Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders.
Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders.
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DOI：
10.2196/jmir.2015
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发表时间：
2012-04-05
影响因子：
7.4
通讯作者：
Garofalo R
中科院分区：
文献类型：
--
作者：
Dowshen N;Kuhns LM;Johnson A;Holoyda BJ;Garofalo R
对于感染人体免疫缺陷病毒（艾滋病毒）/获得性免疫缺陷综合症（艾滋病）的青年人来说，不坚持抗逆转录病毒疗法（ART）可能导致健康状况不佳，预期寿命大幅缩短。评估短信服务（SMS）或短信提醒的可行性，可接受性和初步疗效，以提高艾滋病毒/艾滋病感染者/青年对抗逆转录病毒治疗的依从性。2009年至2010年，我们在一家为艾滋病毒/艾滋病感染者提供临床服务的社区卫生中心进行了这项前瞻性试点研究。合格标准包括艾滋病毒阳性血清状态，年龄14-29岁，使用个人手机，讲英语，正在接受抗逆转录病毒治疗，记录在案的依从性差。在为期24周的研究期间，参与者收到个性化的每日短信提醒和1小时后的随访消息，评估他们是否服用药物，并要求参与者通过短信回复数字1，如果他们服用药物，2如果他们没有。结果的措施是可行性，可接受性和遵守。采用视觉模拟量表（VAS）和艾滋病临床试验组（ACTG）问卷4天回忆来确定自我报告的依从性。在0、12和24周时，病毒载量和CD 4细胞计数作为粘附和疾病进展的生物标志物进行随访。参与者（N = 25）平均年龄23岁（范围14-29），92%（n = 23）男性，60%（n = 15）黑人，84%（n = 21）通过无保护性行为感染。与基线相比，第12周和第24周的平均VAS评分显着增加（第0周：74.7，第12周：93.3，P < .001;第24周：93.1，P < .001）。ACTG问卷4天回忆也有所改善（第0周：2.33，第12周：3.24，P = .002;第24周：3.19，P = .005）。基线和12周或24周随访之间的CD 4细胞计数或病毒载量无显著差异，尽管这些生物标志物有改善的趋势，标准化效应量较小至中等（Cohen d范围：-0.51至0.22）。在25名参与者中，有21名（84%）被保留，完成研究的21名参与者中有20名（95%）发现干预有助于避免遗漏剂量。在这项试点研究中，个性化，互动，每日短信提醒是可行的和可接受的，他们显着提高自我报告的遵守。需要进行更大规模的对照研究，以确定这种干预措施对艾滋病毒/艾滋病感染青年坚持抗逆转录病毒治疗和其他相关健康结果的影响。
For youth living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), nonadherence to antiretroviral therapy (ART) can lead to poor health outcomes and significantly decreased life expectancy. To evaluate the feasability, acceptability, and preliminary efficacy of short message service (SMS) or text message reminders to improve adherence to ART for youth living with HIV/AIDS. We conducted this prospective pilot study using a pre–post design from 2009 to 2010 at a community-based health center providing clinical services to youth living with HIV/AIDS. Eligibility criteria included HIV-positive serostatus, age 14–29 years, use of a personal cell phone, English-speaking, and being on ART with documented poor adherence. During the 24-week study period, participants received personalized daily SMS reminders and a follow-up message 1 hour later assessing whether they took the medication, and asking participants to respond via text message with the number 1 if they took the medication and 2 if they did not. Outcome measures were feasibility, acceptability, and adherence. Self-reported adherence was determined using the visual analog scale (VAS) and AIDS Clinical Trial Group (ACTG) questionnaire 4-day recall. Viral load and CD4 cell count were followed as biomarkers of adherence and disease progression at 0, 12, and 24 weeks. Participants (N = 25) were mean age 23 (range 14–29) years, 92% (n = 23) male, 60% (n = 15) black, and 84% (n = 21) infected through unprotected sex. Mean VAS scores significantly increased at 12 and 24 weeks in comparison with baseline (week 0: 74.7, week 12: 93.3, P < .001; week 24: 93.1, P < .001). ACTG questionnaire 4-day recall also improved (week 0: 2.33, week 12: 3.24, P = .002; week 24: 3.19, P = .005). There was no significant difference in CD4 cell count or viral load between baseline and 12- or 24-week follow-up, although there was a trend toward improvement of these biomarkers and a small to moderate standardized effect size (range of Cohen d: –0.51 to 0.22). Of 25 participants, 21 (84%) were retained, and 20 of the 21 (95%) participants who completed the study found the intervention helpful to avoid missing doses. In this pilot study, personalized, interactive, daily SMS reminders were feasible and acceptable, and they significantly improved self-reported adherence. Larger controlled studies are needed to determine the impact of this intervention on ART adherence and other related health outcomes for youth living with HIV/AIDS.
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