SMS Reminders Research Articles

Impact of Clinical Pharmacist Mediated Discharge Counseling and SMS Reminders Service on Medication Adherence in Chronic Disorders

Aims: This study aimed to assess the effect of discharge counseling with SMS reminders on medication adherence in chronic disorders.
 Study Design: Prospective randomized open-label trial
 Place and Duration of Study: The study was conducted at the dispensing department of a secondary care referral charity hospital located in a small village. The study was conducted for a period of six months from October 2018 to April 2019.
 Methodology: Upon consent, a total of 364 patients were enrolled in this study and randomized into two groups viz., intervention group (n=182) and control group (n=182) respectively, with and without discharge counseling and SMS reminder on medication usage by the clinical pharmacist. The level of medication adherence was measured using a pill count and visual analog scale (VAS) methods at two follow-up visits includes baseline and final follow-up visit (gap of two months). A two-sample Wilcoxon rank‑sum (Mann–Whitney) was used to compare the statistical mean difference of medication adherence levels between two groups at each follow‑up visit.
 Results: The mean age of intervention and control groups were 57.1±8.55 and 58.5±8.53; most of the subjects were >60 years of age and were typically suffering from hypertension (30.2%) and diabetes (34.8%). Initially, at baseline, the values of medication adherence level (pill-count method) were closer in both intervention (82.4±7.3) and control group (81.35±6.4), whereas at follow up visits, the levels of the intervention group (93.2±6.0, 95.6±2.25) were significantly increased (p<0.0001) as compared to the control group (81.2±8.5, 80.6±8.1).
 Conclusion: Thus, the statistical significance infers that the clinical pharmacist-mediated discharge counseling with SMS reminders would increase medication adherence levels in chronic disorders.

SISTEM INFORMASI PENGINGAT KONTRAK KARYAWAN AEROFOOD ACS MENGGUNAKAN SMS GATEWAY (STUDI KASUS PADA KARYAWAN KONTRAK PT AEROFOOD INDONESIA BANDARA INTERNASIONAL SOEKARNO-HATTA, PAJANG, TANGERANG)

Every month PT Aerofood Indonesia has a number of contract employees whose data needs to be managed and the follow-up determined by the HC (Human Capital) Development company. The HC determines the employee concerned for extending his contract or terminating his employment contract. The problem that occurs is the number of contract employees who annually have around 300 employees who need to check the expiration date of the work contract. Checking is still done manually by the HC by checking employee data from stored data files. In this study, an SMS Gateway based reminder information system was developed that can remind HC parties by sending a text message in the form of SMS reminders related to employee data that will be out of contract and send a SMS message to the employee that the contract will expire within one month before the expiry date of the contract, thus system can help the HC in speeding up the file preparation and decision process follow up on related employees.

Evaluation of an SMS-based mHealth intervention to enhance early infant diagnosis follow-up testing and assessment of postnatal prophylaxis.

BackgroundAdherence to infant antiretroviral (ARV) postnatal prophylaxis and early infant diagnosis (EID) uptake is low in Africa. Promoting EID and adherence are necessary for this age group.ObjectivesWe evaluated an SMS-based mobile health (mHealth) intervention to enhance adherence to ARV prophylaxis and knowledge of EID and prevention of mother-to-child transmission (PMTCT) among high-risk and low-risk mother–infant pairs.MethodTwo hundred and fifty-one mothers were recruited from King Edward VIII Hospital between December 2018 and October 2019. Participant information was captured, and SMS reminders were sent postnatally to promote immunisation attendance. Follow-up HIV polymerase chain reaction (PCR) test results were reviewed, and telephonic interviews were utilised for qualitative data.ResultsIn all, 73.3% of infants had HIV PCR tests performed at 10 weeks. This high rate could be attributed to the mHealth intervention as this is considerably higher than other national studies, though not statistically significant compared to rates reported in the district at the same time. Factors that have impacted follow-up EID rates include poor maternal knowledge of EID time points and inadequate implementation of national PMTCT protocols. High-risk mothers were younger, commenced antenatal clinic visit later, were less knowledgeable on prophylaxis and have lower-birthweight infants than lower-risk mothers.ConclusionmHealth can play an important role in improving EID by increasing maternal knowledge. Further studies should focus on whether maternal education over an mHealth platform can increase knowledge on PMTCT and subsequently increase EID.

CORRELATES ASSOCIATED WITH ADHERENCE AMONG FEMALE SEX WORKERS ON HIV PRE- EXPOSURE PROPHYLAXIS IN NAIROBI CITY COUNTY, KENYA

Purpose: The main aim of the study was to assess correlates associated adherence among Female Sex Workers on PrEP in the study. This was done through determining level of knowledge on PrEP, level of adherence, correlates affecting adherence and analysis of strategies to enhancing PrEP adherence.
 Materials and Methods: A cross sectional analytical study with mixed method using both qualitative and quantitative data collection method was carried out between March and May 2021. Three hundred and forty-five Female Sex Workers (FSWs) were enrolled in the study. Data was collected using structured questionnaire from study participants after having their consent. Three focus group discussions (FGD) were conducted for those FSWs who will not be involved in the quantitative arm of study. Key Informant Interview was conducted with service providers using Key informant interview (KII) guide. Data collected was entered into Excel spread sheet in password protect computer. Data analysis was carried out in, Univariate analysis, bivariate analysis and multivariate analysis. Statistical Package of Social Science (SPSS) version 20.0 was used for analysis. Data was presented using graphs and Tables.
 Results: The study found that 72% did not know the name of PrEP, 39% reported to have missed PrEP with 33% having missed appointment for PrEP refill. Qualitative data showed that PrEP engagement meetings should be conducted monthly to enhance PrEP adherence. The respondents who had reminders on when to take medication was as well associated with adherence (p=0.014) compared with those not using reminders. The study also found out that employment status was associated with adherence to PrEP medication (P=0.050) with FSW who were salaried being 2.5 times more likely to adhere to PrEP medication compared to those who were not salaried.
 Unique contribution to theory, practice and policy: The Ministry of Health should ensure that targeted PrEP counselling is done during the initiation for the eligible clients. The information and telecommunication department to work on SMS reminder system in order to remind FSWs using PrEP about appointment dates for the pill pick up thus enhance adherence to FSWs using PrEP. The procurement department should work together with pharmacy department to ensure that there is enough stock for PrEP at every clinic. This will help to ensure that adherence is achieved for the FSWs on PrEP.

Improving the Follow-up Rate for Pediatric Patients (0-16 years) of an Eye Hospital in Nepal: Protocol for a Public Health Intervention Study.

BackgroundThe follow-up of pediatric patients ensures regular ocular morbidity monitoring and better treatment outcome. Hiralal Santudevi Pradhan Institute of Ophthalmic Science (Bharatpur Eye Hospital [BEH]) noticed that the follow-up rate was only 22% among its pediatric patients. Several factors like lack of awareness and forgetfulness among patients may contribute to a lower number of follow-up visits. Therefore, BEH decided to find if counseling and reminders through SMS text messaging and phone calls would improve the follow-up rates.ObjectiveThis study aims to evaluate the impact of interventions like counseling and reminder SMS text messaging and phone calls in improving the follow-up rate of pediatric patients.MethodsThis is a public health intervention study being conducted using quantitative analysis. All children (0-16 years) with ocular conditions requiring at least 3 follow-up visits in the study period will be included. In all, 264 participants will be allocated to 3 groups: routine standard care, counseling, and reminders with SMS text messaging and phone calls. In counseling, patients will take part in 20-minute counseling sessions with trained counselors at each visit, and information leaflets will be provided to them. In the reminder SMS text messaging and phone call group, patients will receive an SMS text message 3 days prior and a phone call 1 day prior to their scheduled visits. Patients attending within 2 days of the scheduled date will be considered compliant to follow-up. The proportion of patients completing all the follow-up visits in each group will be assessed. Informed consent will be taken from parents and children. Univariate and multivariate analyses will be conducted.ResultsThe ethical approval for this study has been obtained from the Ethical Review Board (ERB) of Nepal Health Research Council (ERB protocol registration #761/2020 P). The data collection was initiated on January, 24, 2021, but due to the COVID-19 pandemic, as of September 2021, we have only been able to enroll 154 of the planned 264 participants (58.3% of the sample size).ConclusionsThis study will reliably document not only the factors associated with follow-up rate through an intervention package (counseling and reminders through SMS text messaging and phone calls) but also the cost effectiveness of the intervention package, which can be applied in all the departments of the hospital.Trial RegistrationClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534International Registered Report Identifier (IRRID)DERR1-10.2196/31578

Switching COPD patients from the disposable to the new reusable Respimat soft mist inhaler: a real-world study from Switzerland

Objective The aims of the survey were to assess first experiences of Swiss COPD patients switching from the disposable to the new reusable Respimat inhaler, and to evaluate physicians´ and patients´ views of the new training material. Methods Patients with a confirmed diagnosis of COPD using a disposable Respimat inhaler for at least three months were included. Patients´ demographics, COPD stage, current treatment, and comorbidities relevant for the handling of the device were assessed. Further, patients were trained on the reusable Respimat by placebo inhaler, patient brochure, video cards/demo films and SMS reminder service. After at least one cartridge change, patients gave comprehensive feedback on their satisfaction with the reusable Respimat and physicians evaluated the need for re-training. Results 235 patients participated in the survey. Of these, 37% suffered from comorbidities restricting the handling of the Respimat. 216 (92%) patients had a better overall satisfaction with the reusable than with the disposable Respimat. Dose counter (86%), monthly preparation (81%) and daily handling (77%) were also assessed as better by most of the patients. In 80% of cases, the user ability was stated as better than for the disposable Respimat. Less than 15% of the patients required further training. Placebo inhaler was the mostly preferred training material by both, physicians (in 86% of the patients) and patients (75%). In patients with comorbidities affecting inhaler handling, overall satisfaction was also better in 86% of the patients. Conclusion The majority of patients were satisfied with the new reusable Respimat device and proper handling could be attained using the provided training material, even in patients with restricting comorbidities.

Interventions to improve vaccination coverage of children in hard-to-reach population: A systematic review

In the last decade, vaccination has reduced a quarter of child deaths worldwide. Vaccination coverage increased, but the coverage remains low in the hard-to-reach population. We searched articles from Pubmed MEDLINE, SCOPUS, Web of Science, and Science Direct to systematically review interventions to improve children's vaccination coverage in hard-to-reach populations. The expected outcome was vaccination coverage, which mentioned Odds Ratio, mean difference, or difference-in-difference with a 95% CI or p-value. Out of 102 articles identified, five articles from four different countries met the inclusion criteria. Four of the five studies reported a positive impact in increasing vaccination coverage. Interventions that showed good effectiveness in increasing the coverage of childhood immunizations were the application of mHealth given to vaccinators, multiple interventions involving the community, modification of immunization schedules during outreach activities, and immunization screening cards. Despite the inconsistent finding, mHealth with SMS reminders was the most effective intervention to increase vaccination coverage and relatively low-cost. More research was needed in developing a strategic intervention to increase vaccination coverage of children in hard-to-reach populations.

Effectiveness of mobile text reminder in improving adherence to medication, physical exercise, and quality of life in patients living with HIV: a systematic review

BackgroundMobile text reminder (SMS) system is considered a viable strategy for targeting/facilitating healthy behavioural change including adherence to prescribed physical exercises (PE) and medication (antiretroviral therapy-ART) which should improve the quality of life (Qol) in people living with HIV/AIDS(PLWHA). Thus, the literature was appraised for evidence of SMS effectiveness in improving ART and PE adherence behaviours and QoL in PLWHA.MethodsEight databases–AMED, CINAHL, Cochrane Library, EMBASE, EMCARE, Ovid MEDLINE, PsycINFO, and PubMed-were searched up to December 2020, using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol.This review included only randomised control trials (RCTs) investigating the effectiveness of SMS in improving QoL or PE or ART adherence behaviour or a combination of these variables in PLWHA >18 years. Two independent reviewers determined the eligibility of the studies. Data were extracted and the quality of the study was assessed with the Physiotherapy Evidence Database (PEDro) tool. The primary outcomes were ART and PE adherence behaviours while the secondary outcome was QoL.ResultA pooled estimate of effect was not calculated due to the heterogeneity of methods and outcome measures. Therefore, a narrative synthesis of ten studies that met the inclusion criteria (n = 1621 participants at study completion) comprising males/females, aged ≥ 18 years, was done. There was a significant improvement in ART adherence behaviour except in three underpowered studies. Only the SMS interventions that were developed using the Starks 3-steps Adherence model was associated with positive outcome. The only study that evaluated QoL was underpowered and reported no significant change while there were no RCTs on PE.ConclusionEffects of SMS intervention trends towards a significant improvement in ART adherence behaviour in PLWHA. It is plausible that SMS reminders developed using the broader framework of the interpersonal health behaviour theory(ies) may have positive outcome. Nevertheless, the observed heterogeneity in the methods/outcome measures warrants a cautious interpretation of the findings. There is a lack/paucity of RCTs and therefore no evidence in support of the effectiveness of SMS intervention in improving PE adherence and QoL. Registration number NPLASY202060016.

Designing an SMS reminder intervention to improve vaccination uptake in Northern Nigeria: a qualitative study

BackgroundPenta3 coverage in Nigeria was low at 33 % in 2017. The most reported reason for non-vaccination was lack of knowledge about the immunization place, time, and need. To address knowledge gaps and improve vaccination uptake, we designed an Immunization Reminder and Information SMS System (IRISS) to educate and remind parents/caregivers about immunization using SMS. A formative study was conducted to understand the contextual and behavioural factors that would inform the IRISS intervention design and implementation.MethodsWe conducted the study in four Local Government Areas (LGAs) of Kebbi State Nigeria in October 2018, amongst a diverse selection of participants. Data on social norms about vaccinations, barriers to immunization uptake, mobile phone use, SMS message testing, and willingness to accept SMS reminders were collected from focus group discussions (N = 11), in-depth interviews (N = 12), and key informant interviews (N = 13). In addition, we assessed 33 messages covering schedule reminders, normative, motivational, educational, and informative contents for clarity, comprehensibility, relevance, cultural appropriateness, and ability to motivate action among community members from Argungu and Fakai LGAs. All interviews were analyzed using a thematic analysis approach.ResultsWe interviewed 135 people, and 90 % were community members. While we found positive perceptions about immunizations among those interviewed, pockets of misconceptions existed among community members. Lack of awareness on the importance of vaccination was a consistent reason for under-vaccination across the LGAs. In addition, most community members do not own phones, could not read SMS messages, and were unaware of how to check/open text messages received. Despite concerns about low literacy levels and phone ownership, community members still saw a role in SMS reminders when phone owners receive messages. For instance, community leaders can disseminate said messages to community members through existing channels such as town announcers and religious gatherings. Therefore, the SMS becomes a source of information, with phone owners acting as a conduit to community dissemination mechanisms. We generally found the tested messages to be relevant, motivating, and culturally acceptable.ConclusionsSMS reminders have the potential to bridge the information gap in community awareness for vaccination, which can translate to improved immunization uptake. In rural communities with low literacy levels and phone ownership, immunization information can be disseminated when existing community leadership structures are engaged.

Dynamic Perceived HIV Risk and Sexual Behaviors Among Young Women Enrolled in a PrEP Trial in Kenya: A Qualitative Study.

Background: In Kenya and elsewhere in sub-Saharan Africa, young women are disproportionately affected by the HIV epidemic compared to young men. The extent to which young women's self-perceptions about risk of HIV acquisition influence their sexual behaviors and use of HIV prevention methods remains unclear. We therefore conducted a qualitative study to explore these issues among young women enrolled in a pre-exposure prophylaxis (PrEP) trial.Methods: From January 2017 to January 2020, we conducted serial semi-structured in-depth interviews 50 purposively selected young women (18–24 years old) who were participating in the MPYA (Monitoring PrEP for Young Adult women) study—a randomized controlled trial in Thika and Kisumu, Kenya, assessing the impact of SMS reminders on PrEP adherence. Interviews were conducted at three time points (~1 week, 3, and 12 months after initiating PrEP). We used an inductive, content analytic approach to identify key themes related to risk perceptions, sexual behavior, and use of HIV prevention tools.Results: Around the time of enrollment, most of the 50 women interviewed reported being at high risk of HIV because of their own sexual behaviors, such as inconsistent condom use, multiple sexual partners, and transactional sex. Additionally, high risk perception was based on the behavior of their partners, such as refusing to use condoms and being unsure of their partner's HIV status. Young women's perceived risk of HIV acquisition was a key motivator for PrEP initiation and continuation. During PrEP use, participants reported feeling protected and at less risk compared to peers who were not taking PrEP. Some reported no longer using condoms because they were confident that PrEP provided enough protection. Over time, many young women reported reducing risky sexual behaviors because of the regular counseling and HIV testing they received as part of their PrEP services. This lowered risk perception was in most cases accompanied by discontinuation of PrEP.Conclusions: HIV risk perception among young women in Kenya was dynamic and influenced their use of PrEP and condoms over time, suggesting an often-deliberate approach to HIV prevention and sexual health.

Simple Mobile technology health management tool for people with severe mental illness: a randomised controlled feasibility trial

BackgroundSevere mental illness (SMI) is associated with care delivery problems because of the high levels of clinical resources needed to address patient’s psychosocial impairment and to support inclusion in society. Current routine appointment systems do not adequately foster recovery care and are not systematically capturing information suggestive of urgent care needs. This study aimed to assess the feasibility, acceptability, and potential clinical benefits of a mobile technology health management tool to enhance community care for people with severe mental illness.MethodsThis randomised-controlled feasibility pilot study utilised mixed quantitative (measure on subjective quality of life as primary outcome; questionnaires on self-management skills, medication adherence scale as secondary outcomes) and qualitative (thematic analysis) methodologies. The intervention was a simple interactive technology (Short Message Service - SMS) communication system called ‘Florence’, and had three components: medication and appointment reminders, daily individually defined wellbeing scores and optionally coded request for additional support. Eligible participants (diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder ≥1 year) were randomised (1:1) to either treatment as usual (TAU, N = 29) or TAU and the technology-assisted intervention (N = 36).ResultsPreliminary results suggest that the health technology tool appeared to offer a practicable and acceptable intervention for patients with SMI in managing their condition. Recruitment and retention data indicated feasibility, the qualitative analysis identified suggestions for further improvement of the intervention. Patients engaged well and benefited from SMS reminders and from monitoring their individual wellbeing scores; recommendations were made to further personalise the intervention. The care coordinators did not utilise aspects of the intervention per protocol due to a variety of organisational barriers. Quantitative analysis of outcomes (including a patient-reported outcome measure on subjective quality of life, self-efficacy/competence and medication adherence measures) did not identify significant changes between groups over time in favour of the Florence intervention, given high baseline scores. The wellbeing scores, however, were positively correlated with all outcome measures.ConclusionIt is feasible to conduct an adequately powered full trial to evaluate this intervention. Inclusion criteria should be revised to include patients with a higher level of need and clinicians should receive more in-depth assistance in managing the tools effectively. The preliminary data suggests that this intervention can aid recovery care and individually defined wellbeing scores are highly predictive of a range of recovery outcomes; they could, therefore, guide the allocation of routine care resources.Trial registrationISRCTN34124141; retrospectively registered, date of registration 05/11/2019.

The impact of mobile phone voice message reminders on agricultural outcomes in Mali

AbstractBased on theories of learning that suggest that repetition is important for knowledge retention and application, this article hypothesized that sending farmers reminders about cereal management information received during face‐to‐face training has impact on the adoption of recommended practices and related agricultural outcomes over and above what could be realized after receiving training alone. We provide a test of this hypothesis using a randomized controlled trial in Sikasso, Mali. Farmers in 99 villages received face‐to‐face training, after which 44 villages received mobile phone voice messages that reinforced the training recommendations. This setup allowed us to evaluate the impact of the voice SMS reminders on selected indicators. Our results show that the reminders significantly induced timely harvesting, reduced on‐farm cereal losses, increased uptake of improved grain storage technology, and increased the likelihood of pre‐harvest sales contracting. However, we found no overwhelming evidence that the reminders increased yields, and no evidence of impact on revenues were detected. We draw lessons for development policy and practice.

Treatment adherence with diclofenac 3% gel among patients with multiple actinic keratoses: an integrated low-intensity intervention program versus standard-of-care.

Diclofenac 3% gel is a widely used topical treatment with proven efficacy in reducing the burden of actinic keratosis (AK); however, clinical benefit might not fully translate in clinical practice as nonadherence is substantial for prolonged treatment regimens. We evaluated the efficacy of an integrated low-intensity intervention program versus standard-of-care on treatment adherence among patients with multiple AK receiving diclofenac in hyaluronic acid gel 3%. We designed an open label, randomized, parallel group, interventional, multicenter, longitudinal cohort study including patients with multiple, grade I/II AKs. Visits were scheduled for end of treatment (T4), follow-up 1 (T5) and follow-up 2 (T6) at 90, 180 and 365 days from baseline, respectively. Patients in the intervention group received additional visits at 30 and 60 days from baseline, a brief health education intervention, an enhanced patient-physician communication, a weekly SMS reminder to medication prescriptions. Patients were equally allocated between intervention (intervention group [IG], N.=86) and control group ([CG] N.=86); at baseline, both groups had similar socio-demographic and clinical characteristics. Change scores from baseline showed a slight increment in quality of life related to AK in both groups (CG: <inf>ΔT4-T1</inf>=-0.079; IG: <inf>ΔT4-T1</inf>=-0.006; P=0.39) and in quality of physician-patient interaction reported by IG (Δ<inf>T3-T2</inf>=0.18; P<0.0001). Adherence rate was not statistically different between IG and CG (28.4% vs. 40.7%; P=0.11). Patients reported similar satisfaction for effectiveness, convenience and side effects of treatment. Clinical conditions improved over time and results did not differ between groups; complete clearance rate at 1 year was 18% and 29% for CG and IG, respectively. Our findings showed no difference in adherence rate between the two groups, suggesting that enhanced follow-up interventions and health care education may not be sufficient drivers to promote adherence among this clinical population. Further studies are needed to explore barriers to adherence with treatments for AKs.

Aplikasi Reminder Pengobatan Pasien Penyakit Diabetes Berbasis SMS Gateway Di Puskesmas Kampung Bali Kota Bengkulu

So far, not all DM patients know the schedule of treatment at the Kampung Bali Health Center, Bengkulu City, because the information about the patient's treatment is not / lacking. In addition, the Kampung Bali Bengkulu Community Health Center does not yet have an application that can manage diabetes patient care schedules and there is also no interactive forum for the public to find out information about diabetes patient care at the Kampung Bali Bengkulu Community Health Center. so that the health center has difficulty in providing information to diabetes patients. diabetes about the next treatment schedule. Application Reminder Treatment for Diabetes Patients at Kampung Bali Health Center, Bengkulu City is an SMS Gateway-based application that can be used to process data about Medications, Patients, Medicines, Treatment Schedules, and can also send SMS to patients individually, and patients can also get information . This diabetic patient medication reminder application features SMS Gateway, SMS Reminder. Application Reminder Treatment for Diabetes Patients at the Kampung Bali Health Center, Bengkulu City, was created using the PHP programming language, MySQL Database, and Gammu. The tool used to receive and based on tests that have been carried out, the Reminder Application for Diabetes Treatment Patients at the Kampung Bali Community Health Center, Bengkulu City can do an SMS Reminder / Schedule (which sends an SMS notification / reminder about the immunization schedule 1 day before the due date)

Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial

SummaryBackgroundThere is limited access to eye health services in many low-income and middle-income populations. We aimed to assess the effectiveness in increasing service utilisation of the Peek Community Eye Health (Peek CEH) system, a smartphone-based referral system comprising decision support algorithms (Peek Community Screening app), SMS reminders, and real-time reporting.MethodsIn this cluster-randomised controlled trial of eye health in Kenya, community unit clusters were defined as one health centre and its catchment population. Clusters were randomly allocated (1:1) to receive Peek CEH and referral (intervention group) or standard care via periodic health centre-based outreach clinics and onward referral (control group). Individuals in the intervention group were assessed at home by screeners and those referred were asked to present for triage assessment in a central location. They received regular SMS reminders. In both groups, community sensitisation was done followed by a triage clinic at the cluster health centre 4 weeks after sensitisation. During triage, individuals in both groups were assessed and treated and, if necessary, referred to a specific hospital. Individuals in the intervention group received further SMS reminders. The primary outcome was the mean attendance rate (the number of people per 10 000 population) at triage of those with confirmed eye conditions, as assessed at 4 weeks after sensitisation in the intention-to-treat population. We estimated the intervention effect using a Student's t-test on cluster-level rates. This trial is registered with Pan African Clinical Trial Registry, number 201807329096632.FindingsBetween Nov 26, 2018, and June 7, 2019, of the 85 community units in Trans Nzoia County, Kenya, 49 were excluded. We randomly allocated 18 community units each to the intervention group (68 348 individuals) and the control group (60 243 individuals). 9387 individuals from the intervention group and 3070 from the control group attended triage assessment. The mean attendance rate at triage by individuals with eye problems was 1429 (92% CI 1228–1629) in the intervention group and 522 (418–625) in the control group (rate difference 906 per 10 000 [95% CI 689–1124; p<0·0001]).InterpretationThe Peek CEH system increased primary care attendance by people with eye problems compared with standard approaches, indicating the potential of this mobile health package to increase service uptake and guide appropriate task sharing.FundingThe Queen Elizabeth Diamond Jubilee Trust and Wellcome Trust.

Evaluation of adherence monitoring system using evriMED with a differentiated response compared to standard of care among drug-sensitive TB patients in three provinces in South Africa: a protocol for a cluster randomised control trial

BackgroundSouth Africa has achieved drug-susceptible TB (DS-TB) treatment success of only 77% among people with new and previously treated TB. Alternative approaches are required to improve medication adherence and treatment completion to limit transmission, TB relapse and the development of resistance. This study aims to implement and evaluate the use of adherence medication monitors (Wisepill evriMED 1000) with a differentiated response to patient care, among DS-TB patients in three provinces of South Africa.MethodsIn total, 18 public health clinics across three provinces were selected. Clinics were randomised to intervention or standard of care clinics. In each clinic, approximately 145 DS-TB patients are being enrolled to reach a total of 2610. All patients have their daily adherence monitored using medication monitors. In the intervention arm, patients are receiving medication monitor reminders and differentiated care in response to adherence data. This weekly review of daily real-time monitoring will be undertaken from a central database. The differentiated care model includes automated SMS reminders with a missed dose, research staff-initiated phone call to the patient with a second or third missed dose, a home visit if four or more doses are missed, and motivational counselling if four or more doses are missed repeatedly. Fidelity of the intervention will be measured through process evaluation. Patients in control clinics will receive medication monitors for adherence tracking, standard of care TB education, and normal clinic follow-up procedures. The primary outcome is the proportion of patients by arm with >80% adherence, as measured by the medication monitor. The feasibility and acceptability of the intervention will be assessed by in-depth interviews with patients, stakeholders, and study staff. A cost effectiveness analysis of the intervention and standard of care clinics will be conducted.SignificanceThis trial will provide evidence for the use of an intervention, including medication monitors and differentiated care package, to improve adherence to TB treatment. Improved adherence should also improve TB treatment completion rates, thus reducing loss to follow-up rates, and TB relapse among people with TB. The intervention is intended to ultimately improve overall TB control and reduce TB transmission in South Africa.Trial registrationPan African Trial Registry PACTR201902681157721. Registered on 11 February 2019.

Structured and sustained family planning support facilitates effective use of postpartum contraception amongst women living with HIV in South Western Uganda: A randomized controlled trial.

BackgroundDespite low pregnancy intentions, many women accessing contraception discontinue use, increasing the risk of unwanted pregnancies among women living with HIV (WLWH). We evaluate whether a family planning support intervention, inclusive of structured immediate one-on-one postpartum counseling, and a follow-up mechanism through additional health information and SMS reminders affects continuous contraceptive use and pregnancy incidence among recently postpartum WLWH.MethodsWe performed a randomized controlled trial between October 2016 and June 2018 at a referral hospital in southwestern Uganda. We included adult WLWH randomized and enrolled in a 1:1 ratio to receive family planning support or standard of care (control) and completed an interviewer-administered questionnaire at enrolment, 6 and 12 months postpartum. Our two primary outcomes of interest were; continuous use of contraception, and incidence of pregnancy. Secondary outcomes included contraception uptake, method change, discontinuation and pregnancy intentions. The trial was registered with clinicaltrials.gov (NCT02964169).ResultsA total of 317(99%) completed all study procedures. Mean age was 29.6 (SD = 6.0) vs 30.0 (SD = 5.9) years for the intervention vs control groups respectively. All women were enrolled on ART. Total women using contraception continuously were 126 (79.8%) in the intervention compared to 110 (69.2%) in control group (odds ratio (OR) = 1.75; confidence interval (CI) = 1.24-2.75, P = 0.003). Pregnancy rates were 2% (N = 3) in the intervention vs 9% (N = 14) in the control group (OR = 0.20, 95% CI = 0.05-0.62, P = 0.006). Pregnancy intention was lower in the intervention vs control group (OR = 0.23, 95% CI = 0.08-0.64, P = 0.002). Women actively enrolled on contraception reduced more in the control compared to the intervention group (OR = 3.92, 95% CI = 1.66-9.77, P = 0.001). Women enrolled on each contraceptive method did not differ by group except for implants. More women initiating contraception use within three months postpartum had better continued use for either intervention (N = 123, 97.6% vs N = 3,2.4%) or control group (N = 86,78.2% vs N = 24,21.8%). Method-related side effects were less reported in the intervention group (OR = 0.25, 95% CI = 0.10-0.60, P = 0.001).ConclusionWe found that sustained and structured family planning support facilitates continuous use of contraception and lowers rates of pregnancy amongst postpartum WLWH in rural southwestern Uganda. Women who initiated contraception within three months postpartum were more likely to maintain continuous use of contraception than those initiating later. Further evaluation of actual and perceived facilitators to the continuous contraception use by this support intervention will help replication in similar settings.Trial registrationNCT02964169

Assessing DNA rates within first time psychiatric referrals and the extent to which DNA rates are reduced by an SMS reminder service

Aims1) To assess the average wait time for patients to be offered an appointment and to establish any correlations between longer waiting times and 'Did not attend (DNA)' rates 2) To assess the number of patients who have opted into the text message appointment reminder service and whether this had an effect on DNA rates.BackgroundResearch has indicated that the Did Not Attend (DNA) rate in Psychiatry is estimated at 20%, twice that of other medical specialties (1). With NHS Digital estimating that DNAs cost the NHS £1 Billion per annum, there has been much interest in reducing the rate of DNAs within Psychiatry (2). Findings have shown that short waiting times are associated with higher rates of attendance (3). In addition, poor appointment attendance within Psychiatry is also associated with increased disease severity and higher rates of hospital admission (4).MethodWe conducted retrospective data collection on 99 patients referred to Professor Oyebode between January 2018 and August 2019. Our data collection involved assessing time the referral was received, time to first appointment and the patient's communication preference (e.g. whether they opted in to the SMS alert service). All data collection was conducted through use of RIO and coded/ammonized into a Excel spreadsheet. No sampling methods were employed and our population only consisted of first-time referrals to Professor Oyebodes clinic.Result1) We found no correlation between a longer waiting time to first appointment and an increased DNA rate.2) All patient waiting times between 1st January - 31st August were within the maximum limit set by national guidelines3) Opting into the text messaging service remains severely low. Of the patients audited, 95% had not completed a communication preference form. Overall, it is still unclear whether the text messaging service has a positive impact on DNA rates.ConclusionOur data have shown no significant correlation between a longer waiting time and an increased DNA rate for first time Psychiatry appointments. Secondly, we have concluded that between the audited period, waiting times were still within the maximum 18 week wait set by the Mental Health Standards. Finally, we can conclude that uptake of the text messaging service remains very low at 4%. Due to a limited sample size of only 4 patients, it is still unclear from this audit whether opting into the text messaging services will have a positive decrease on the number of DNA's.

Text message reminders and peer education increase HIV and Syphilis testing among female sex workers: a pilot quasi-experimental study in Uganda

BackgroundGlobally, female sex workers (FSW) are disproportionately affected by HIV and other sexually transmitted infections (STIs). However, uptake of STI and HIV testing services among FSW in sub-Saharan Africa remains low. We aimed to assess the effect of FSW-led peer education and text message reminders on 3-monthly syphilis and HIV testing among FSW in Uganda.MethodsBetween September 2019 and February 2020, we implemented weekly peer education sessions and bi-monthly SMS reminders for FSW in Mbarara (intervention city). Peer education sessions were implemented by 20 FSW, who received five days of basic training as peer educators. We held monthly meetings with peer educators throughout the six-month implementation period. FSW in Mbale (control city) continued to receive standard of care consisting of HIV testing outreach campaigns, and facility-based testing. Using a quasi-experimental design in one intervention city, and one control city, we conducted pre- and post- questionnaire-based surveys on recent syphilis and HIV testing behavior among FSW in July-October 2018, and March 2020. We compared proportions and prevalence ratios at baseline and follow-up using chi-square tests and negative binomial regression.ResultsWe conducted 436 interviews (200 before/236 after) with FSW. At baseline similar proportions reported taking an HIV test (57 % vs. 54 %; p = 0.72), and a syphilis serology test (35 % vs. 39 %; p = 0.67) in the intervention and control cities, respectively, in the prior three months. After the intervention, this proportion increased to 82 % (95 % confidence interval [CI] 74.0-88.2) for HIV, and 81 % (95 % CI: 73.0–87.0) for syphilis in the intervention city. Relative to baseline in the control city, the proportion testing for HIV was unchanged (52 %) but decreased for syphilis (26 %).ConclusionsBi-monthly text message reminders with weekly peer education sessions increased uptake of 3-monthly syphilis and HIV testing in a Ugandan female sex work population and could help increase sex worker engagement in HIV/STI services in line with World Health Organization recommendations.

PERBANDINGAN TINGKAT KEPATUHAN PASIEN HIPERTENSI YANG DIBERIKAN KONSELING DENGAN ALAT BANTU PESAN PENGINGAT DAN BROSUR

Hypertension is a condition with blood pressure in 140/90 > mmHg. Medication compliance in hypertension patient can control blood pressure. Complience can improve with counseling and use tools of counselling. The aim of this study was to know the effect of counselling with the tools i.e an SMS reminder and brochure for compliance of hypertension patient. The study was observational analytical study by using the instrument of Adherence Morisky questionnaire Modified Scale (MMAS-8) to measure the level of compliance of the patient. Patients (n=61) were divided into 3 groups i.e the patients were only given counselling, given counselling and sms reminder (2 weeks), given counseling and brochures. Results of this study was compliance levels respectively high, medium and low were 21.74%; 43.48% and 34.78% (group counselling), 46.67%; 13.33% and 40% (group counseling and sms reminder) and 39.13%; 34.78% and 26.09% (group counseling and brochures). There was effect of counselling with an SMS reminder and brochure for compliance of hypertension patient (sig. 0,000) and there was no difference for compliance of hypertension patients in patients who given counseling with an SMS reminder or brochure (sig 0,497)