Text messages helped Kenyans with HIV

Sending simple text messages by cellphone to HIV patients in Kenya increased the likelihood that they would stay healthy, Canadian researchers have found.

The messages were sent once a week, asking "Mambo?" or "How are you?" in Kishwahili.

Study participants were more likely to follow their medication regimen, 62 per cent, compared with 50 per cent among those who didn't get the texts, researchers from the University of British Columbia and the University of Manitoba reported in Tuesday's online issue of The Lancet. 

Those who were randomly assigned to receive the messages were also more likely to have an undetectable level of HIV a year after starting treatment, the researchers found.

"Patients who received the SMS [text messaging] support were more likely to report adherence to anti-retroviral therapy and were more likely to have their viral load suppressed below detection levels than patients who received the standard care alone," the study's authors concluded.

Standard care was limited to counselling at clinic visits.

In the study, patients who received the text messages were asked to respond within 48 hours that either they were doing well ("Sawa") or that they had a problem ("Shida.")

A clinician called patients who said they had a problem or who didn't respond within two days.

The results mean that one extra patient would achieve adherence for every nine patients using the text messaging service and one extra person would achieve viral suppression for every 12 treated, the researchers said.

Getting support

"It's not actually reminders, per se, it's actually the support that they seek, and timely triggers to be able to report on any problems that they have," UBC study author Dr. Richard Lester told the Canadian Press on Tuesday from Washington, where he was presenting the research. 

"It's a weekly check-in and it provides them the chance to report on any problems they have with their medications very early, and then the nurse or clinical officer would actually call them back and sort out those problems and triage them."

About three per cent of participants in the text messaging group reported a need for followup.

The researchers estimated one nurse could potentially manage 1,000 patients by test messaging and expect to call 33 patients per week.

Low-cost idea

The texts might work by improving communication and rapport between the nurse and patients, who reported during the pilot phase that "it feels like someone cares," Benjamin Chi and Jeffrey Stringer agreed in a journal editorial.

The text messages are also inexpensive and the cellphone infrastructure already exists, but it's not yet clear whether the findings would apply to other countries or diseases, the study's authors said.

The findings show the promise of technology in developing countries, said Chi and Stringer, both of the Centre for Infectious Disease Research in Lusaka, Zambia, and the University of Alabama School of Medicine in Birmingham.

"However, technology-based approaches represent only one of many effective means that should be considered by policy-makers and health providers to improve adherence to anti-retrovirals," the pair concluded.

The study was funded by the U.S. President's Emergency Plan for AIDS Relief.