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HIV/AIDS care and control Will Mobile Technology "Do It"? Review on current technology

HIV/AIDS care and control Will Mobile Technology "Do It"? Review on current technology. Richard Lester, MD, FRCPC BCCDC / University of British Columbia University of Nairobi, WelTel July 25, 2012. CREDIT: http://www.armybase.us/2009/04/air-force-yields-in-f-22-fighter-dispute/.

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HIV/AIDS care and control Will Mobile Technology "Do It"? Review on current technology

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  1. HIV/AIDS care and controlWill Mobile Technology "Do It"?Review on current technology Richard Lester, MD, FRCPC BCCDC / University of British Columbia University of Nairobi, WelTel July 25, 2012

  2. CREDIT: http://www.armybase.us/2009/04/air-force-yields-in-f-22-fighter-dispute/

  3. Can mobile (communication) technologies “Do it”?

  4. mPhones =A Gift mHealth-Hype? Problem: People living with HIV Response: People on ART People with mobile phones

  5. HIV Cascade of care

  6. HIV Care & Prevention Access + Adherence + Retention = Engagement

  7. Two Randomized Controlled Trials (Kenya) WelTel weekly SMS check-ins (two way): *24% improvement in achieving 95% adherence over 1y *19% improvement in achieving viral suppression at 1y (NNT = 9 & 11) SMS reminders/motivation (one way): *Weekly (short) messages 32% improvement in 90% adherence (MEMS) over 1y *9% decrease in treatment interruptions *No adherence improvement with daily, longer reminders *No viral load/clinical outcomes Nov 27, 2010 March 27, 2011

  8. 243 references ID’d to Nov 2011:

  9. Bella Hwang – mHealth Summit 2011 WelTel: PEPFAR (2.485M people) +230,000 suppressed Figure . Costs of SMS Intervention vs. Costs Savings over 3 years for PEPFAR Global Cohort on ART (2.485M patients)

  10. What doesn’t work?

  11. Reminders or Support? • Targeted adherence counselling • persistent effect on adherence and viral suppression • A medication reminder alarm device • no effect on adherence or viral suppression • Adherence to antiretroviral therapy: supervision or support? Lancet ID, Feb 2012 • http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70354-1/fulltext Chung et al. PLoS Med, March 2011

  12. Monitoring Adherence & Results Challenges in Using Mobile Phones for Collection of Antiretroviral Therapy Adherence Data in a Resource-Limited Setting SMS and IVR Adherence Real Time Monitoring in Uganda Jessica E. Haberer1, 2, 3 , Julius Kiwanuka4, Denis Nansera4, Ira B. Wilson5 and David R. Bangsberg2, 3, 6 • (1) Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA(2) Harvard Initiative for Global Health, MbararaUniversity of Science and Technology, Kampala, Uganda, online: 8 June 2010 High acceptability for cell phone text messages to improve communication of laboratory results with HIV-infected patients in rural Uganda: a crosssectional survey study. • BMC Med Inform DecisMak. 2012 Jun 21;12(1):56. [Epub ahead of print] • Siedner MJ, Haberer JE, Bwana MB, Ware NC, Bangsberg DR.

  13. Other cell phone studies AIDS Patient Care STDS. 2011 Mar;25(3):153-61. Epub 2011 Feb 16. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. N=19 adults Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR Trials. 2011 Jun 9;12:145. The challenges and opportunities of conducting a clinical trial in a low resource setting: the case of the Cameroon mobile phone SMS (CAMPS) trial, an investigator initiated trial. N=198 adults Mbuagbaw L, Thabane L, Ongolo-Zogo P, Lang T. AIDS Patient Care STDS. 2011 May;25(5):303-10. Epub 2011 Apr 2. Brief behavioral self-regulation counselingfor HIV treatment adherence delivered by cell phone: an initial test of concept trial. N=40 adults Kalichman SC, Kalichman MO, Cherry C, Swetzes C, Amaral CM, White D, Jones M, Grebler T, Eaton L. Lancet. 2011 Aug 27;378(9793):795-803. Epub 2011 Aug 3. The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial. N=2269 children Zurovac D, Sudoi RK, Akhwale WS, Ndiritu M, Hamer DH, Rowe AK, Snow RW.

  14. “mobile phone HIV” publications

  15. AIDS 2012: mHealth abstracts • 27 abstracts “mobile/cell phones, text message”

  16. AIDS 2012: RCT2 • TUPE673 - Poster Exhibition SMS messaging improves treatment outcome among the HIV-positive Mayan population in rural Guatemala • J.M. Ikeda1, R. Barrios2, J.B. Lopez Lopez3, N. Hearst4 • 226 HIV positive clients from the Integrated Care Clinic in Quetzaltenango • The mean time to viral load suppression: 7 months intervention group and 10 months control group.

  17. Summary of RCT Evidence on mHealth Interventions to improve ART outcomes • Adherence monitoring by SMS? - ? • not yet known if effective for adherence promotion • Challenging to implement, cost, compliance, stigma? • Targeted adherence counselling? - Y • improves adherence and viral suppression (1yr) • Digital alarm reminders? - N • No improvement on adherence or VL (1yr) • One way cell phone SMS reminders? – N/Y • no improvement in adherence (by MEMS), for daily reminders • effective with short weekly messages. (1yr) • Two-way cell phone SMS çheck-ins’/access to HCW? -Y • Improves adherence and viral suppression (1yr) • Level of Evidence:Grade A (weekly SMS) • Support (access to care) > Reminders?

  18. My take home messages • Keep it simple • Every extra step (complexity) loses someone • Keep it low cost • Resource limited settings, vulnerable groups • Conduct controlled studies • What really works, and what doesn’t? • Seize the opportunity • mHealth is a gift

  19. Can mobile (communication) technologies “Do it”?

  20. Future Direction Grand Challenges Canada Current Research Projects: WelTel HAARTBC1 Oak Tree Clinic, Vancouver Supported by BCCDC foundation and Bristol-Myers-Squibb WelTel LTBI BCCDC TB clinics, latent TB infection support (RCT) Supported by BCLA, CIHR WelTel Retain Pre-ART retention in care with AMREF in Kenya Supported by NIMH EPIC PrEP in San Francisco Supported by NIMH • Formed a non-profit organization to assist implementing the WelTel model globally (WelTel International mHealth Society). • PMTCT in Kenya • Supported by IDRC/GHRI

  21. Thank you Your health, in your hands The future is now. www.weltel.org

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