Feasibility and acceptability of mobile phone short message service as a support for patients receiving antiretroviral therapy in rural Uganda: a cross-sectional study.

Jiho Kim,Wendy Zhang,Mastula Nanfuka,Maureen Nyonyitono,David M Moore,Lillian Lourenco,Paula Munderi,Pontiano Kaleebu,Josephine Birungi,Richard T Lester,Stephen Okoboi

doi:10.7448/ias.18.1.20311

Abstract

IntroductionMobile phone technologies have been promoted to improve adherence to antiretroviral therapy (ART). We studied the receptiveness of patients in a rural Ugandan setting to the use of short messaging service (SMS) communication for such purposes.MethodsWe performed a cross-sectional analysis measuring mobile phone ownership and literacy amongst patients of The AIDS Support Organisation (TASO) in Jinja, Uganda. We performed bivariate and multivariate logistic regression analyses to examine associations between explanatory variables and a composite outcome of being literate and having a mobile phone.ResultsFrom June 2012 to August 2013, we enrolled 895 participants, of whom 684 (76%) were female. The median age was 44 years. A total of 576 (63%) were both literate and mobile phone users. Of these, 91% (527/ 576) responded favourably to the potential use of SMS for health communication, while only 38.9% (124/319) of others were favourable to the idea (p<0.001). A lower proportion of literate mobile phone users reported optimal adherence to ART (86.4% vs. 90.6%; p=0.007). Male participants (AOR=2.81; 95% CI 1.83–4.30), sub-optimal adherence (AOR=1.76; 95% CI 1.12–2.77), those with waged or salaried employment (AOR=2.35; 95% CI 1.23–4.49), crafts/trade work (AOR=2.38; 95% CI 1.11–5.12), or involved in petty trade (AOR=1.85; 95% CI 1.09–3.13) (in comparison to those with no income) were more likely to report mobile phone ownership and literacy.ConclusionsIn a rural Ugandan setting, we found that over 60% of patients could potentially benefit from a mobile phone-based ART adherence support. However, support for such an intervention was lower for other patients.

Highlights

Mobile phone technologies have been promoted to improve adherence to antiretroviral therapy (ART)
Our study found that a sizeable proportion of HIV/AIDS patients receiving ART could benefit from the use of mobile phone-based support even in a rural Ugandan setting
The community-focused supports at The AIDS Support Organisation (TASO) Jinja, which have resulted in very high proportions of client retention, low mortality and good virologic outcomes, provide additional examples of programme components which may foster good client outcomes among ART programme participants in such settings

Summary

Introduction

Mobile phone technologies have been promoted to improve adherence to antiretroviral therapy (ART). We studied the receptiveness of patients in a rural Ugandan setting to the use of short messaging service (SMS) communication for such purposes. A lower proportion of literate mobile phone users reported optimal adherence to ART (86.4% vs 90.6%; p00.007). Conclusions: In a rural Ugandan setting, we found that over 60% of patients could potentially benefit from a mobile phone-based ART adherence support. Support for such an intervention was lower for other patients. Despite the dramatic expansion of access to antiretroviral therapy (ART) in recent years, HIV/AIDS continues to be a major global health problem, especially in sub-Saharan Africa. Methods requiring less intensive resources include ‘‘medicine companions’’ [3], reminder devices [4], HIV-specialized pharmacies [5] and automated voice messaging [6], among others

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