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SMSaude: Evaluating Mobile Phone Text Reminders to Improve Retention in HIV Care for Patients on Antiretroviral Therapy in Mozambique
Ark, Maputo, Mozambique; †Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
Örebro University, Orebro University School of Business, Örebro University, Sweden. Department of Mathematics and Informatics, Eduardo Mondlane University, Maputo, Mozambique.ORCID iD: 0000-0001-8933-2906
Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique.
Ark, Maputo, Mozambique.
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2016 (English)In: Journal of Acquired Immune Deficiency Syndromes, ISSN 1525-4135, E-ISSN 1944-7884, Vol. 73, no 2, E23-E30 p.Article in journal (Refereed) Published
Abstract [en]

Objective: We evaluated whether regular mobile phone text reminders improved patients' retention in antiretroviral therapy (ART) care in Mozambique.

Design: SMSaude was a randomized control trial of HIV-infected patients on ART who received regular text message reminder vs. standard of care at 3 public health facilities in Maputo Province, Mozambique. The primary outcome was retention in HIV care. Between November 2011 and March 2012, 830 eligible HIV-infected patients on ART were randomized 1: 1 to the text reminder intervention or standard of care.

Methods: We used Kaplan-Meier estimators and log-rank tests to compare proportions of patients who received SMS reminders who were retained in HIV care compared to the control group who received standard of care. Post hoc analyses were performed using Cox proportional hazards models stratified by urban/rural facility and when initiated ART (<= 3 months vs. >3 months). Hazard ratios and confidence intervals (CIs) are reported. Analysis was with intention to treat.

Results: Patients who received text messages had lower attrition from HIV care at 12 months, though the difference was nonsignificant (RR: 0.68, 95% CI: 0.41 to 1.13). Among urban patients, text messages improved retention in HIV care (RR: 0.54, 95% CI: 0.31 to 0.95). Intervention patients newly initiated on ART (<3 months) had lower attrition than control patients (HR: 0.54; 95% CI: 0.23 to 0.91), especially urban newly initiated patients (HR: 0.20, 95% CI: 0.06 to 0.64). Text messages had no effect on retention among rural patients.

Conclusions: Text messages did not improve retention in HIV care for all patients on ART but improved retention in care of urban patients and those who recently started ART and received text reminders compared with standard of care.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016. Vol. 73, no 2, E23-E30 p.
Keyword [en]
SMS reminders, text messages, retention in care, Mozambique, ART
National Category
Infectious Medicine Immunology in the medical area
Research subject
Infectious Diseases; Immunology
Identifiers
URN: urn:nbn:se:oru:diva-53172DOI: 10.1097/QAI.0000000000001115ISI: 000384109800002Scopus ID: 2-s2.0-84988336269OAI: oai:DiVA.org:oru-53172DiVA: diva2:1039519
Note

Funding Agencies:

Ark

Vodacom Mozambique

UCLA Postdoctoral Fellowship Training Program in Global HIV Prevention Research T32MH080634

Available from: 2016-10-24 Created: 2016-10-24 Last updated: 2017-05-17Bibliographically approved
In thesis
1. Integration of Mobile Technologies with Routine Healthcare Services in Mozambique
Open this publication in new window or tab >>Integration of Mobile Technologies with Routine Healthcare Services in Mozambique
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Mobile technologies are emerging as one way to help address health challenges in many countries, including in Least Developed Countries. Mobile technology can reach a large share of the population but in order to provide effective support to healthcare services, technology, information collection and dissemination, and work processes need to be well aligned. The thesis uses a design science methodological approach and mixes qualitative and quantitative data analysis to address the question of, How can mobile technologies be effectively integrated with routine healthcare services?

The study concerns the design, implementation, and evaluation of a mobile technology-based system, called SMSaúde, with the aim of improving the care of patients with HIV/AIDS and tuberculosis in Mozambique. The work started with the elicitation of functional and user requirements, based on focus group discussions. An important challenge, as in many mHealth interventions, was the integration with routine healthcare services and the existing IT systems, as well as developing a scalable technical structure. The system has now been in routine use since 2013 in more than 16 healthcare clinics in Mozambique. Evaluation was done by a randomised controlled study. Analysis of patient records showed that retention in care in urban areas was significantly higher in the intervention group than in the control group. In a user study both patients and health professionals were very positive to the system. The thesis contributes to research by demonstrating how information system artefacts can be constructed and successfully implemented in resource-constrained settings. The practical contributions include the designed artefact itself as well as improved healthcare practices and mHealth policy recommendations.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017. 136 p.
Series
Örebro Studies in Informatics, 13
Keyword
mobile technologies, mobile health, mHealth, Least Developed Countries, Mozambique, mobile phones, information systems artefact, design science research
National Category
Information Systems, Social aspects
Identifiers
urn:nbn:se:oru:diva-56948 (URN)978-91-7529-195-6 (ISBN)
Public defence
2017-06-12, Örebro universitet, Musikhögskolan, Hörsal M, Fakultetsgatan 1, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2017-04-04 Created: 2017-04-04 Last updated: 2017-05-24Bibliographically approved

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