Abstract
BackgroundIn Cameroon, only two-thirds of children with HIV exposure or infection receive appropriate HIV-directed medical care. Mortality, antiretroviral therapy resistance and suboptimal virological response are strongly related to missed opportunities for treatment, and, more specifically, to skipped scheduled medical appointments. The present trial, MORE CARE (Mobile Reminders for Cameroonian Children Requiring HIV Care) seeks to determine if reminders sent by text message (SMS), phone call, or concomitant SMS and phone calls most increase the presence at medical appointments of HIV-infected or -exposed children (efficacy), and which is the most efficient related to working time and financial cost (efficiency).Methods/DesignWe will carry out a multicenter single-blind, randomized, factorial controlled trial. A randomization list will be electronically generated using random block sizes. Central allocation will be determined by sequentially numbered. A total of 224 subjects will be randomized into four groups (SMS, Call, SMS + Call, and Control) with an allocation ratio of 1:1:1:1. SMS and calls will be sent between 48 and 72 hours before the scheduled appointment. A medical assistant will send out text messages and will call participants. Our primary outcome is appointment measured by efficacy and efficiency of interventions. We hypothesize that two reminders (concomitant use of SMS and phone calls) as an appointment reminder is more effective to improve appointment compared to one reminder (only SMS or only call), and that the most efficient is use of only SMS. The analysis will be intention to treat.DiscussionThis trial investigates the potential of SMS and phone calls as motivational reminders to improve children’s adherence to medical appointments for HIV-related care in Cameroon. The intervention will act to end missed appointment due to forgetfulness.Trial registrationPan African Clinical Trials Registry: PACTR201304000528276
Highlights
In Cameroon, only two-thirds of children with human immunodeficiency virus (HIV) exposure or infection receive appropriate HIV-directed medical care
A recent Cochrane review concludes that appointment reminders sent via mobile phone text messaging (SMS) are as efficacious as voice phone call reminders in increasing patient attendance at medical visits and the effect is greater for both sent by text message (SMS) and phone calls interventions as compared to no reminder [17]
Participants We will include in the study all persons aged 18 years or older accompanying a HIV-infected or exposed child aged less than 15 years for HIV care and consenting to participate in the study
Summary
Some studies investigating the use of mobile text message and phone calls to improve adherence to medicals appointments showed various results [10,11,12,13,15,16,17,18]. Unlike those studies, our MORE CARE trial will measure a possible synergic interaction of combining text message and phone call. The study will possibly contribute to increasing evidence of the usefulness of mobile phone technology for promoting health in low- to middle-income countries like Cameroon [26].
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