Effect of an interactive text-messaging service on patient retention during the first year of HIV care in Kenya (WelTel Retain): an open-label, randomised parallel-group study.
Effect of an interactive text-messaging service on patient retention during the first year of HIV care in Kenya (WelTel Retain): an open-label, randomised parallel-group study.
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DOI：
10.1016/s2468-2667(17)30239-6
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发表时间：
2018-03
期刊：
影响因子：
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通讯作者：
Lester RT
中科院分区：
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作者：
van der Kop ML;Muhula S;Nagide PI;Thabane L;Gelmon L;Awiti PO;Abunah B;Kyomuhangi LB;Budd MA;Marra C;Patel A;Karanja S;Ojakaa DI;Mills EJ;Ekström AM;Lester RT
将患者留在艾滋病毒护理中对于确保及时开始治疗、抑制病毒传播和避免艾滋病相关死亡至关重要。我们进行了一项随机试验，以确定在HIV护理的第一年，短信干预是否改善了保留率。这项不加掩饰的随机平行分组研究是在肯尼亚内罗毕非正式住区的两家诊所进行的。符合条件的参与者年龄在18岁或以上，艾滋病毒呈阳性，拥有自己的移动电话或可以使用移动电话，并且能够使用简单的短信(或者有人可以代表他们发送短信)。参与者被随机分配(1：1)，随机区组大小为2，4和6，分为干预组或对照组。干预组的参与者每周收到一条来自自动Weltel服务的短信，为期1年，并被要求在48小时内做出回应。对照组的参与者没有收到短信。两组参与者都接受了常规护理，包括心理社会支持和咨询；患者教育；CD4细胞计数；治疗；结核病、机会性感染和性传播感染的筛查；预防母婴传播和计划生育服务；以及最多两个错过预约的电话。主要结果是在12个月(即第一次就诊后10-14个月)保留在护理中。没有参加这一为期12个月的预约的参与者被追踪，我们认为那些被确认在其他地方积极接受护理的参与者被保留。数据分析员和诊所工作人员戴着面具参加小组任务，而参与者和研究护士则不戴面具。我们对意向治疗人群进行了分析。这项试验在ClinicalTrials.gov注册，编号NCT01630304。在2013年4月4日至2015年6月4日期间，我们筛选了1068人，其中700人被招募。干预组349人，对照组351人。参与者被跟踪调查的时间中位数为55周(智商51-60)。在12个月时，干预组349名参与者中277名(79%)得以保留，而对照组351名参与者中285名(81%)被保留(风险比0·98，95%可信区间0·91-1·05；p=0·54)。有一个与干预有关的轻微不良事件，当参与者的伴侣对每周的信息和后续电话产生怀疑时，就会发生家庭纠纷。这项每周一次的短信服务并没有改善接受早期艾滋病毒护理的人的保留率。在类似环境中接受艾滋病毒护理的个人，干预措施可能在改善自我感知的与健康相关的生活质量方面起到一定的作用。
Retention of patients in HIV care is crucial to ensure timely treatment initiation, viral suppression, and to avert AIDS-related deaths. We did a randomised trial to determine whether a text-messaging intervention improved retention during the first year of HIV care. This unmasked, randomised parallel-group study was done at two clinics in informal settlements in Nairobi, Kenya. Eligible participants were aged 18 years or older, HIV-positive, had their own mobile phone or access to one, and were able to use simple text messaging (or have somebody who could text message on their behalf). Participants were randomly assigned (1:1), with random block sizes of 2, 4, and 6, to the intervention or control group. Participants in the intervention group received a weekly text message from the automated WelTel service for 1 year and were asked to respond within 48 h. Participants in the control group did not receive text messages. Participants in both groups received usual care, which comprised psychosocial support and counselling; patient education; CD4 cell count; treatment; screening for tuberculosis, opportunistic infections, and sexually transmitted infections; prevention of mother-to-child transmission and family planning services; and up to two telephone calls for missed appointments. The primary outcome was retention in care at 12 months (ie, clinic attendance 10–14 months after the first visit). Participants who did not attend this 12-month appointment were traced, and we considered as retained those who were confirmed to be active in care elsewhere. The data analyst and clinic staff were masked to the group assignment, whereas participants and research nurses were not. We analysed the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01630304. Between April 4, 2013, and June 4, 2015, we screened 1068 individuals, of whom 700 were recruited. 349 people were allocated to the intervention group and 351 to the control group. Participants were followed up for a median of 55 weeks (IQR 51–60). At 12 months, 277 (79%) of 349 participants in the intervention group were retained, compared with 285 (81%) of 351 participants in the control group (risk ratio 0·98, 95% CI 0·91–1·05; p=0·54). There was one mild adverse event related to the intervention, a domestic dispute that occurred when a participant’s partner became suspicious of the weekly messages and follow-up calls. This weekly text-messaging service did not improve retention of people in early HIV care. The intervention might have a modest role in improving self-perceived health-related quality of life in individuals in HIV care in similar settings.