MobileActive.org

[Adapted from Abstract]

This paper presents a year long study protocol for a trial, to evaluate the influence of mobile phone reminders on adherence to first-line antiretroviral treatment in South India (Chennai and Bangalore).

Researchers plan to enroll 600 treatment naïve patients for first-line treatment as per the national antiretroviral treatment guidelines at two clinics in South India. Patients will be randomized into control and intervention arms. The control arm will receive the standard of care; the intervention arm will receive the standard of care plus mobile phone reminders.

Each reminder will take the form of an automated call and a picture message. Reminders will be delivered once a week, at a time chosen by the patient. Patients will be followed up for 24 months or till the primary outcome i.e. virological failure, is reached, whichever is earlier.
Self-reported adherence is a secondary outcome. Analysis is by intention-to-treat. A cost-effectiveness study of the intervention will also be carried out.

A step-by-step outline of designing a 24-month long trial to determine effectiveness of phone reminders for anti-retroviral adherence.

The opportunities in South Africa for using mobile technologies to support initiatives in the HIV/AIDS sector are enormous. A huge number of people have cellphone access, and there are a range of innovative ways in which cellphones can be used to support treatment, disseminate information, provide anonymous counselling, gather data and link patients to services.

Cell-Life is an NGO based in Cape Town, South Africa, that seeks to improve the lives of people infected and affected by HIV through the appropriate use of technology.

This paper describes three pilot interventions that use cellphones for behaviour change communication; i.e. that are experimenting with different cellphone technologies to disseminate information, undertaken as part of Cell-Life’s Cellphones4HIV project: ARV adherence SMSs, USSD content delivery and content delivery via MXit. Challenges around measuring impact in behaviour change communications are briefly discussed, and some of Cell-Life’s upcoming initiatives are outlined.

As Kaplan points out in his 2006 literature review of the subject, “There is almost no literature on using mobile telephones as a healthcare intervention for HIV, TB, malaria, and chronic conditions in developing countries”. Although the initiatives discussed in this paper are very much in their infancy, we hope that by sharing our ideas and approaches with others in the field we will generate discussion around some of the practicalities of mHealth.