Development and Pilot Testing of Daily Interactive Voice Response (IVR) Calls to Support Antiretroviral Adherence in India: A Mixed-Methods Pilot Study

Abstract

This two-phase pilot study aimed to design, pilot, and refine an automated Interactive Voice Response (IVR) intervention to support antiretroviral adherence for people living with HIV (PLH), in Kolkata, India. Mixed-methods formative research included a community advisory board (CAB) for IVR message development, one-month pre-post pilot, post-pilot focus groups, and further message development. Two IVR calls are made daily, timed to patients’ dosing schedules, with brief messages (<1-minute) on strategies for self-management of three domains: medical (adherence, symptoms, co-infections), mental health (social support, stress, positive cognitions), and nutrition and hygiene (per PLH preferences). Three ART appointment reminders are also sent each month. One-month pilot results (n=46, 80% women, 60% sex workers) found significant increases in self-reported ART adherence, both within past three days (p=0.05) and time since missed last dose (p=0.015). Depression was common. Messaging content and assessment domains were expanded for testing in a randomized trial is currently underway.

Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence

“…A total of 31 studies, including one dissertation [29] and 30 journal articles, were included for data extraction. Among the studies, 15 used mixed methods [16,17,29–41] and 16 were qualitative studies [15,42–56]. All studies were conducted in a single country.…”

“…All studies were conducted in a single country. Twelve studies were conducted in high-income countries (HICs: Canada and United States) [33,34,40,44–46,48–52,56], 13 in middle-income countries (MICs: Brazil, China, India, Nigeria, Peru, Romania, South Africa, Swaziland, Thailand and Zambia) [15,17,30–32,36,38,41–43,47,53,54] and six in low-income countries (LICs: Mozambique, Rwanda, Tanzania, Uganda and Zimbabwe) [16,29,35,37,55]. The overall studies focused on children living with HIV (two studies) [30,54], adolescents (four studies) [43,45,48,53], adults (21 studies) [15,16–37,39–41,44,46,49–52,54,56] and pregnant women (one study) [55].…”

“…Twenty-three studies provided detailed experiences of PLHIV [15,17,29,32–37,39,40,44–46,48–56]. Thirteen studies explored the experiences of healthcare providers and lay health workers in addition to the experiences of PLHIV [15,16,31,33,35,37,38,41–43,47,54,55].…”

“…Qualitative research provides useful information on personal experiences [14] in addition to social and cultural factors influencing ART adherence [15]. Qualitative research has been increasingly integrated into interventions focused on improving ART adherence [16,17]. …”

Text-Messaging, Online Peer Support Group, and Coaching Strategies to Optimize the HIV Prevention Continuum for Youth: Protocol for a Randomized Controlled Trial (Preprint)

“…Self-monitoring intervention studies have varied based on the frequency of probes; duration, technology platforms; and diverse software development partners. These studies demonstrate feasibility and acceptability [68,69], validity and reliability [70,71], compliance (i.e., protocol adherence) [20,72], and user-preferences [68,73]. The efficacy of theory-based mobile self-monitoring to support self-directed self-management has also been demonstrated [70,[74][75][76][77].…”