Journal Article

Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial

Rampal, Lekhraj, Kadir Shahar, Hayati, Ibrahim, Faisal, Abdulrahman, Surajudeen Abiola, Radhakrishnan, Anuradha P., Othman, Norlijah

2017

Overview

Adherence to treatment remains the cornerstone of long term viral suppression and successful treatment outcomes among patients receiving Antiretroviral Therapy (ART). Evaluate the effectiveness of mobile phone reminders and peer counseling in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia. A single-blind, parallel group RCT conducted in Hospital Sungai Buloh, Malaysia in which 242 adult Malaysian patients were randomized to intervention or control groups. Intervention consisted of a reminder module delivered through SMS and telephone call reminders by trained research assistants for 24 consecutive weeks (starting from date of ART initiation), in addition to adherence counseling at every clinic visit. The length of intended follow up for each patient was 6 months. Data on adherence behavior of patients was collected using specialized, pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires. Data on weight, clinical symptoms, CD4 count and viral load tests were also collected. Data was analyzed using SPSS version 22 and R software. Repeated measures ANOVA, Friedman's ANOVA and Multivariate regression models were used to evaluate efficacy of the intervention. The response rate after 6 months follow up was 93%. There were no significant differences at baseline in gender, employment status, income distribution and residential location of respondents between the intervention and control group. After 6 months follow up, the mean adherence was significantly higher in the intervention group (95.7; 95% CI: 94.39-96.97) as compared to the control group (87.5; 95% CI: 86.14-88.81). The proportion of respondents who had Good (>95%) adherence was significantly higher in the intervention group (92.2%) compared to the control group (54.6%). A significantly lower frequency in missed appointments (14.0% vs 35.5%) (p = 0.001), lower viral load (p = 0.001), higher rise in CD4 count (p = 0.017), lower incidence of tuberculosis (p = 0.001) and OIs (p = 0.001) at 6 months follow up, was observed among patients in the intervention group. Mobile phone reminders (SMS and telephone call reminders) and peer counseling are effective in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia. These findings may be of potential benefit for collaborative adherence planning between patients and health care providers at ART commencement.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Acquired Immunodeficiency Syndrome - drug therapy / Adequacy / Adhesion / Adolescent / Adult / Adults / AIDS / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Antiretroviral Therapy, Highly Active - methods / Biology and Life Sciences / Cell Phone / Cellular telephones / Clinical trials / Coal mines / Communities / Cost analysis / Covariance / Data acquisition / Data collection / Death / Developing countries / Diglycerides / Discrimination / Distance Counseling - methods / Drugs / Engineering and Technology / Feedback / Female / Guidelines / Health aspects / Highly active antiretroviral therapy / HIV / Hospitals / Human immunodeficiency virus / Humans / Immunology / Innovations / Intervention / Inventories / LDCs / Malaysia / Male / Medicine / Medicine and Health Sciences / Messages / Middle Aged / Morbidity / Mutation / Optimization / Patient Compliance / Patients / Peer Group / People and Places / Power efficiency / Pregnancy / Protocol (computers) / Psychology / Public health / Regression models / Scheduling / Social Sciences / Studies / Telemedicine - methods / Text messaging / Therapy / Treatment Outcome / Tuberculosis / Variance analysis / Wireless telephones