In-Depth Analysis of Patient-Clinician Cell Phone Communication during the WelTel Kenya1 Antiretroviral Adherence Trial |
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| Authors: | Mia L. van der Kop Sarah Karanja Lehana Thabane Carlo Marra Michael H. Chung Lawrence Gelmon Joshua Kimani Richard T. Lester |
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| Affiliation: | 1. University of British Columbia, Vancouver, British Columbia, Canada.; 2. British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.; 3. University of Manitoba, Nairobi, Kenya.; 4. McMaster University, Hamilton, Ontario, Canada.; 5. University of Washington, Seattle, Washington, United States of America.; 6. University of Nairobi, Nairobi, Kenya.; University of Pennsylvania, United States of America, |
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| Abstract: | BackgroundThe WelTel Kenya1 trial demonstrated that text message support improved adherence to antiretroviral therapy (ART) and suppression of HIV-1 RNA load. The intervention involved sending weekly messages to patients inquiring how they were doing; participants were required to respond either that they were well or that there was a problem.Objectives1) Describe problems participants identified through mobile phone support and reasons why participants did not respond to the messages; 2) investigate factors associated with indicating a problem and not responding; and 3) examine participant perceptions of the intervention.DesignSecondary analysis of WelTel Kenya1 trial data.MethodsReasons participants indicated a problem or did not respond were extracted from the study log. Negative binomial regression was used to determine participant characteristics associated with indicating a problem and non-response. Data from follow-up questionnaires were used to describe participant perceptions of the intervention.ResultsBetween 2007 and 2009, 271 participants generated 11,873 responses; 377 of which indicated a problem. Health issues were the primary reason for problem responses (72%). Rural residence (adjusted incidence rate ratio [IRR] 1.96; 95%CI 1.19–3.25; p = 0.009 and age were associated with indicating a problem (adjusted IRR 0.63 per increase in age group category; 95%CI 0.50–0.80; p<0.001). Higher educational level was associated with a decreased rate of non-response (adjusted IRR 0.81; 95%CI 0.69–0.94; p = 0.005). Of participants interviewed, 62% (n = 129) stated there were no barriers to the intervention; cell phone issues were the most common barrier. Benefits included reminding patients to take medication and promoting a feeling that “someone cares”.ConclusionsThe WelTel intervention enabled frequent communication between clinicians and patients during the WelTel Kenya1 trial. Many patients valued the service for the support it provided, with health-related concerns comprising the majority of problems identified by participants. Few sociodemographic characteristics were associated with participant engagement in the intervention. |
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