Text Messages Can Help Improve Adherence to ART
Sending your patients short text reminders every week may help improve their adherence to antiretroviral therapy.
Mobile phones are already being used to deliver novel health interventions, but few data are available on their use for this purpose in resource-constrained settings, where cell phones are now ubiquitous. In this prospective randomized trial in Kenya, researchers provided 428 HIV-infected patients with mobile phones and then evaluated whether reminder text messages would improve their adherence to antiretroviral therapy (ART).
All the patients had initiated ART in the 3 months prior to study enrollment (mostly with AZT/3TC + nevirapine), and 97% resided within cell phone network range. One third of the patients served as a control group, while the others received either short or long text messages, delivered either daily or weekly. The short messages were simply reminders, whereas the long messages also included words of encouragement. Adherence was monitored using MEMS (Medication Event Monitoring System) bottle caps.
At 48 weeks, 16% of all study participants were lost to follow up; the proportion did not differ significantly among groups. In the control group, adherence was 76% overall and declined during follow-up, with only 46% of patients achieving high adherence levels (>90%) in weeks 37 through 48.
In a 48-week intent-to-treat analysis, weekly reminders had a positive effect on adherence, but daily reminders did not. Whether the messages were long or short did not seem to matter. The proportion of patients who achieved high adherence levels was 53% in the weekly-reminder groups, versus 41% in the daily-reminder groups and 40% in the control group. Similarly, the proportion of patients who interrupted treatment for at least 48 hours was 81%, 86%, and 90%, respectively.
Comment: This study demonstrates how much we still need to do to improve adherence to ART in developing countries. Only about 45% of patients in this study had high adherence levels, and although viral-load data were not presented, we can predict that rates of virologic suppression were not optimal. Reminder text messages may be an effective means of improving adherence to ART among patients in resource-limited settings who have cell phones, as long as the messages are kept short and sent only weekly.
— Carlos del Rio, MD <http://aids-clinical-care.jwatch.org/misc/board_about.dtl>
Published in Journal Watch HIV/AIDS Clinical Care <http://aids-clinical-care.jwatch.org> February 18, 2011
Citation(s):
Pop-Eleches C 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 Feb 10; [e-pub ahead of print]. (http://dx.doi.org/10.1097/QAD.0b013e32834380c1 <http://dx.doi.org/10.1097/QAD.0b013e32834380c1> )
Monday, March 14, 2011
Text Messages Can Help Improve Adherence to ART
Monday, February 28, 2011
Monday, February 14, 2011
I Left My Heart in Navrongo: Visiting the MOTECH Project in Ghana
Ellen Yiadom is Grameen Foundation’s Africa Legal Fellow. She graduated from the University of Virginia School of Law in May 2010 and is a recipient of Dewey & LeBoeuf’s Community Service Fellowship.
Last November, I visited Grameen Foundation’s Mobile Technology for Community Health project (MOTECH) in Ghana. The project covers 15 health facilities in Kassena-Nankana, a district in the Upper East Region that is only a few miles from Ghana’s northern border with Burkina Faso. I was there to observe the operations of the project and help the field staff update patient care information.
We flew into Tamale, the capital of the Northern Region of Ghana, and drove two hours to Navrongo, which became my base for this trip. As we drove from Tamale to Navrongo, I was impressed by the lushness and serenity of the natural landscape, which was a contrast to the bustle of Accra, Ghana’s capital, where I was born.
Although there was very little human activity along the road, small towns would spring up along the way and the road would quickly become populated with people on bicycles, motorbikes and even an occasional donkey. These small vehicles often included several passengers. I even saw very small children riding behind or in front of their parents seemingly without fear.
Upon arriving in Navrongo, I visited a health facility in Kurugu, a sub-district in Kassena-Nankana, to help update patient care information in the MOTECH system that provides customized health information to pregnant women through mobile phones.
One key service is Mobile Midwife, which provides weekly phone calls and text messages to women about prenatal and postnatal care. After registering for the service, pregnant women receive information tailored to their stage of pregnancy, while women with newborns receive vital information during the baby’s first year of life. For example, if a woman is six weeks pregnant, she would receive information about what to expect during her first trimester. Additionally, the messages encourage the women to visit the nearest health facility throughout their pregnancy and give them tips on staying healthy during their pregnancy. Because Mobile Midwife is run through an Interactive Voice Response Server, women can call in to listen to any messages they may have missed. There’s also a call center where women can ask questions about technical issues such as the alerts and messages they are receiving; staff in the field also go out to meet with women who are more comfortable speaking in person than over the phone.
As the women come in for their health check-ups and their immunizations, the nurses keep records of this information by entering it into the mobile phones they received as part of the MOTECH project. This enables women who are registered with MOTECH to receive automatic notifications about any immunizations they need. The nurses can also enter information about upcoming appointments and the server will send automatic reminders to pregnant and new mothers. Of course, if the patient care information is not entered, or entered incorrectly, then the women will receive inaccurate alerts and reminders, so it’s very important for the nurses to update in a timely, accurate way.
During my time in Navrongo I visited other health facilities and was able to meet some of the participants in Mobile Midwife. One of them was Cecelia Ayebe, who had given birth the week before we arrived. She showed us her beautiful baby girl, who looked quite big and healthy for a one-week-old. When asked about the main difference between this pregnancy (her second) and her first, she explained that she became more informed and proactive about her care after listening to the Mobile Midwife messages. For example, she learned that she had to visit the nearest health facility when she experienced certain pains. Consequently after experiencing pains in her womb she visited the nearest health facility and learned that her baby was not positioned well. In her local culture, women are often discouraged from visiting a health facility when they are experiencing pain during their pregnancy. Without the information from Mobile Midwife, she might have ignored the pain, and possibly hurt her baby.
Despite having almost no formal education, the other women I met during my time in Navrongo were dedicated to improving the health of their families – just like Cecilia. MOTECH offers them the information they need to have a healthy pregnancy and baby.
Original post at: http://grameenfoundation.wordpress.com/2011/02/11/i-left-my-heart-in-navrongo-visiting-the-motech-project-in-ghana/#more-1477
Thursday, February 10, 2011
FW: ODK Clinic
for OpenMRS on
android phones. This is the type of functionality we have discussed for
MoTeCH if Ghana Health Service (or other implementations) want to move
to a truly paper-less system for nurses. Might be worth looking into
this more deeply as a starting place when we're ready to investigate
this type of functionality more deeply.
Thursday, January 27, 2011
Lessons Learned from AppLab's First Three Years in Uganda
Interesting blog post from Eric Cantor, who led Grameen Foundation’s AppLab Uganda. Nice to see that we have listened to what was learnt there, and are putting in place systems which build on that experience.
Creating a World Without Poverty
Lessons Learned from AppLab’s First Three Years in Uganda
By grameenfoundation
Eric Cantor has led Grameen Foundation’s AppLab efforts in Uganda for the past three years, and continues to serve as an advisor on the project.
More than three years ago, I landed in Uganda to establish Grameen Foundation’s “Application Laboratory” – a program conceived to explore the potential of mobile phones to improve the lives of the poor. In our quest to test, develop and expand mobile services that are useful for the most often-ignored people on the planet, our team spent (and spends) extensive time talking to our users, in the places they work and live, to hear about the good and the bad of the methods we are testing to empower them.
We sit under the mango tree at the rural health clinic, hearing about how people learn to avoid and treat common and devastating diseases like malaria and HIV. We walk the banana plantations of farmers in the West, trying to gauge how they can best control banana wilt, using locally available resources and techniques. We observe the effects of the rapidly growing “mobile money” phenomenon – essentially digital currency delivered through a mobile phone network – and assess how it can improve the lives of villagers. We see how people interact with the Internet and other unfamiliar services available through the few laptops and smartphones in a community. And we listen to farming groups, led by Community Knowledge Workers (CKWs), as they plan and prepare to bulk their crops for sale to the highest-paying buyers. As white winter washes over the US, and the rains wind down and planting season approaches in Uganda, we share some lessons learned through this work in the hopes that our growing body of work, as well as that of other practitioners in this field, will benefit.
In AppLab’s early work, we tested a number of information services, leading up to our launch, with MTN (one of the primary mobile phone services providers in east Africa) and Google, of Google SMS Tips, the product that won the award for “Best use of Mobile for Social and Economic Development” at the 2010 GSM Mobile World Congress. It was rewarding to sit on a farm and hear how making organic pesticides using local chemicals or even waste products found on the farm helped save a farmer money, and increase her yields and incomes.
Community Knowledge Workers act as valuable local intermediaries, bridging the "last kilometer" to bring essential information to other rural farmers in Uganda. Here, a CKW uses her high-end mobile phone to check for information on banana wilt.
But what became quickly apparent was that information alone is not a complete solution. A reference pointer or a tip about maternal health techniques may be useful to an expectant mother, but creating deep, impactful behavior change – what information-driven development initiatives seek – requires a context in which that information has a value. People certainly have a hunger for knowledge and a willingness to embrace the mobile phone to search for answers, as shown by all the questions they asked from the beginning about family planning, and HIV and other sexually transmitted infections, which affect them directly and for which few reliable, anonymous sources are available. But we require several things to make this information actionable and impactful: specific information, a context in which to make it useful, and relevant services and resources.
We’ve also found that village-based intermediaries help increase the benefits of mobile phone-based applications. We saw this in our Village Phone work, as well as other involvements in microfinance and social enterprises serving the poor. CKWs are farming group leaders, nominated and elected by their peers because they meet a number of important criteria, who have been rigorously trained to harness the power of mobile technology to benefit the group. She or he encourages, cajoles and reminds the group to farm better and organizes them to get to market, enhancing the information already being shared among the group and then funneled back to the NGOs, government agencies and buyers they interact with. By closing the loop and covering the “last kilometer,” intermediaries like this can ensure that information is put to best use by those who can best benefit from it. As Kentaro Toyama points out in a recent piece, “the human intent and competence ICT4D [Information and Communication Technologies for Development] aims to generate must already be in place for the technology to work.” In the case of CKWs, the competence and intent are already in place in functioning agriculture extension programs and liquid markets. The addition of the technology through a trusted intermediary adds efficiency. And as farmers increase yields and sell more at the market, their incomes rise.
Another thing we learned during our early work in Uganda was how carefully messages must be communicated. With more than 800 languages spoken in Africa, and varying degrees of literacy, linguistics remains a clear challenge for mobile service practitioners. Though we launched Google SMS Tips in Luganda, the local vernacular, it proved difficult to parse incoming queries and match keywords using the English-language logic behind the app. Adding in one more language – let alone the remaining 45 necessary to reach all Ugandans – would have proven exponentially complex because of the overlap of words and the fact that most of those languages were not designed to be written.
That said, the challenge in communicating in a written form makes us excited about the potential for using voice-based information to deliver the message more effectively. Few studies exist documenting the comprehension of information delivered en masse, which is understandable given that this approach is new, and that mobile provides a more scalable way to deliver information than anything that previously existed. And even if we get users to understand the message, changing behavior based on that understanding is another step. People hear the “don’t smoke” message over and over, but they still do. We are exploring the best ways to leverage voice-based technologies and to test comprehension and changes in behavior as the work moves forward.
The movement to realize the potential of mobile phone-based apps for the benefit of underserved markets is in its infancy, but there is an urgency to demonstrate value and share what we learn. Grameen Foundation’s AppLab programs will continue generating insights on how best to leverage information and communication technologies to improve the lives of those who are least connected. As we succeed or fail, we will continue to keep you posted on the journey.
Friday, January 7, 2011
mLearning: A Platform for Educational Opportunities at the Base of the Pyramid
The GSMA Development Fund is pleased to announce the publication of its new report entitled mLearning : A Platform for Educational Opportunities at the Base of the Pyramid. This is an exciting area exploring how mobile devices can be used as an intervention tool to extend the reach and raise access to educational resources at the base of the pyramid. The GSMA's initial thoughts and findings have been compiled into this comprehensive report with an aim of generating the thinking that will catalyse the growth of mLearning in the future.
The key areas highlighted in the report are :
- The current challenges facing learning today
- The benefits and opportunities afforded to and by mLearning
- An interesting selection of case studies
- Recommendations for Mobile Network Operators and how to get involved.
If you would like to read more about this exciting area, download your copy here
RE: Mobile money services in health care
In this two-part series, MobileActive.org explores how mobile money services can support health care in developing countries. In part one, we described the key ways in which mobile money services can be adopted by the health sector. At the primary level of care, subscription-based mobile payment services can create two-way links between patients and health care providers, as summarized here…
http://www.mobileactive.org/mobile-money-mobile-health-use-cases