The Use of Cell Phone Reminder Calls for Assisting HIV-Infected Adolescents and Young Adults to Adhere to Highly Active Antiretroviral Therapy: A Pilot Study

Abstract

Long-term medication regimen adherence is challenging in all populations, but in the HIVinfected adolescent population the frequency of poverty, homelessness, substance abuse, and mental illness make highly active antiretroviral therapy (HAART) adherence even more challenging. In 2003, we developed a pilot program for HIV-infected adolescents and young adults between the ages of 16 and 24 who were either going to begin a HAART regimen for the first time or begin a new HAART regimen. Participants received a free cell phone with a local service plan for approximately 6 months. Participants received phone call reminders for 12 weeks. Call frequency was tapered at 4-week intervals. Patients were assessed at 4-week intervals to determine the perceived intrusiveness or helpfulness of receiving calls, and missed medication doses. Eight consecutive patients were recruited for the study, and five were able to complete it through the 24 weeks. Most participants found the calls to be helpful and the level of intrusion into their daily lives acceptable. Using cell phone reminders to assist patients does not require an extensive amount of daily staff time. Tapering calls rapidly over 3 months, followed by discontinuation of calls provided inadequate support for subjects, especially those with significant psychosocial issues such as substance abuse. Use of cell phone reminders to assist adolescents adhere with HIV medications was practical and acceptable to pilot study participants. Viral suppression waned for all but two patients after termination of cell phone reminders and suggests that a 12-week intervention was not adequate for most subjects. Larger prospective studies of cell phone observation of therapy will be needed to determine if this intervention can improve long-term adherence and health outcomes.

Acceptability and Feasibility of a Cell Phone Support Intervention for Youth Living with HIV with Nonadherence to Antiretroviral Therapy

“…This study intervention has demonstrated a fairly robust impact when compared to previous interventions for youth living with HIV who demonstrate poor adherence. [10][11][12][13] This study evaluated a very nonadherent population based on low baseline adherence (33% in past month) and very high baseline viral loads …”

“…8,9 There have been several studies of modestly successful intervention approaches for youth living with HIV who had poor medication adherence including motivational interviewing, 10 directly observed therapy, 11 personalized text message reminders, 12 and cell phone call reminders. 13 More recently, we published an initial randomized controlled trial utilizing cell phone support among nonadherent virologically detectable youth which demonstrated statistically significant improvements in self-reported adherence and reduction in HIV RNA (viral load) at the conclusion of the 24-week intervention and 24 weeks following the completion of the intervention. There were large to medium effect sizes.…”

Reminder use to improve service referral use among participants in a community engagement program (Preprint)

“…Reasons frequently cited by patients missing their appointments are "forgetting the appointment" or "misunderstanding the date or time of the appointment" or "lack of motivation to go to the appointment" [7][8][9][10]. Phone calls, postal, and text reminders have been extensively studied as memory aids to reduce missed appointments [11][12][13]. Mobile phone-based reminders have been found to be effective interventions for missed health care appointments and they increase the rate of attendance among clinical populations.…”

Mobile Health Applications User Trends in Turkey

“…While some of them aim to improve care for those with chronic diseases, such as texting reminders to improve adherence to treatment in people with HIV (Puccio et al, 2006), the others aim to promote youth sexual health and disease prevention by downloading applications via smartphones (Levine, 2007). More advanced programs facilitate two-way communications between clients and their healthcare providers, for example, in the self management of diabetes, with clients texting their blood glucose levels and their clinicians reporting back recommendations to alter management (Kim, H-S., Kim, N-C., & Ahn, 2006;Ferrer-Roca, Cardenas, & Diaz-Cardama, 2004).…”