anti-retroviral therapy adherence and clinic appointment keeping in resource-limited settings. PubMed, OvidMedline, Google Scholar, K4Health's mHealth Evidence database, the mHealth Working Group project resource, and Health COMpass were searched. A request to online communities for recommendations on message content was also made. 1010 unique sources were identified, of which 51 were included. The information was organized into three categories: pre-message development, message development, and security and privacy. Fifteen of the publications explicitly provided their message content. Important lessons when developing the content of SMS were: (1) conducting formative research; (2) grounding content in behaviour change theory; and (3) reviewing proposed content with experts. Best practices exist for developing message content for behaviour change. Efforts should be continued to apply lessons learned from the existing literature to inform mHealth initiatives supporting HIV/AIDS care and treatment.
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Affiliation(s)
- Andrew Kerrigan
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Nadi N. Kaonga
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Tufts University Clinical and Translational Science Institute, Boston, MA, USA
| | - Alice M. Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Michael R. Jordan
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
| | - Steven Y. Hong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
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Dunn Navarra AM, Viorst Gwadz M, Bakken S, Whittemore R, Cleland CM, D'Eramo Melkus G. Adherence Connection for Counseling, Education, and Support: Research Protocol for a Proof-of-Concept Study. JMIR Res Protoc 2019; 8:e12543. [PMID: 30920377 PMCID: PMC6458537 DOI: 10.2196/12543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background The highest rates of new HIV infections are observed in African Americans and Hispanics/Latinos (ethnic minority) adolescents and young adults (youth). HIV-infected ethnic minority youth are less likely to initiate and maintain adherence to antiretroviral treatment (ART) and medical care, as compared with their adult counterparts. Objective The objective of this research protocol was to describe our proposed methods for testing a peer-led mobile health cognitive behavioral intervention, delivered via remote videoconferencing and smartphones with HIV-infected ethnic minority youth, Adherence Connection for Counseling, Education, and Support (ACCESS). Our secondary aim was to obtain initial estimates of the biobehavioral impact of ACCESS on HIV virologic outcomes and self-reported ART adherence, beliefs and knowledge about ART treatment, adherence self-efficacy, and health care utilization (retention in care). Methods An exploratory, sequential mixed-methods study design will be used with conceptual determinants of adherence behavior informed by the information-motivation-behavioral skills model. HIV-infected ethnic minority youth aged 16 to 29 years with a detectable HIV serum viral load of more than 200 copies/ml (N=25) will be recruited. Qualitative pretesting will be conducted, including semistructured, in-depth, individual interviews with a convenience sample meeting the study inclusion criteria. Preliminary analysis of qualitative data will be used to inform and tailor the ACCESS intervention. Testing and implementation will include a one-group pre-posttest pilot, delivered by a trained successful peer health coach who lives with HIV and is well-engaged in HIV care and taking ART. A total of 5 peer-led remote videoconferencing sessions will be delivered using study-funded smartphones and targeting adherence information (HIV knowledge), motivation (beliefs and perceptions), and behavioral skills (self-efficacy). Participant satisfaction will be assessed with poststudy focus groups and quantitative survey methodology. Bivariate analyses will be computed to compare pre- and postintervention changes in HIV biomarkers, self-reported ART adherence, beliefs and knowledge about ART, adherence self-efficacy, and retention in care. Results As of December 2018, we are in the data analysis phase of this pilot and anticipate completion with dissemination of final study findings by spring/summer 2019. The major outcomes will include intervention feasibility, acceptability, and preliminary evidence of impact on serum HIV RNA quantitative viral load (primary adherence outcome variable). Self-reported ART adherence and retention in care will be assessed as secondary outcomes. Findings from the qualitative pretesting will contribute to an improved understanding of adherence behavior. Conclusions Should the ACCESS intervention prove feasible and acceptable, this research protocol will contribute to a shift in existent HIV research paradigms by offering a blueprint for technology-enabled peer-led interventions and models. International Registered Report Identifier (IRRID) DERR1-10.2196/12543
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Affiliation(s)
| | - Marya Viorst Gwadz
- Silver School of Social Work, New York University, New York, NY, United States
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, NY, United States
| | - Robin Whittemore
- School of Nursing, Yale University, New Haven, CT, United States
| | - Charles M Cleland
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Gail D'Eramo Melkus
- Rory Meyers College of Nursing, New York University, New York, NY, United States
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Moyano D, Morelli D, Santero M, Belizan M, Irazola V, Beratarrechea A. Perceptions and Acceptability of Text Messaging for Diabetes Care in Primary Care in Argentina: Exploratory Study. JMIR Diabetes 2019; 4:e10350. [PMID: 30882362 PMCID: PMC6441856 DOI: 10.2196/10350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/27/2018] [Accepted: 12/28/2018] [Indexed: 01/25/2023] Open
Abstract
Background Engagement in self-care behaviors that are essential to optimize diabetes care is challenging for many patients with diabetes. mHealth interventions have been shown to be effective in improving health care outcomes in diabetes. However, more research is needed on patient perceptions to support these interventions, especially in resource settings in low- and middle-income countries. Objective The goal of the research was to explore perceptions and acceptability of a short message service (SMS) text messaging intervention for diabetes care in underserved people with diabetes in Argentina. Methods A qualitative exploratory methodology was adopted as part of the evaluation of a program to strengthen diabetes services in primary care clinics located in low-resource settings. The diabetes program included a text messaging intervention for people with diabetes. A total of 24 semistructured telephone interviews were conducted with people with diabetes. Results Twenty-four middle-aged persons with diabetes were interviewed. Acceptability was considered adequate in terms of its actual use, frequency, and the role of texts as a reminder. We found that text messages could be a mediating device in the patient’s learning processes. Also, being exposed to the texts seemed to help bring about changes in risk perception and care practices and to function as psychosocial support. Another relevant finding was the role of text messaging as a potential facilitator in diabetes care. In this sense, we observed a strong association between receiving text messages and having a better patient-physician relationship. Additionally, social barriers that affect diabetes care such as socioeconomic and psychosocial vulnerability were identified. Conclusions Our findings show positive contributions of a text messaging intervention for the care of people with diabetes. We consider that an SMS strategy has potential to be replicated in other contexts. However, further studies are needed to explore its sustainability and long-term impact from the perspective of patients.
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Affiliation(s)
- Daniela Moyano
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Daniela Morelli
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Marilina Santero
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Maria Belizan
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andrea Beratarrechea
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Kimera E, Vindevogel S, De Maeyer J, Reynaert D, Engelen AM, Nuwaha F, Rubaihayo J, Bilsen J. Challenges and support for quality of life of youths living with HIV/AIDS in schools and larger community in East Africa: a systematic review. Syst Rev 2019; 8:64. [PMID: 30808419 PMCID: PMC6390353 DOI: 10.1186/s13643-019-0980-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 02/14/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Youths living with HIV/AIDS (YLWHA) experience innumerable challenges within schools and the larger community. Nonetheless, these environments are potential sources of support for such youths. This review provides a synthesis of evidence about these challenges and support available for YLWHA to inform the design and implementation of interventions that support the wellbeing of youths living with HIV/AIDS in an East African context. METHODS We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane central registry of systematic reviews and randomized control trials for studies conducted in East Africa and published in English in the last 10 years (March 2007 to March 2017). We also searched Google Scholar and reference lists of all included studies. We purposed to include both qualitative and quantitative data but no quantitative data merited inclusion. We analyzed qualitative data using a framework thematic analysis. RESULTS We included 16 primary studies conducted in clinic and community settings that used qualitative or mixed methods. Three overarching themes-psychosocial wellbeing, treatment and health, and disclosure of HIV status together with a sub-theme of stigma that was important across the three overarching themes-were the basis for analysis. In each overarching theme, a duality of challenges versus support was reported. Psychosocial wellbeing included subthemes of challenges in schools and larger community, financial challenges, domestic violence, sexual and reproductive health challenges, and psychosocial support. CONCLUSION YLWHA experience numerous challenges and support needs, some of which occur in schools and affect their QoL. The effects of these challenges are poor health and educational outcomes as well as school dropout. The schools in which youths spend most of their formative years have not provided adequate support for YLWHA. This review identified that although most of the challenges that studies identified arose from within schools and that a few supportive approaches were available, none of the studies explored how these supportive approaches would work in schools. It was additionally identified that stigma complicates challenges of living with HIV/AIDS necessitating interventions for the wellbeing of YLWHA to understand and address HIV-stigma and its ramifications. Such interventions ought to be sustainable in schools, culturally appropriate, and multidisciplinary in order to promote the general health of all students.
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Affiliation(s)
- Emmanuel Kimera
- Department of Public Health, School of Health Sciences, Mountain of the Moon University, Fort Portal, Uganda.
| | - Sofie Vindevogel
- Department of Orthopedagogy, Health and Social Work, Faculty of Education, University College Gent, Gent, Belgium
| | - Jessica De Maeyer
- Health and Social Work, Faculty of Education, University College Gent, Gent, Belgium
| | - Didier Reynaert
- Health and Social Work, Faculty of Education, University College Gent, Gent, Belgium
| | - Anne-Mie Engelen
- Department of Occupational therapy, Health and Social Work, Faculty of Education, University College Gent, Gent, Belgium
| | - Fred Nuwaha
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Rubaihayo
- Department of Public Health, School of Health Sciences, Mountain of the Moon University, Fort Portal, Uganda
| | - Johan Bilsen
- Department of Public Health, Mental Health and Wellbeing research group, Vrije Universiteit Brussels, Brussels, Belgium
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St Clair-Sullivan N, Mwamba C, Whetham J, Bolton Moore C, Darking M, Vera J. Barriers to HIV care and adherence for young people living with HIV in Zambia and mHealth. Mhealth 2019; 5:45. [PMID: 31620472 PMCID: PMC6789205 DOI: 10.21037/mhealth.2019.09.02] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/27/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The control of HIV/AIDS has been a contemporary public health success story however, whilst infection rates are falling and people are living longer due to antiretroviral therapy, adolescents and young people remain disproportionally affected. Infection rates and AIDS-related deaths continue to increase in these age groups in some areas globally. This has been primarily attributed to structural barriers including HIV-services not being youth friendly with opening hours conflicting with school time, fears around unintended disclosure and confidentiality, and the attitudes of healthcare professionals-but research targeting these specific age groups remains limited. Early mHealth (i.e., the use of mobile and wireless devices to assist in achieving health objectives) projects have been shown to improve health outcomes in other disease areas and health settings however, amongst people living with HIV, current research is limited. The aim of this study was to explore barriers to HIV care and the acceptability and feasibility of using mHealth to improve retention into care and ART adherence for young people living with HIV (16-24 years old) in Lusaka, Zambia. METHODS Qualitative in-depth interviews and focus group discussions were carried out in four CIDRZ-supported health facilities in Lusaka, Zambia. Six interviews were carried out with nurses and peer-support workers working with young people living with HIV and three focus groups with a total of 24 young people. Recruitment was via purposive sampling. Interviews and focus groups were recorded, translated and transcribed and entered into NVivo for thematic analysis. RESULTS Twenty-four of the young persons interviewed had access to mobile phones and reported using them for social networking, information gathering and regular communication. Barriers to HIV care and adherence were largely underpinned by stigma. Participants described healthcare facilities as not being conducive for confidentiality and therefore were reluctant to be seen attending or collecting medication from the pharmacy due to possible unintended disclosure and consequential HIV-related stigma. Clinic opening and waiting times and experiences with healthcare professionals also served as barriers. It was felt unanimously by participants that mHealth would be beneficial in improving retention into care and ART adherence in young people living with HIV. CONCLUSIONS HIV-related stigma remains a barrier to care. With growing access to mobile phones and internet, and a growing population of adolescents who are already using their phones to support each other and seek information, mHealth appears to be both a feasible and acceptable tool to support retention, provide young people with information, and potentially reduce time spent at health facilities via appointment reminders and electronic drug refill requests.
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Affiliation(s)
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia, Mass Media, Zambia
| | | | - Carolyn Bolton Moore
- Centre for Infectious Disease Research in Zambia, Mass Media, Zambia
- University of Alabama at Birmingham, Birmingham, USA
| | | | - Jaime Vera
- Brighton and Sussex Medical School, Brighton, East SussexUK
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Velloza J, Ngure K, Kiptinness C, Quame-Amaglo J, Thuo N, Dew K, Kimani M, Gakuo S, Unger JA, Kolko B, Baeten JM, Celum C, Mugo N, Heffron R. A clinic-based tablet application to support safer conception among HIV serodiscordant couples in Kenya: feasibility and acceptability study. Mhealth 2019; 5:4. [PMID: 30976596 PMCID: PMC6414336 DOI: 10.21037/mhealth.2019.01.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/27/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND HIV serodiscordant couples are at heightened risk of HIV transmission when attempting to conceive, yet reproductive goals can outweigh concerns about HIV exposure. Safer conception strategies support fertility desires while minimizing HIV transmission risk and novel mHealth tools can optimize their use. The objective of this analysis is to examine the feasibility and usability of short message service (SMS) messages and a mobile application to support safer conception for HIV serodiscordant couples. METHODS We enrolled 74 heterosexual HIV serodiscordant couples with immediate pregnancy desires into a pilot safer conception intervention study in Thika, Kenya. Prior to pregnancy, women received daily 6-item SMS surveys to capture fertility indicators (e.g., menses, basal body temperature) and sexual behavior. The intervention also provided daily oral pre-exposure prophylaxis (PrEP) for the HIV-negative partner and in-depth counseling to accompany publicly-provided antiretroviral therapy (ART) for the HIV-infected partner. Couples attended monthly visits until pregnancy occurred. We measured PrEP use with medication event monitoring system (MEMS) caps and ART use via quarterly viral load quantification. We imported SMS, MEMS, and viral load data into an Android tablet application designed specifically for this setting for couples to view during clinic visits and included predictions of peak fertility days using SMS data. We used descriptive statistics to summarize SMS response data and developed a Google Analytics platform to monitor tablet application usage during follow-up. We also conducted semi-structured interviews with a purposive sample of 5 healthcare providers and 19 couples. Qualitative data were analyzed using a modified constant comparative approach to identify themes related to mHealth intervention feasibility and acceptability. RESULTS In our sample, 34 (45.9%) couples had an HIV-infected female partner. The median age of the female partner was 30 years [interquartile range (IQR), 27-35 years], education was 10 years (IQR, 8-12 years), and partnership duration was 3 years (IQR, 2-7 years). Couples were followed for a median of 218 days (IQR, 116-348 days) prior to pregnancy. Participants completed 13,181 of 16,905 (78.0%) SMS surveys surveys sent with a median of 167 completed surveys (IQR, 74-299) per participant. Most participants completed at least 75% of the total SMS messages received (N=58; 77.3%). The tablet application was opened by counselors 1,806 times during the study period (March 2016 through April 2018). In qualitative interviews, the SMS messages were reportedly easy to respond to and "part of the daily routine". Few participants had concerns about message confidentiality. mHealth tools were also found to be acceptable for tracking fertility indicators and enhancing provider-patient communication. CONCLUSIONS mHealth strategies are feasible to use and acceptable to support the delivery of safer conception intervention services among HIV serodiscordant couples in Kenya.
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Affiliation(s)
- Jennifer Velloza
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kenneth Ngure
- Department of Community of Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | | | - Nicholas Thuo
- Partners in Health and Research Development, Nairobi, Kenya
| | - Kristin Dew
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - Mary Kimani
- Partners in Health and Research Development, Nairobi, Kenya
| | - Stephen Gakuo
- Partners in Health and Research Development, Nairobi, Kenya
| | - Jennifer A. Unger
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Beth Kolko
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - Jared M. Baeten
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Connie Celum
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA
- Partners in Health and Research Development, Nairobi, Kenya
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Renee Heffron
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Meyer AJ, Babirye D, Armstrong-Hough M, Mark D, Ayakaka I, Katamba A, Haberer JE, Davis JL. Text Messages Sent to Household Tuberculosis Contacts in Kampala, Uganda: Process Evaluation. JMIR Mhealth Uhealth 2018; 6:e10239. [PMID: 30459147 PMCID: PMC6280036 DOI: 10.2196/10239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 01/18/2023] Open
Abstract
Background Previous studies have reported the inconsistent effectiveness of text messaging (short message service, SMS) for improving health outcomes, but few have examined to what degree the quality, or “fidelity,” of implementation may explain study results. Objective The aim of this study was to determine the fidelity of a one-time text messaging (SMS) intervention to promote the uptake of tuberculosis evaluation services among household contacts of index patients with tuberculosis. Methods From February to June 2017, we nested a process evaluation of text message (SMS) delivery within the intervention arm of a randomized controlled trial of tuberculosis contact investigation in Kampala, Uganda. Because mobile service providers in Uganda do not provide delivery confirmations, we asked household tuberculosis contacts to confirm the receipt of a one-time tuberculosis-related text message (SMS) by sending a text message (SMS) reply through a toll-free “short code.” Two weeks later, a research officer followed up by telephone to confirm the receipt of the one-time text message (SMS) and administer a survey. We considered participants lost to follow-up after 3 unsuccessful call attempts on 3 separate days over a 1-week period. Results Of 206 consecutive household contacts, 119 had a text message (SMS) initiated from the server. While 33% (39/119) were children aged 5-14 years, including 20% (24/119) girls and 13% (15/119) boys, 18 % (21/119) were adolescents or young adults, including 12% (14/119) young women and 6% (7/119) young men. 50% (59/119) were adults, including 26% (31/119) women and 24% (28/119) men. Of 107 (90%) participants for whom we could ascertain text message (SMS) receipt status, 67% (72/107) confirmed text message (SMS) receipt, including 22% (24/107) by reply text message (SMS) and 45% (48/107) during the follow-up telephone survey. No significant clinical or demographic differences were observed between those who did and did not report receiving the text message (SMS). Furthermore, 52% (56/107) reported ever reading the SMS. The cumulative likelihood of a text message (SMS) reaching its target and being read and retained by a participant was 19%. Conclusions The fidelity of a one-time text message (SMS) intervention to increase the uptake of household tuberculosis contact investigation and linkage to care was extremely low, a fact only discoverable through detailed process evaluation. This study suggests the need for systematic process monitoring and reporting of implementation fidelity in both research studies and programmatic interventions using mobile communications to improve health.
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Affiliation(s)
- Amanda J Meyer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, United States.,Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Diana Babirye
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Mari Armstrong-Hough
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, United States.,Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - David Mark
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Irene Ayakaka
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Jessica E Haberer
- Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States
| | - J Lucian Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, United States.,Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, Yale University, New Haven, CT, United States
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MacCarthy S, Saya U, Samba C, Birungi J, Okoboi S, Linnemayr S. "How am I going to live?": exploring barriers to ART adherence among adolescents and young adults living with HIV in Uganda. BMC Public Health 2018; 18:1158. [PMID: 30286746 PMCID: PMC6172755 DOI: 10.1186/s12889-018-6048-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Studies from sub-Saharan Africa (SSA) document how barriers to ART adherence present additional complications among adolescents and young adults living with HIV. We qualitatively explored barriers to ART adherence in Uganda among individuals age 14–24 to understand the unique challenges faced by this age group. Methods We conducted focus group (FG) discussions with Community Advisory Board members (n = 1), health care providers (n = 2), and male and female groups of adolescents age 14–17 (n = 2) and youth age 18–24 (n = 2) in Kampala, Uganda. FGs were transcribed verbatim and translated from Luganda into English. Two investigators independently reviewed all transcripts, developed a detailed codebook, achieved a pooled Cohen’s Kappa of 0.79 and 0.80, and used a directed content analysis to identify key themes. Results Four barriers to ART adherence emerged: 1) poverty limited adolescents’ ability to buy food and undercut efforts to become economically independent in their transition from adolescence to adulthood; 2) school attendance limited their privacy, further disrupting ART adherence; 3) family support was unreliable, and youth often struggled with a constant change in guardianship because they had lost their biological parents to HIV. In contrast peer influence, especially among HIV-positive youth, was strong and created an important network to support ART adherence; 4) the burden of taking multiple medications daily frustrated youth, often leading to so-called ‘drug holidays.’ Adolescent and youth-specific issues around disclosure emerged across three of the four barriers. Conclusions To be effective, programs and policies to improve ART adherence among youth in Uganda must address the special challenges that adolescents and young adults confront in achieving optimal adherence. For example, training on budgeting and savings practices could help promote their transition to financial independence. School staff could develop strategies to help students take their medications consistently and confidentially. While challenging to extend the range of services provided by HIV clinics, successful efforts will require engaging the family, peers, and larger community of health and educational providers to support adolescents and young adults living with HIV to live longer and healthier lives. Trial registration ClinicalTrials.gov Identifier: NCT02514356. Registered August 3, 2015.
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Affiliation(s)
- Sarah MacCarthy
- RAND Corporation, Behavioral and Policy Sciences, 1776 Main Street, Santa Monica, CA, USA.
| | - Uzaib Saya
- Pardee RAND Graduate School, 1776 Main Street, Santa Monica, CA, USA
| | - Clare Samba
- TASO Uganda, Old Mulago Complex, Kampala, P.O.Box 10443, Kampala, Uganda
| | - Josephine Birungi
- TASO Uganda, Old Mulago Complex, Kampala, P.O.Box 10443, Kampala, Uganda.,Old Mulago Complex, Kampala P.O.Box 10443, Kampala, Uganda
| | - Stephen Okoboi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Sebastian Linnemayr
- RAND Corporation, Economics, Sociology, and Statistics, 1776 Main Street, Santa Monica, CA, USA
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Fairbanks J, Beima-Sofie K, Akinyi P, Matemo D, Unger JA, Kinuthia J, O'Malley G, Drake AL, John-Stewart G, Ronen K. You Will Know That Despite Being HIV Positive You Are Not Alone: Qualitative Study to Inform Content of a Text Messaging Intervention to Improve Prevention of Mother-to-Child HIV Transmission. JMIR Mhealth Uhealth 2018; 6:e10671. [PMID: 30026177 PMCID: PMC6072973 DOI: 10.2196/10671] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/20/2018] [Indexed: 12/28/2022] Open
Abstract
Background Prevention of mother-to-child HIV transmission (PMTCT) relies on long-term adherence to antiretroviral therapy (ART). Mobile health approaches, such as text messaging (short message service, SMS), may improve adherence in some clinical contexts, but it is unclear what SMS content is desired to improve PMTCT-ART adherence. Objective We aimed to explore the SMS content preferences related to engagement in PMTCT care among women, male partners, and health care workers. The message content was used to inform an ongoing randomized trial to enhance the PMTCT-ART adherence. Methods We conducted 10 focus group discussions with 87 HIV-infected pregnant or postpartum women and semistructured individual interviews with 15 male partners of HIV-infected women and 30 health care workers from HIV and maternal child health clinics in Kenya. All interviews were recorded, translated, and transcribed. We analyzed transcripts using deductive and inductive approaches to characterize women’s, partners’, and health care workers’ perceptions of text message content. Results All women and male partners, and most health care workers viewed text messages as a useful strategy to improve engagement in PMTCT care. Women desired messages spanning 3 distinct content domains: (1) educational messages on PMTCT and maternal child health, (2) reminder messages regarding clinic visits and adherence, and (3) encouraging messages that provide emotional support. While all groups valued reminder and educational messages, women highlighted emotional support more than the other groups (partners or health care workers). In addition, women felt that encouraging messages would assist with acceptance of their HIV status, support disclosure, improve patient-provider relationship, and provide support for HIV-related challenges. All 3 groups valued not only messages to support PMTCT or HIV care but also messages that addressed general maternal child health topics, stressing that both HIV- and maternal child health–related messages should be part of an SMS system for PMTCT. Conclusions Women, male partners, and health care workers endorsed SMS text messaging as a strategy to improve PMTCT and maternal child health outcomes. Our results highlight the specific ways in which text messaging can encourage and support HIV-infected women in PMTCT to remain in care, adhere to treatment, and care for themselves and their children. Trial Registration ClinicalTrials.gov NCT02400671; https://clinicaltrials.gov/ct2/show/NCT02400671 (Archived by WebCite at http://www.webcitation.org/70W7SVIVJ)
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Affiliation(s)
- Jade Fairbanks
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | | | - Jennifer A Unger
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Kenyatta National Hospital, Nairobi, Kenya.,Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Gabrielle O'Malley
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Epidemiology, University of Washington, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States.,Department of Medicine, University of Washington, Seattle, WA, United States
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, United States
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Saltiel D, Steels S, Fenney D. Developing a typology of mobile phone usage in social care: A critical review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:449-457. [PMID: 28758275 DOI: 10.1111/hsc.12482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 06/07/2023]
Abstract
The ways in which mobile phones have transformed the boundaries of time and space and the possibilities of communication have profoundly affected our lives. However, there is little research on the use of mobiles in social care though evidence is emerging that mobile phones can play an important role in delivering services. This paper is based on a scoping review of the international literature in this area. A typology of mobile interventions is suggested. While most mobile phone interventions remain unidirectional and sit within traditional social care service provider-service user relationships, a minority are bi- or multidirectional and contain within them the potential to transform these traditional relationships by facilitating a collective development of social networks and social capital. Such transformations are accompanied by a range of issues and dilemmas that have made many service providers reluctant to engage with new technologies. We suggest that our typology is a useful model to draw on when researching the use of mobile phones in social care to support and empower isolated, marginalised and vulnerable service users.
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Affiliation(s)
- David Saltiel
- School of Healthcare, University of Leeds, Leeds, UK
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Mao L, Buchanan A, Wong HTH, Persson A. Beyond mere pill taking: SMS reminders for HIV treatment adherence delivered to mobile phones of clients in a community support network in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:486-494. [PMID: 29336111 DOI: 10.1111/hsc.12544] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 06/07/2023]
Abstract
SMS reminders sent to personal mobiles are increasingly used by clinical services to promote patient engagement, including adherence to antiretroviral treatment (ART) for HIV. From August to September 2015, a 6-week, randomised SMS reminder for ART adherence intervention was implemented among 98 HIV-positive clients of Australian's largest HIV charitable organisation located in Sydney. This was followed by a mixed-method evaluation, comprising a self-completed online survey and a one-to-one interview. Of the 62 survey participants, all being men, the majority were gay (85.5%) and living long-term with HIV (median year of HIV diagnosis = 1998). While everyone was on ART, a substantial proportion (n = 27, 43.5%) had interrupted treatment in the past. At the end of the intervention, based on the standard SMAQ measure, 82% had consistently adhered to ART in the previous week. While there was no statistically significant intervention effect, perceiving less stigma were independently associated with better ART adherence (adjusted odds ratio = 0.37; 95% CI 0.16-0.89; P = .026). Of the 11 interviewees, despite limited add-on effects on individual ART adherence, the campaign was well-received as a unique community support service. This study underscores the essential role of empowerment through enhancing disease self-management, increasing social support and reducing stigma, particularly for long-term HIV survivors. SMS messaging, part of mHealth, delivered by community services could have broader impacts on reducing health and social inequity.
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Affiliation(s)
- Limin Mao
- Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia
| | | | - Horas Tze Hoo Wong
- Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia
| | - Asha Persson
- Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia
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Eysenbach G, Atukunda EC, Tumuhimbise W, Pisarski EE, Tam M, Wyatt MA, Ware NC, Haberer JE. Acceptability and Feasibility of Real-Time Antiretroviral Therapy Adherence Interventions in Rural Uganda: Mixed-Method Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e122. [PMID: 29773527 PMCID: PMC5981052 DOI: 10.2196/mhealth.9031] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/11/2018] [Accepted: 03/19/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Wireless electronic adherence monitors can detect antiretroviral therapy (ART) adherence lapses and trigger interventions in real time, thus potentially avoiding unnecessary HIV viremia. Evidence about the acceptability and feasibility of these monitors and associated interventions, however, is limited. OBJECTIVE The aim of this study was to assess the acceptability and feasibility of real-time adherence monitoring linked to text messaging (short message service, SMS) reminders and notifications to support adherence among individuals living with HIV who are taking ART in rural southwestern Uganda. METHODS Individuals living with HIV who were initiating ART were enrolled in a pilot randomized controlled trial and followed up for 9 months. Participants received a real-time adherence monitor and were randomized to one of the following study arms: (1) scheduled SMS, (2) SMS triggered by missed or delayed doses, or (3) no SMS. SMS notifications were also sent to 45 patient-identified social supporters for sustained adherence lapses in the scheduled SMS and triggered SMS arms. Study participants and social supporters participated in qualitative semistructured in-depth interviews on acceptability and feasibility of this technology. An inductive, content analytic approach, framed by the unified theory of acceptance and use of technology model, was used to analyze qualitative data. Quantitative feasibility data, including device functionality and SMS tracking data, were recorded based upon device metrics collected electronically and summarized descriptively. RESULTS A total of 63 participants participated in the study. Participants reported that real-time monitoring intervention linked to SMS reminders and notifications are generally acceptable; the predominant feedback was perceived utility-the intervention was beneficial in motivating and reminding patients to take medication, as well as enabling provision of social support. The intervention was found to be technically feasible, as data were obtained from most participants as expected most of the time. Potential challenges included the impact of the technology on confidentiality, shared phone ownership, usability skills, and availability of electricity. CONCLUSIONS Real-time adherence monitoring integrated with SMS reminders and social support notifications is a generally acceptable (based primarily on perceived utility) and feasible intervention in a resource-limited country. Future efforts should focus on optimized device design, user training to overcome the challenges we encountered, cost effectiveness studies, as well as studying the monitoring aspect of the device without accompanying interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT01957865; https://clinicaltrials.gov/ct2/show/NCT01957865 (Archived by WebCite at http://www.webcitation.org/6zFiDlXDa).
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Affiliation(s)
| | | | | | | | - Melanie Tam
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Monique A Wyatt
- Harvard Medical School, Boston, MA, United States.,Harvard Global, Cambridge, MA, United States
| | - Norma C Ware
- Harvard Medical School, Boston, MA, United States
| | - Jessica E Haberer
- Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States
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Ronen K, Unger JA, Drake AL, Perrier T, Akinyi P, Osborn L, Matemo D, O'Malley G, Kinuthia J, John-Stewart G. SMS messaging to improve ART adherence: perspectives of pregnant HIV-infected women in Kenya on HIV-related message content. AIDS Care 2017; 30:500-505. [PMID: 29254362 DOI: 10.1080/09540121.2017.1417971] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There is growing evidence that mobile health (mHealth) approaches including short messaging service (SMS) can improve antiretroviral therapy (ART) adherence, but consensus is lacking regarding communication of HIV-related information. Most interventions to date have delivered SMS that do not overtly refer to HIV or ART in order to avoid risk of status disclosure. In formative work for an ongoing randomized controlled trial (RCT) evaluating one-way and two-way educational SMS for prevention of mother-to-child-transmission (PMTCT) adherence in Kenya, we conducted 10 focus group discussions (FGDs) with 87 HIV-infected peripartum women to determine desirability and preferred terminology of HIV-related content. SMS for the RCT were developed based on FGD findings. Roughly half of FGD participants supported receiving SMS containing overtly HIV-related terms, such as "HIV" and "medication", citing desire for detailed educational messages about ART and PMTCT. Those opposed to overt content expressed concerns about confidentiality. Many participants argued that acceptability of HIV-related content depended on the recipient's disclosure status and others' access to her phone. Based on these findings, both covert and overt SMS were developed for the RCT and participants who owned their phone or had disclosed their HIV status to anyone with access to their phone were able to choose one of three options: (1) covert SMS only, (2) overt SMS only in response to HIV-related questions from the participant, (3) overt SMS routinely, initiated by the study. Of the 825 participants in the RCT, 94% were eligible to receive overt SMS. Of these, 66% opted to receive routine overt SMS and 10% to receive participant-initiated overt SMS. These findings show there may be interest in overt HIV-related information by SMS when risk of status disclosure is low, and support use of messaging strategies that allows participant choice in HIV-related content while protecting against undesired disclosure.
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Affiliation(s)
- Keshet Ronen
- a Department of Global Health , University of Washington , Seattle , WA , USA.,b Department of Epidemiology , University of Washington , Seattle , WA , USA
| | - Jennifer A Unger
- a Department of Global Health , University of Washington , Seattle , WA , USA.,c Department of Obstetrics and Gynecology , University of Washington , Seattle , WA , USA
| | - Alison L Drake
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Trevor Perrier
- d Department of Computer Science and Engineering , University of Washington , Seattle , WA , USA
| | | | - Lusi Osborn
- e Kenyatta National Hospital , Nairobi , Kenya
| | | | - Gabrielle O'Malley
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - John Kinuthia
- e Kenyatta National Hospital , Nairobi , Kenya.,f Department of Obstetrics and Gynecology , University of Nairobi , Nairobi , Kenya
| | - Grace John-Stewart
- a Department of Global Health , University of Washington , Seattle , WA , USA.,b Department of Epidemiology , University of Washington , Seattle , WA , USA.,g Department of Medicine , University of Washington , Seattle , WA , USA.,h Department of Pediatrics , University of Washington , Seattle , WA , USA
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Linnemayr S, Huang H, Luoto J, Kambugu A, Thirumurthy H, Haberer JE, Wagner G, Mukasa B. Text Messaging for Improving Antiretroviral Therapy Adherence: No Effects After 1 Year in a Randomized Controlled Trial Among Adolescents and Young Adults. Am J Public Health 2017; 107:1944-1950. [PMID: 29048966 DOI: 10.2105/ajph.2017.304089] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effectiveness of Short Message Service (SMS) reminder messages on antiretroviral and cotrimoxazole prophylaxis adherence among HIV-positive youths as well as the relative effectiveness of SMS with and without a response option. METHODS Eligible HIV-positive patients aged 15 to 22 years at 2 HIV clinics in Kampala, Uganda, participated in a year-long parallel individual-randomized controlled trial and were assigned in a 1-to-1-to-1 ratio to a weekly SMS message group, weekly SMS message with response option group, or a usual-care control group. RESULTS We enrolled 332 participants. Electronically measured mean adherence was 67% in the control group, 64% in the 1-way SMS group (95% confidence interval [CI] = 0.77, 1.14), and 61% in the 2-way SMS group (95% CI = 0.75, 1.12) in an intent-to-treat analysis. Results for secondary outcomes and complete-case analysis were similarly statistically insignificant across groups. CONCLUSIONS Despite previous evidence that interventions using SMS reminders can promote antiretroviral therapy adherence, this study shows that they are not always effective in achieving behavior change. More research is needed to find out for whom, and under what conditions, they can be beneficial. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00830622.
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Affiliation(s)
- Sebastian Linnemayr
- Sebastian Linnemayr, Jill Luoto, and Glenn Wagner are with the RAND Corporation, Santa Monica, CA. Haijing Huang is with the Pardee RAND Graduate School, Santa Monica. Andrew Kambugu is with Infectious Diseases Institute and Makerere University, Kampala, Uganda. Harsha Thirumurthy is with Department of Health Policy and Management and Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Jessica E. Haberer is with Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, MA. Barbara Mukasa is with Mildmay Uganda, Kampala
| | - Haijing Huang
- Sebastian Linnemayr, Jill Luoto, and Glenn Wagner are with the RAND Corporation, Santa Monica, CA. Haijing Huang is with the Pardee RAND Graduate School, Santa Monica. Andrew Kambugu is with Infectious Diseases Institute and Makerere University, Kampala, Uganda. Harsha Thirumurthy is with Department of Health Policy and Management and Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Jessica E. Haberer is with Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, MA. Barbara Mukasa is with Mildmay Uganda, Kampala
| | - Jill Luoto
- Sebastian Linnemayr, Jill Luoto, and Glenn Wagner are with the RAND Corporation, Santa Monica, CA. Haijing Huang is with the Pardee RAND Graduate School, Santa Monica. Andrew Kambugu is with Infectious Diseases Institute and Makerere University, Kampala, Uganda. Harsha Thirumurthy is with Department of Health Policy and Management and Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Jessica E. Haberer is with Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, MA. Barbara Mukasa is with Mildmay Uganda, Kampala
| | - Andrew Kambugu
- Sebastian Linnemayr, Jill Luoto, and Glenn Wagner are with the RAND Corporation, Santa Monica, CA. Haijing Huang is with the Pardee RAND Graduate School, Santa Monica. Andrew Kambugu is with Infectious Diseases Institute and Makerere University, Kampala, Uganda. Harsha Thirumurthy is with Department of Health Policy and Management and Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Jessica E. Haberer is with Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, MA. Barbara Mukasa is with Mildmay Uganda, Kampala
| | - Harsha Thirumurthy
- Sebastian Linnemayr, Jill Luoto, and Glenn Wagner are with the RAND Corporation, Santa Monica, CA. Haijing Huang is with the Pardee RAND Graduate School, Santa Monica. Andrew Kambugu is with Infectious Diseases Institute and Makerere University, Kampala, Uganda. Harsha Thirumurthy is with Department of Health Policy and Management and Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Jessica E. Haberer is with Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, MA. Barbara Mukasa is with Mildmay Uganda, Kampala
| | - Jessica E Haberer
- Sebastian Linnemayr, Jill Luoto, and Glenn Wagner are with the RAND Corporation, Santa Monica, CA. Haijing Huang is with the Pardee RAND Graduate School, Santa Monica. Andrew Kambugu is with Infectious Diseases Institute and Makerere University, Kampala, Uganda. Harsha Thirumurthy is with Department of Health Policy and Management and Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Jessica E. Haberer is with Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, MA. Barbara Mukasa is with Mildmay Uganda, Kampala
| | - Glenn Wagner
- Sebastian Linnemayr, Jill Luoto, and Glenn Wagner are with the RAND Corporation, Santa Monica, CA. Haijing Huang is with the Pardee RAND Graduate School, Santa Monica. Andrew Kambugu is with Infectious Diseases Institute and Makerere University, Kampala, Uganda. Harsha Thirumurthy is with Department of Health Policy and Management and Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Jessica E. Haberer is with Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, MA. Barbara Mukasa is with Mildmay Uganda, Kampala
| | - Barbara Mukasa
- Sebastian Linnemayr, Jill Luoto, and Glenn Wagner are with the RAND Corporation, Santa Monica, CA. Haijing Huang is with the Pardee RAND Graduate School, Santa Monica. Andrew Kambugu is with Infectious Diseases Institute and Makerere University, Kampala, Uganda. Harsha Thirumurthy is with Department of Health Policy and Management and Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Jessica E. Haberer is with Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, MA. Barbara Mukasa is with Mildmay Uganda, Kampala
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Kassavou A, Sutton S. Reasons for non-adherence to cardiometabolic medications, and acceptability of an interactive voice response intervention in patients with hypertension and type 2 diabetes in primary care: a qualitative study. BMJ Open 2017; 7:e015597. [PMID: 28801402 PMCID: PMC5724082 DOI: 10.1136/bmjopen-2016-015597] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES This study explored the reasons for patients' non-adherence to cardiometabolic medications, and tested the acceptability of the interactive voice response (IVR) as a way to address these reasons, and support patients, between primary care consultations. DESIGN, METHOD, PARTICIPANTS AND SETTING The study included face-to-face interviews with 19 patients with hypertension and/or type 2 diabetes mellitus, selected from primary care databases, and presumed to be non-adherent. Thirteen of these patients pretested elements of the IVR intervention few months later, using a think-aloud protocol. Five practice nurses were interviewed. Data were analysed using multiperspective, and longitudinalthematic analysis. RESULTS Negative beliefs about taking medications, the complexity of prescribed medication regimens, and the limited ability to cope with the underlying affective state, within challenging contexts, were mentioned as important reasons for non-adherence. Nurses reported time constraints to address each patient's different reasons for non-adherence, and limited efficacy to support patients, between primary care consultations. Patients gave positive experiential feedback about the IVR messages as a way to support them take their medicines, and provided recommendations for intervention content and delivery mode. Specifically, they liked the voice delivering the messages and the voice recognition software. For intervention content, they preferred messages that were tailored, and included messages with 'information about health consequences', 'action plans', or simple reminders for performing the behaviour. CONCLUSIONS Patients with hypertension and/or type 2 diabetes, and practice nurses, suggested messages tailored to each patient's reasons for non-adherence. Participants recommended IVR as an acceptable platform to support adherence to cardiometabolic medications between primary care consultations. Future studies could usefully test the acceptability, and feasibility, of tailored IVR interventions to support medication adherence, as an adjunct to primary care.
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Affiliation(s)
- Aikaterini Kassavou
- Behavioural Science Group, Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
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Dobroszycki J, Lee P, Romo DL, Rosenberg MG, Wiznia A, Abadi J. Antiretroviral therapy in HIV-infected adolescents: clinical and pharmacologic challenges. Expert Rev Clin Pharmacol 2017; 10:509-516. [PMID: 28288535 DOI: 10.1080/17512433.2017.1301205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION With the currently available combined antiretroviral therapy regimens, durable suppression of viral replication, preservation of immune function and normalizing life expectancy, are all becoming achievable goals. Teenagers and young adults living with HIV present unique clinical and pharmacologic challenges to optimizing antiretroviral treatment outcomes. Areas covered: In this expert review of the topic, we examine recent clinical trial data and draw on our program's 25 year experience working with both perinatally and behaviorally HIV infected adolescents. Expert commentary: In order to be effective, the antiretrovirals we provide must be combined with multidisciplinary interventions and ongoing socio-behavioral support to ensure treatment adherence and prevent the emergence of viral resistance.
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Affiliation(s)
- Joanna Dobroszycki
- a Jacobi Medical Center, Department of Pediatrics, Division of Infectious Diseases , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Philip Lee
- b Montefiore Medical Center , Department of Pediatrics, Division of Infectious Diseases , Bronx , NY , USA
| | - Dina L Romo
- c Jacobi Medical Center, Department of Pediatrics, Division of Adolescent Medicine , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Michael G Rosenberg
- a Jacobi Medical Center, Department of Pediatrics, Division of Infectious Diseases , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Andrew Wiznia
- d Jacobi Medical Center, Department of Pediatrics, Division of Allergy-Immunology , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Jacobo Abadi
- a Jacobi Medical Center, Department of Pediatrics, Division of Infectious Diseases , Albert Einstein College of Medicine , Bronx , NY , USA
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The Acceptability and Perceived Usefulness of a Weekly Clinical SMS Program to Promote HIV Antiretroviral Medication Adherence in KwaZulu-Natal, South Africa. AIDS Behav 2016; 20:2629-2638. [PMID: 26781866 DOI: 10.1007/s10461-016-1287-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Short message service (SMS) text messages have been used to remind and encourage patients to take ART in research studies. However, few studies have assessed the feasibility and acceptability of SMS in routine clinical practice. We report patient perspectives on a weekly SMS adherence support program after implementation into clinical care at an HIV clinic in KwaZulu-Natal, South Africa. We conducted structured interviews with a cross-sectional convenience sample of 100 adult patients who were invited to join the program, 88 of whom had received a program SMS. Of these respondents, 81 (92 %) would recommend the program to a friend. Sixty-eight (77 %) felt the program helped them remember clinic appointments, a response associated with male gender [odds ratio (OR) 5.88, 95 % confidence interval (CI) 1.52-23.26, P = 0.011] and HIV disclosure outside the home [OR 3.40, 95 %CI 1.00-11.60, P = 0.050]. This clinical SMS adherence program was found to have high patient-perceived usefulness.
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