Mobile health technologies (mHealth) for promoting adherence to antiretroviral therapy: a systematic review Butler LM,1 Horvath T,1 Baggaley RC, 2 SutharAB,2 Negussie EK,2 Rutherford GW1 1. Global Health Sciences, AIDS Research Institute and Cochrane HIV/AIDS Group, University of California, San Francisco, San Francisco, California, USA 2. Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
Background
With the dramatic scale-up of antiretroviral therapy (ART) provision in resource-limited settings, identification of effective strategies for optimizing ART adherence and retention in HIV care is a priority. Use of mHealth technologies offers a promising way to support patient engagement, adherence and retention in care. A 2012 Cochrane review found high-quality evidence that weekly text messages improved adherence and suppressed viral load. To inform World Health Organization guidelines on health services delivery, we expanded the review's inclusion criteria to include voice messaging, pagers, and other mHealth approaches.
Methods We used a comprehensive strategy to identify all studies published between 1996-2012, including PubMed, EMBASE, Cochrane Central Register, and other key databases. Randomized controlled trials (RCTs) and observational studies with comparators were eligible for inclusion. Outcomes included adherence, virologic suppression, morbidity, and mortality. Cochrane screening, selection, abstraction and analysis methods were used. Evidence quality for each outcome was assessed using GRADE methodology.
Results
GRADE evidence profile for key outcomes. Effect estimates are for non-event.
Conclusions mHealth strategies show promise in improving ART adherence and viral suppression, though results are inconsistent. Rigorous research of mHealth adherence interventions is still needed, including cost-effectiveness, identification of populations that stand to benefit the most, ideal message frequency during chronic care, and culturally acceptable message content. Further, there is a need for evaluation of mHealth implementation, including how to best integrate mHealth strategies into clinic- and community-based health care, public-private partnerships, and use of combination of mHealth and other adherence interventions in routine care settings. Contact: Lisa M. Butler, PhD, MPH
[email protected]
We identified 453 references, examined full texts of 29 references, and selected nine studies. Six RCTs and two observational studies included mobile phone textmessaging. One small RCT included pager messaging. Countries included Brazil, Cameroon, Guatemala, Italy, Kenya, Peru and the US. There is high quality evidence that brief, weekly mobile phone text messages improve adherence and viral suppression. Although there is high quality evidence that daily text messages show no effect on adherence, there is also moderate quality evidence that daily messages improve viral suppression. There is very low to moderate quality evidence of improved adherence with messages at other intervals. There is very low quality evidence that pager messages several times daily improved adherence. Bibliography (RCTs): 1. “Cell-POS.” Curioso W et al at Universidad Peruana Cayetano Heredia. “Evaluation of a ComputerBased System Using Cell Phones for HIV-Infected People in Peru.” ClinicalTrials.gov # NCT01118767 [Personal communication] 2. da Costa TM, Barbosa BJ, E Costa DA, Sigulem D, de Fatima Marin H, Filho AC, et al. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform. 2012 Apr;81(4):257-69. 3. Ikeda JM, Barrios R, Lopez-Lopez JB, Hearst N. SMS messaging improves treatment outcome among the HIV-positive Mayan population in rural Guatemala. In: XIX International AIDS Conference, Washington, 22-27 July 2012, #TUPE673 (Poster). [also: personal communication with J. Ikeda] 4. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet 2010 Nov 27;376(9755):1838-45. 5. Mbuagbaw L, Thabane L, Ongolo-Zogo P, et al. The Cameroon Mobile Phone SMS (CAMPS) trial: a randomized trial of text messaging versus usual care for adherence to antiretroviral therapy. PLoS One. 2012;7(12):e46909. 6. Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, de Walque D, et al. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011;25(6):825-34.
