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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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Huang H, Xu Z, Ge Q, Zhou X, Zou M, Qin G, Cao Y, Duan X, Chu M, Zhuang X. The Impact of Customized Short Message Service on High-Risk Behaviors Among MSM in China, a Randomized Controlled Trial Study. AIDS Behav 2023:10.1007/s10461-023-03995-4. [PMID: 36705771 PMCID: PMC9880942 DOI: 10.1007/s10461-023-03995-4] [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] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
An individual based randomized controlled trial (RCT) was designed to evaluate the impact of a customized short message service (SMS) intervention on HIV-related high-risk behaviors among Men who have sex with men (MSM). In total, 631 HIV-negative MSM were enrolled at baseline and divided into intervention and control groups randomly. Nine months later, the intervention group who received additional customized SMS intervention reported significantly lower rates of multiple partners, unclear partner infection status and condomless anal intercourse compared to the control group who received the routine intervention only. Six months post stopping the SMS intervention, the rates of unclear partner infection status and condomless anal intercourse still remained lower report in the intervention group. Our study shown that the customized SMS interventions can significantly reduce the HIV-related high-risk behaviors among MSM and with sustained effects over a period of time.
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Affiliation(s)
- Hao Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Zhengcheng Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Qiwei Ge
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Xiaoyi Zhou
- Nantong Center for Disease Control and Prevention, Nantong, Jiangsu China
| | - Meiyin Zou
- Department of Infectious Diseases, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu China
| | - Gang Qin
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Yuxin Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Xiaoyang Duan
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Minjie Chu
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
| | - Xun Zhuang
- Department of Epidemiology and Health Statistics, School of Public Health, Nantong University, Nantong, Jiangsu China
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Bressan T, Valdivia-Gago A, Silvera-Ccallo RM, Llanos-Cuentas A, Condor DF, Padilla-Huamantinco PG, Vilcarromero S, Miranda JJ, Zavaleta-Cortijo C. Challenges of design, implementation, acceptability, and potential for, biomedical technologies in the Peruvian Amazon. Int J Equity Health 2022; 21:183. [PMID: 36536404 PMCID: PMC9762865 DOI: 10.1186/s12939-022-01773-7] [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: 06/22/2022] [Accepted: 10/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Biomedical technologies have the potential to be advantageous in remote communities. However, information about barriers faced by users of technology in general and in remote Indigenous communities is scarce. The purpose of this study was to characterize the leading challenges faced by researchers who have used biomedical technologies in the Peruvian Amazon. METHODS This exploratory, qualitative study with a phenomenological approach depicts the lived experience of participants who were researchers with experience working with biomedical technologies in the Peruvian Amazon in the past five years. Analysis was based on three core themes: design, implementation, and acceptability. Sub-themes included environment, community, and culture. Of the 24 potential participants identified and contacted, 14 agreed to participate, and 13 met inclusion criteria and completed semi-structured interviews. Results were sent to each participant with the opportunity to provide feedback and partake in a 30-minute validation meeting. Five participants consented to a follow-up meeting to validate the results and provide further understanding. RESULTS Participants recognized significant challenges, including technologies designed out-of-context, difficulty transporting the technologies through the Amazon, the impact of the physical environment (e.g., humidity, flooding), and limited existing infrastructure, such as electricity and appropriately trained health personnel. Participants also identified cultural factors, including the need to address past experiences with technology and health interventions, understand and appropriately communicate community benefits, and understand the effect of demographics (e.g., age, education) on the acceptance and uptake of technology. Complementary challenges, such as corruption in authority and waste disposal, and recommendations for technological and health interventions such as co-design were also identified. CONCLUSIONS This study proposes that technological and health interventions without efforts to respect local cultures and health priorities, or understand and anticipate contextual challenges, will not meet its goal of improving access to healthcare in remote Amazon communities. Furthermore, the implications of corruption on health services, and improper waste disposal on the environment may lead to more detrimental health inequities.
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Affiliation(s)
- Tiana Bressan
- grid.34429.380000 0004 1936 8198School of Engineering, University of Guelph, 50 Stone Rd E, Guelph, ON N1G 2W1 Canada
| | - Andrea Valdivia-Gago
- grid.11100.310000 0001 0673 9488Escuela de Nutrición, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102
| | - Rosa M. Silvera-Ccallo
- grid.11100.310000 0001 0673 9488Unidad de Ciudadania Intercultural y Salud Indigena, Facultad de Salud Publica y Administracion, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102
| | - Alejandro Llanos-Cuentas
- grid.11100.310000 0001 0673 9488Unidad de Ciudadania Intercultural y Salud Indigena, Facultad de Salud Publica y Administracion, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.11100.310000 0001 0673 9488Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru Av. Honorio Delgado 430, 15102
| | - Daniel F. Condor
- grid.11100.310000 0001 0673 9488School of Nursing, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.11100.310000 0001 0673 9488Biomedical Informatics in Global Health Unit, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.11100.310000 0001 0673 9488 CuidART-e Research Group, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102
| | - Pierre G. Padilla-Huamantinco
- grid.11100.310000 0001 0673 9488Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru Av. Honorio Delgado 430, 15102 ,Health Innovation Lab, Institute of Tropical Medicine Alexander von Humboldt, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.7870.80000 0001 2157 0406Institute for Biological and Medical Engineering, Schools of Engineering, Medicine, and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile Av Vicuña Mackenna 4860,
| | - Stalin Vilcarromero
- grid.420173.30000 0000 9677 5193Hospital Nacional Edgardo Rebagliati Martins (HNERM), EsSalud, Lima, Peru Av. Edgardo Rebagliati 490, 15072
| | - J. Jaime Miranda
- grid.11100.310000 0001 0673 9488CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.11100.310000 0001 0673 9488 School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.1005.40000 0004 4902 0432The George Institute for Global Health, UNSW, Sydney, Australia
| | - Carol Zavaleta-Cortijo
- grid.11100.310000 0001 0673 9488Unidad de Ciudadania Intercultural y Salud Indigena, Facultad de Salud Publica y Administracion, Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102 ,grid.11100.310000 0001 0673 9488Unidad de Ciudadanía Intercultural y Salud Indígena (UCISI), Universidad Peruana Cayetano Heredia, Lima, Peru Av. Honorio Delgado 430, 15102
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Dhinagaran DA, Martinengo L, Ho MHR, Joty S, Kowatsch T, Atun R, Tudor Car L. Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework. JMIR Mhealth Uhealth 2022; 10:e38740. [PMID: 36194462 PMCID: PMC9579935 DOI: 10.2196/38740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/02/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Conversational agents (CAs), also known as chatbots, are computer programs that simulate human conversations by using predetermined rule-based responses or artificial intelligence algorithms. They are increasingly used in health care, particularly via smartphones. There is, at present, no conceptual framework guiding the development of smartphone-based, rule-based CAs in health care. To fill this gap, we propose structured and tailored guidance for their design, development, evaluation, and implementation. OBJECTIVE The aim of this study was to develop a conceptual framework for the design, evaluation, and implementation of smartphone-delivered, rule-based, goal-oriented, and text-based CAs for health care. METHODS We followed the approach by Jabareen, which was based on the grounded theory method, to develop this conceptual framework. We performed 2 literature reviews focusing on health care CAs and conceptual frameworks for the development of mobile health interventions. We identified, named, categorized, integrated, and synthesized the information retrieved from the literature reviews to develop the conceptual framework. We then applied this framework by developing a CA and testing it in a feasibility study. RESULTS The Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER) conceptual framework includes 8 iterative steps grouped into 3 stages, as follows: design, comprising defining the goal, creating an identity, assembling the team, and selecting the delivery interface; development, including developing the content and building the conversation flow; and the evaluation and implementation of the CA. They were complemented by 2 cross-cutting considerations-user-centered design and privacy and security-that were relevant at all stages. This conceptual framework was successfully applied in the development of a CA to support lifestyle changes and prevent type 2 diabetes. CONCLUSIONS Drawing on published evidence, the DISCOVER conceptual framework provides a step-by-step guide for developing rule-based, smartphone-delivered CAs. Further evaluation of this framework in diverse health care areas and settings and for a variety of users is needed to demonstrate its validity. Future research should aim to explore the use of CAs to deliver health care interventions, including behavior change and potential privacy and safety concerns.
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Affiliation(s)
| | - Laura Martinengo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Moon-Ho Ringo Ho
- School of Social Sciences, Nanyang Technological University Singapore, Singapore, Singapore
| | - Shafiq Joty
- School of Computer Sciences and Engineering, Nanyang Technological University Singapore, Singapore, Singapore
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St Gallen, St Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Rifat Atun
- Department of Global Health & Population, Department of Health Policy & Management, Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Cambridge, MA, United States
- Health Systems Innovation Lab, Harvard TH Chan School of Public Health, Harvard University, Cambridge, MA, United States
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Hyuha GM, Sawe HR, Kilindimo S, Mussa RY, Gulamhussein MA, Rwegoshora SS, Shayo F, Mdundo W, Mfinanga JA, Weber EJ. Feasibility and efficacy of text messaging to promote care among trauma patients screened for HIV at an urban emergency department in Tanzania. Int J Emerg Med 2021; 14:72. [PMID: 34906068 PMCID: PMC8903523 DOI: 10.1186/s12245-021-00395-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the high prevalence of human immunodeficiency virus (HIV) in Tanzania, provider-initiated HIV testing for patients attending any health care setting is recommended. However, follow-up and linkage to care by those tested remain poor. We determined the feasibility and efficacy of text messaging to promote follow-up among otherwise healthy trauma patients who underwent provider-initiated HIV testing and counseling at an emergency department (ED) in Tanzania. MATERIAL AND METHODS This randomized controlled trial (RCT) was conducted at Muhimbili National Hospital (MNH) ED between September 2019 and February 2020. Adult trauma patients consenting to HIV testing and follow-up text messaging were randomized to standard care (pre-test and post-test counseling) or standard care plus a series of three short message service (SMS) text message reminders for follow-up in an HIV clinic, if positive, or for retesting, if negative. Investigators blinded to the study assignment called participants 2 months after the ED visit if HIV-positive or 4 months if HIV-negative. We compared the proportion of people in the intervention and control groups completing recommended follow-up. Secondary outcomes were the proportion of patients agreeing to testing, proportion of patients agreeing to receiving text messages, and the proportion of HIV-positive and HIV-negative patients in each study arm who followed up. RESULTS Of the 290 patients approached, 255 (87.9%) opted-in for testing and agreed to receive a text message. The median age of the study population was 29 [IQR 24-40] years. There were 127 patients randomized to the intervention group and 128 to the control group. The automated SMS system verified that 381 text messages in total were successfully sent. We traced 242 (94.9%) participants: 124 (51.2%) in the intervention group and 18 (488%) in the control group. A total of 100 (39.2%) subjects reported completing a follow-up visit, of which 77 (60.6%) were from the intervention group and 23 (17.9%) were from the control group (RR = 3.4, 95% CI 2.3-5.0). This resulted in a number needed to treat (NNT) of 2.3. Of the 246 HIV-negative participants, 37% underwent repeat screening: 59% of those in the intervention group and 16% in the control group (RR = 3.7, P = < 0.0001, NNT 2.3). Among the nine positive patients, all five in the intervention group and only three in the controls had follow-up visits. CONCLUSION Automated text message is a feasible and effective way to increase follow-up in HIV-tested individuals in a limited income country.
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Affiliation(s)
- Gimbo M Hyuha
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania. .,Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
| | - Said Kilindimo
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.,Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Raya Y Mussa
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Masuma A Gulamhussein
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Shamila S Rwegoshora
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Frida Shayo
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Winnie Mdundo
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Juma A Mfinanga
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.,Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Ellen J Weber
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.,Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA
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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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Reback CJ, Fletcher JB, Fehrenbacher AE, Kisler K. Text Messaging to Improve Linkage, Retention, and Health Outcomes Among HIV-Positive Young Transgender Women: Protocol for a Randomized Controlled Trial (Text Me, Girl!). JMIR Res Protoc 2019; 8:e12837. [PMID: 31359867 PMCID: PMC6690158 DOI: 10.2196/12837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 05/26/2019] [Accepted: 06/28/2019] [Indexed: 12/25/2022] Open
Abstract
Background Transgender women in the United States experience numerous risk factors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, sex work, and nonprescribed hormone and soft tissue–filler injections. In addition, transgender women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically with young transgender women aged 35 years and younger, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older transgender women and nontransgender young adult counterparts. Young transgender women living with HIV experience a range of barriers that challenge their ability to be successfully linked and retained in HIV care. Objective The aim of this randomized controlled trial, Text Me, Girl!, is to assess the impact of a 90-day, theory-based, transgender-specific, text-messaging intervention designed to improve HIV-related health outcomes along the HIV care continuum among young (aged 18-34 years) transgender women (N=130) living with HIV/AIDS. Methods Participants were randomized into either Group A (immediate text message intervention delivery; n=61) or Group B (delayed text message intervention delivery whereby participants were delivered the text-messaging intervention after a 90-day delay period; n=69). Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized specifically for young transgender women living with HIV. Participants received 3 messages per day in real time within a 10-hour gradual and automated delivery system. The text-message content was scripted along the HIV care continuum and based on social support theory, social cognitive theory, and health belief model. The desired outcome of Text Me, Girl! was virological suppression. Results Recruitment began on November 18, 2016, and the first participant was enrolled on December 16, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations will conclude on August 31, 2019. Primary outcome analyses will begin immediately following the conclusion of the follow-up evaluations. Conclusions Text messaging is a communication platform well suited for engaging young transgender women in HIV care because it is easily accessible and widely used, as well as private, portable, and inexpensive. Text Me, Girl! aimed to improve HIV care continuum outcomes among young transgender women by providing culturally responsive text messages to promote linkage, retention, and adherence, with the ultimate goal of achieving viral suppression. The Text Me, Girl! text message library is readily scalable and can be adapted for other hard-to-reach populations. International Registered Report Identifier (IRRID) DERR1-10.2196/12837
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Affiliation(s)
- Cathy J Reback
- Friends Research Institute, Inc, Los Angeles, CA, United States
| | | | - Anne E Fehrenbacher
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kimberly Kisler
- Friends Research Institute, Inc, Los Angeles, CA, United States
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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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Yoon S, Kim HYS, Kim J, Kim S, Seo KY, Kim SY. A current status of teleophthalmology in low- and middle-income countries: literature review. ACTA ACUST UNITED AC 2019. [DOI: 10.35500/jghs.2019.1.e41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sangchul Yoon
- Department of Global Health, Graduate School of Public Health, Yonsei University, Seoul, Korea
- Department of Ophthalmology, College of Medicine, Yonsei University, Seoul, Korea
| | | | - Jaewon Kim
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Sohyun Kim
- Division of Pacific Technical Support, World Health Organization, Nandi, Fiji
| | - Kyoung Yul Seo
- Department of Ophthalmology, College of Medicine, Yonsei University, Seoul, Korea
| | - So Yoon Kim
- Department of Health Law and Ethics, College of Medicine, Yonsei University, Seoul, Korea
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10
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Bayona E, Menacho L, Segura ER, Mburu G, Roman F, Tristan C, Bromley E, Cabello R. The Experiences of Newly Diagnosed Men Who Have Sex with Men Entering the HIV Care Cascade in Lima, Peru, 2015-2016: A Qualitative Analysis of Counselor-Participant Text Message Exchanges. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2018. [PMID: 28622034 DOI: 10.1089/cyber.2016.0435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mobile phone technology (mHealth) is a promising tool that has been used to improve HIV care in high-risk populations worldwide. Understanding patient perspectives of newly diagnosed men who have sex with men (MSM) in Lima, Peru during linkage and engagement in the HIV care continuum can help close the gaps in care following initial HIV diagnosis and ensure retention in continuous care. From June 2015 to March 2016, as part of a randomized controlled trial, 40 MSM participants were linked to care with an mHealth intervention within 3 months of HIV diagnosis at Via Libre clinic. For 12 weeks, participants agreed to receive weekly predetermined, standardized short message service (SMS), WhatsApp©, and/or Facebook© messages from an assigned HIV counselor. Text messaging was bi-directional, meaning participants could also send messages to their counselor at any time. In this qualitative study, we coded and thematically analyzed 947 SMS, 918 WhatsApp, and 2,694 Facebook bi-directional messages. Mean age of participants was 29.8 years (20-50); with 70 percent reporting some post-high school education and 73 percent self-identifying as homosexual. We identified six recurring themes that emerged from the data: (a) mental health symptoms; (b) coping behaviors; (c) interpersonal support; (d) physical symptoms; (e) HIV knowledge; and (f) care coordination. Participants sent text messages describing depressive symptoms and seeking mental health services during this initial stage of HIV care. For newly diagnosed MSM entering the HIV care continuum, a bi-directional mHealth intervention provided support to facilitate care while eliciting deeply personal mental and emotional states. Future interventions could benefit from using mHealth interventions as ancillary support for clinicians.
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Affiliation(s)
- Erik Bayona
- 1 David Geffen School of Medicine, University of California , Los Angeles, California
| | | | - Eddy R Segura
- 1 David Geffen School of Medicine, University of California , Los Angeles, California.,3 Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas , Lima, Peru
| | - Gitau Mburu
- 4 International HIV/AIDS Alliance , Hove, United Kingdom
| | | | | | - Elizabeth Bromley
- 1 David Geffen School of Medicine, University of California , Los Angeles, California
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11
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Health information technologies for sexual and reproductive health: Mapping the evidence in Latin America and the Caribbean. J Public Health Policy 2017; 37:213-231. [PMID: 27899796 DOI: 10.1057/s41271-016-0014-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In Latin America and the Caribbean (LAC), the sexual and reproductive health (SRH) of populations is a high priority for governments. Health information technologies (HITs) have been proposed as tools to close access gaps for SRH services. We developed an "evidence map" through a systematic search of articles published between 2005 and 2015 about the use of HITs to enhance SRH services in LAC countries. Two hundred and thirty-two registries were identified and screened. Thirty-one were eligible for full-text assessment. Most of the documents retrieved correspond to information provided by technology developers, targeting primarily the prevention of sexually transmitted infections and adolescent health. Although there has been clear progress in the use of HITs for SRH in the region, many institutional and technological challenges persist. Further studies should be carried out to test the beneficial effects of HITs on improving access to SRH services.
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Wandell GM, Molina Y, Sánchez H, Greer AC, Ríos J, Bain C, Segura P, Lama JR, Sánchez J, Duerr A. Knowledge and preferences concerning acute HIV testing programs among both Peruvian men who have sex with men and transgender women. Int J STD AIDS 2017; 28:1010-1017. [PMID: 28056724 DOI: 10.1177/0956462416685674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Immediate antiretroviral therapy (ART) for acute HIV infection (AHI) may decrease HIV transmission in high-risk populations. This study evaluated knowledge of AHI and AHI testing program preferences in Lima, Peru through four semi-structured focus groups with high-risk men who have sex with men (MSM) ( n = 20) and transgender women (TW) ( n = 16). Using content analysis, emergent themes included knowledge of AHI symptoms, AHI transmission potential, and the HIV testing window period, and preferences concerning point of care results. Participants demonstrated low familiarity with the term AHI, but many correctly identified AHI symptoms. However, these symptoms may not motivate testing because they overlap with common viral illnesses and AIDS. Some were aware that infectiousness is highest during AHI, and believe this knowledge would facilitate HIV testing. The shortened window period with AHI testing would encourage testing following high-risk sex. Delayed result notification would not decrease AHI testing demand among MSM, although it might for some TW.
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Affiliation(s)
- Grace M Wandell
- 1 University of Washington School of Medicine, Seattle, WA, USA
| | - Yamile Molina
- 2 School of Public Health, University of Illinois, Chicago, IL, USA
| | | | - Anna C Greer
- 1 University of Washington School of Medicine, Seattle, WA, USA
| | - Jessica Ríos
- 4 Asociación Civil Impacta Salud y Educación, Lima, Perú
| | - Carolyn Bain
- 5 Vaccine and Infectious Disease & Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Javier R Lama
- 4 Asociación Civil Impacta Salud y Educación, Lima, Perú.,6 Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
| | - Jorge Sánchez
- 4 Asociación Civil Impacta Salud y Educación, Lima, Perú.,6 Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
| | - Ann Duerr
- 5 Vaccine and Infectious Disease & Public Health Science Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,6 Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
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Mayer JE, Fontelo P. Meta-analysis on the effect of text message reminders for HIV-related compliance. AIDS Care 2016; 29:409-417. [PMID: 27477580 DOI: 10.1080/09540121.2016.1214674] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
For the treatment of HIV, compliance in regard to appointment attendance and medication usage is critical. Various methods have been attempted to increased HIV care compliance, and a method that has inspired many published studies is text message reminders. We conducted a meta-analysis of the literature from inception through May 2016 using the following databases: Pubmed, Embase, CINAHL, Web of Science, and Cochrane. Examples of terms used in the search included exploded versions of "HIV, "AIDS", "cell phone", "SMS", "text message", "reminder". After abstract and manuscript review, articles were discussed with co-author and included based on consensus. We excluded qualitative analyses, observational studies without an intervention, and studies without a control or pre-intervention group. We used random-effects models to calculate odds ratios (OR) and standardized mean differences (SMDs) for the text message intervention. Thirty-four unique studies were found and included in the meta-analysis. For the seven articles relating to non-attendance, text message reminders significantly reduced the rates of non-attendance (OR, 0.66; 95% CI, 0.48-0.92; P = .01; I2 = 52%). For the 20 articles on drug adherence, text message reminders significantly increased adherence (SMD, 0.87; 95% CI, 0.06-1.68; P = .04; I2 = 99%). For the 11 articles with physiologic measures (CD4 count or viral load), text message reminders led to significant improvement (SMD, 1.53; 95% CI, 0.52-2.55; P = .003; I2 = 99%). This meta-analysis reveals that text message reminders are a promising intervention that can be used to increase HIV care compliance when logistically feasible. Further study should focus on which populations benefit the most from this intervention, and successful implementers could create an established technological infrastructure for other clinics to adopt when seeking to boost compliance.
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Affiliation(s)
- Jonathan E Mayer
- a Department of Medicine , Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Paul Fontelo
- b National Library of Medicine , Lister Hill National Center for Biomedical Communications, National Institutes of Health , Bethesda , MD , USA
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14
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Conserve DF, Jennings L, Aguiar C, Shin G, Handler L, Maman S. Systematic review of mobile health behavioural interventions to improve uptake of HIV testing for vulnerable and key populations. J Telemed Telecare 2016; 23:347-359. [PMID: 27056905 DOI: 10.1177/1357633x16639186] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction This systematic narrative review examined the empirical evidence on the effectiveness of mobile health (mHealth) behavioural interventions designed to increase the uptake of HIV testing among vulnerable and key populations. Methods MEDLINE/PubMed, Embase, Web of Science, and Global Health electronic databases were searched. Studies were eligible for inclusion if they were published between 2005 and 2015, evaluated an mHealth intervention, and reported an outcome relating to HIV testing. We also reviewed the bibliographies of retrieved studies for other relevant citations. The methodological rigor of selected articles was assessed, and narrative analyses were used to synthesize findings from mixed methodologies. Results A total of seven articles met the inclusion criteria. Most mHealth interventions employed a text-messaging feature and were conducted in middle- and high-income countries. The methodological rigor was moderate among studies. The current literature suggests that mHealth interventions can have significant positive effects on HIV testing initiation among vulnerable and key populations, as well as the general public. In some cases, null results were observed. Qualitative themes relating to the use of mobile technologies to increase HIV testing included the benefits of having low-cost, confidential, and motivational communication. Reported barriers included cellular network restrictions, poor linkages with physical testing services, and limited knowledge of appropriate text-messaging dose. Discussion MHealth interventions may prove beneficial in reducing the proportion of undiagnosed persons living with HIV, particularly among vulnerable and key populations. However, more rigorous and tailored interventions are needed to assess the effectiveness of widespread use.
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Affiliation(s)
- Donaldson F Conserve
- 1 Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Larissa Jennings
- 2 Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Carolina Aguiar
- 3 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Grace Shin
- 1 Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Lara Handler
- 4 Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Suzanne Maman
- 1 Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Devi BR, Syed-Abdul S, Kumar A, Iqbal U, Nguyen PA, Li YCJ, Jian WS. mHealth: An updated systematic review with a focus on HIV/AIDS and tuberculosis long term management using mobile phones. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 122:257-265. [PMID: 26304621 DOI: 10.1016/j.cmpb.2015.08.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/25/2015] [Accepted: 08/03/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the utilization of mobile phone technology for treatment adherence, prevention, education, data collection, monitoring long-term management of HIV/AIDS and TB patients. METHODS Articles published in English language from January 2005 until now from PubMed/MEDLINE, EMBASE, Web of Science, WHO databases, and clinical trials were included. Data extraction is based on medication adherence, quality of care, prevention, education, motivation for HIV test, data collection from HIV lab test results and patient monitoring. Articles selected for the analysis cover RCTs and non RCTs related to the use of mobile phones for long-term care and treatment of HIV/AIDS and TB patients. RESULTS Out of 90 articles selected for the analysis, a large number of studies, 44 (49%) were conducted in developing countries, 24 (26%) studies from developed countries, 12 (13%) are systematic reviews and 10 (11%) did not mention study location. Forty seven (52.2%) articles focused on treatment, 11 (12.2%) on quality of care, 8 (9%) on prevention, 13 (14.4%) on education, 6 (6.6%) on data collection, and 5 (5.5%) on patient monitoring. Overall, 66 (73%) articles reported positive effects, 21 (23%) were neutral and 3 (4%) reported negative results. CONCLUSIONS Mobile phone technology is widely reported to be an effective tool for HIV/AIDS and TB long-term care. It can substantially reduce disease burden on health care systems by rendering more efficient prevention, treatment, education, data collection and management support.
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Affiliation(s)
- Balla Rama Devi
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Shabbir Syed-Abdul
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Arun Kumar
- Department of Pharmacy Practice, ISF College of Pharmacy, India
| | - Usman Iqbal
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Phung-Anh Nguyen
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan; Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan
| | - Wen-Shan Jian
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan; Faculty of Health Sciences, Macau University of Science and Technology, Macau, China.
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16
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Tang EC, Segura ER, Clark JL, Sanchez J, Lama JR. The syphilis care cascade: tracking the course of care after screening positive among men and transgender women who have sex with men in Lima, Peru. BMJ Open 2015; 5:e008552. [PMID: 26384725 PMCID: PMC4577872 DOI: 10.1136/bmjopen-2015-008552] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Syphilis is endemic among men who have sex with men (MSM) and transgender women in Latin America. The objective of this study was to assess if those who screen positive for syphilis are receiving appropriate care and treatment. METHODS We use data from the 2011 Peruvian National HIV Sentinel Surveillance to describe the syphilis care cascade among high-risk MSM and transgender women. Medical records from participants who had a positive syphilis screening test at two of the enrolment sites in Lima were reviewed to determine their subsequent course of care. RESULTS We identified a cohort of 314 syphilis seropositive participants (median age: 30, 33.7% self-identified as transgender). Only 284/314 (90.4%) participants saw a physician for evaluation within 28 days of their positive test. Of these, 72/284 (25.4%) were asked to return for confirmatory results before deciding whether or not to start treatment; however, 45/72 (62.5%) of these participants did not follow up within 28 days. Of the people prescribed three weekly doses of penicillin, 34/63 (54%) received all three doses on time. CONCLUSIONS Many MSM and transgender women with a positive syphilis screening test are lost at various steps along the syphilis care cascade and may have persistent infection. Interventions in this population are needed to increase testing, link seropositive patients into care and ensure that they receive appropriate and timely treatment.
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Affiliation(s)
- Eric C Tang
- Department of Medicine/Division of Infectious Diseases, UCLA Geffen School of Medicine, Los Angeles, California, USA
| | - Eddy R Segura
- Department of Medicine/Division of Infectious Diseases, UCLA Geffen School of Medicine, Los Angeles, California, USA
| | - Jesse L Clark
- Department of Medicine/Division of Infectious Diseases, UCLA Geffen School of Medicine, Los Angeles, California, USA
| | - Jorge Sanchez
- Asociación Civil Impacta Salud y Educación, Lima, Peru
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Exposure to Theory-Driven Text Messages is Associated with HIV Risk Reduction Among Methamphetamine-Using Men Who have Sex with Men. AIDS Behav 2015; 19 Suppl 2:130-41. [PMID: 25563501 DOI: 10.1007/s10461-014-0985-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Fifty-two non-treatment-seeking methamphetamine-using men who have sex with men were enrolled in Project Tech Support, an open-label pilot study to evaluate whether exposure to theory-based [social support theory (SST), social cognitive theory (SCT), and health belief model (HBM)] text messages could promote reductions in HIV sexual risk behaviors and/or methamphetamine use. Multivariable analyses revealed that increased relative exposure to HBM or SCT (vs. SST) text messages was associated with significant reductions in the number of HIV serodiscordant unprotected (i.e., without a condom) anal sex partners, engagement in sex for money and/or drugs, and frequency of recent methamphetamine use; additionally, increased relative exposure to HBM (vs. SCT or SST) messages was uniquely associated with reductions in the overall number of non-primary anal sex partners (all p ≤ 0.05, two-tailed). Pilot data demonstrated that text messages based on the principles of HBM and SCT reduced sentinel HIV risk and drug use behaviors in active methamphetamine users.
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Anderson N, Morrison C, Griffin J, Reiter W, Baldwin LM, Edwards K. Governance strategies for conducting text messaging interventions in clinical research. Clin Transl Sci 2014; 7:127-31. [PMID: 24774328 DOI: 10.1111/cts.12156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
There is increasing interest in medical text messaging interventions being used to achieve positive patient outcomes across a range of clinical research and health practice environments. Short messaging service (SMS) is a low-cost tool that provides an easy communication route to engage potentially broad populations through text messaging, and is part of the growing social trend toward increased adoption of personal communication technologies by patient populations. Testing the effectiveness and impact of various communication strategies requires navigation of a complex web of clinical and research regulations and oversight mechanisms. We describe a case study of the implementation of SMS to provide bidirectional communications between physicians and patients involved in routine care reminders to illustrate the review processes and governance structures needed. By mapping the regulatory and approval processes required to manage and steward a research study across clinical and community boundaries, we provide a guide for other translational health researchers who may utilize similar kinds of personally owned technology interventions as research tools.
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Affiliation(s)
- Nicholas Anderson
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California, USA
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Innovative uses of communication technology for HIV programming for men who have sex with men and transgender persons. J Int AIDS Soc 2014; 17:19041. [PMID: 25280864 PMCID: PMC4185130 DOI: 10.7448/ias.17.1.19041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/05/2014] [Accepted: 09/02/2014] [Indexed: 12/01/2022] Open
Abstract
Globally, overall rates of HIV are on the decline; however, rates among gay men and other men who have sex with men (MSM) and transgender persons are increasing. Meanwhile, there has been exponential growth in access to communication technology over the last decade. More innovative prevention and care technology-based programmes are needed to help address the growing numbers of MSM and transgender persons living with HIV and those at risk for infection. To address this need, a meeting was hosted by the U.S. Agency for International Development (USAID) through the President's Emergency Plan for AIDS Relief (PEPFAR) and co-sponsored by amfAR, The Foundation for AIDS Research and the National Institute of Mental Health (NIMH). The meeting brought together researchers, community implementers, advocates and federal partners to discuss the current landscape of technology-based interventions for MSM and transgender persons and to discuss key considerations. Presentations and discussions focused on the research gaps, facilitators and barriers to programme implementation and public–private partnerships. This article summarizes the meeting proceedings and outlines key considerations for future work in this area.
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