Pilot RCT of bidirectional text messaging for ART adherence among nonurban substance users with HIV.
Pilot RCT of bidirectional text messaging for ART adherence among nonurban substance users with HIV.
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DOI：
10.1037/hea0000295
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发表时间：
2015-12
期刊：
影响因子：
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通讯作者：
Hosseinbor S
中科院分区：
文献类型：
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作者：
Ingersoll KS;Dillingham RA;Hettema JE;Conaway M;Freeman J;Reynolds G;Hosseinbor S
这项试点研究测试了基于理论的双向短信干预(TEXT)在HIV感染者中对抗逆转录病毒(ART)依从性、错过护理访问和药物使用的初步效果。来自2个非城市HIV诊所的最近药物使用和ART未坚持的参与者被随机分成TEXT组或常规护理组(UC)。文本干预包括对艺术依从性、情绪和物质使用的日常询问。该系统发送由参与者创建的应急干预消息，用于报告遵守/不遵守、情绪良好/情绪不佳以及没有使用/使用药物。分别在干预前、干预后和干预后3个月进行评估。目的主要结果是依从性，通过过去3个月的药房补充率来衡量，以及错过就诊的比例(PMV)，通过病历来衡量。从时间线回访的药物使用天数的比率是次要结果。63名患者参与，其中33名随机接受TEXT治疗，30名接受UC治疗。干预前依从性为64.0%，PMV为26.9%，使用药物天数比例为53.0%。在干预后，文本条件下的依从性从66%提高到85%，而UC参与者的依从性从62%到71%(p=0.04)。文本参与者的PMV从23%提高到9%，UC参与者从31%提高到28%(p=.12)。在干预后的物质使用天数方面，不同条件之间没有显著差异。在3个月的随访中，差异不显著。个性化的双向短信提高了遵从性，并显示出提高访问出勤率的承诺，但并未减少实质使用天数。这种干预值得进一步测试，而且考虑到其自动化程度，可能具有成本效益。
This pilot study tested the preliminary efficacy of a theory-based bidirectional text messaging intervention (TEXT) on antiretroviral (ART) adherence, missed care visits, and substance use among people with HIV. Participants with recent substance use and ART nonadherence from 2 nonurban HIV clinics were randomized to TEXT or to usual care (UC). The TEXT intervention included daily queries of ART adherence, mood, and substance use. The system sent contingent intervention messages created by participants for reports of adherence/non-adherence, good mood/poor mood, and no substance use/use. Assessments were at pre-intervention, post-intervention, and 3-month post-intervention follow-up. Objective primary outcomes were adherence, measured by past 3-month pharmacy refill rate, and proportion of missed visits (PMV), measured by medical records. The rate of substance-using days from the timeline follow-back was a secondary outcome. Sixty-three patients participated, with 33 randomized to TEXT and 30 to UC. At pre-intervention, adherence was 64.0%, PMV was 26.9%, and proportion of days using substances was 53.0%. At post-intervention, adherence in the TEXT condition improved from 66% to 85%, compared to 62 to 71% in UC participants (p=.04). PMV improved from 23% to 9% for TEXT participants and 31% to 28% in UC participants (p =.12). There were no significant differences between conditions in substance-using days at post-intervention. At 3-month follow-up, differences were not significant. Personalized bidirectional text messaging improved adherence and shows promise to improve visit attendance, but did not reduce substance using days. This intervention merits further testing and may be cost-efficient given its automation.