Phone Texts Fail to Boost Adherence to HIV Therapy

Douala — Mobile phone text messaging does not considerably enhance HIV/AIDS patients' adherence to treatment, a study conducted in Cameroon reveals.

The study, which was published in PLoS ONE last month (6 December), found that the use of weekly motivational text messages did little to increase the number of patients sticking to antiretroviral treatment (ART).

"Our study did not find a significant effect from motivational SMS texts on improving adherence to antiretroviral treatment over a six-month period," says lead author of the study Lawrence Mbuagbaw, researcher at the Yaoundé Central Hospital's Centre for the Development of Best Practices in Health and at Canada's McMaster University.

The findings undermine the case for using mobile phones to help improve healthcare in resource-stricken settings. They also contradict the conclusions of similar studies, such as in South Africa and the Kenyan WelTel trial that endorsed text message reminders as ART adherence boosters.

The trial sought to establish the effectiveness of using mobile phones to improve adherence to ART treatment, which can be undermined by stigma associated with HIV/AIDS and the cost of treatment in resource-constrained Cameroon.

In November and December 2010, the researchers enrolled 200 participants for the study from Cameroon's largest HIV/AIDS accredited treatment centre, which is in the capital, Yaoundé. Participants had to be 21 or older and have been receiving ART for at least one month.

They were randomly split into two groups. Those in the intervention group received weekly motivational texts reminding them to take their medication as well as their usual care, including occasional home visits and ART counselling. Control group subjects were not sent the text message reminders.

Adherence was measured using a visual analogue scale - an instrument that measures a characteristic or attitude across a spectrum from none to extreme and can be used in questionnaires- the number of missed doses and pharmacy prescription refill data.

Most study participants did not adhere to treatment and even those who got message reminders did not have considerably higher adherence rates.

Mbuagbaw says that, although the Kenyan WelTel trial demonstrated the effectiveness of interactive text messaging with add-on counselling, further research is required to determine how motivational content can be delivered by text messagealone.

Stephanie Akiye, an HIV/AIDS motivational speaker, says: "I'm not very surprised about the findings. There's still a lot of stigma and patients want maximum privacy about their status. Imagine the embarrassment if a text reminder comes into a phone left in a public place or is seen by friends and relatives."

Cameroon's Ministry of Public Health says the country had a HIV prevalence rate of 4.3 per cent in 2011 according to a health demographic survey conducted annually and down from 5.5 percent in 2004

"We're providing antiretroviral drugs to 120,000 patients and intend on increasing coverage to 150,000 next year. Such trials help us determine how to best boost treatment reliability," says public health minister Andre Mama Fouda.

This article has been produced by SciDev.Net's Sub-Saharan Africa desk.

Link to full study

References

PLoS ONE 7(12): e46909. doi:10.1371/journal.pone.0046909