Evaluation of mHealth strategies to optimize adherence and efficacy of PMTCT/ART

评估移动医疗策略以优化 PMTCT/ART 的依从性和疗效

• 批准号: 9060183
• 负责人: Grace John-Stewart
• 金额: $ 66.43万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9060183
• 关键词: AIDS prevention; Adherence; Adult; Africa; Anti-Retroviral Agents; Antiretroviral resistance; Breast Feeding; CD4 Lymphocyte Count; Car Phone; Caring; Cellular Phone; Characteristics; Clinic; Collaborations; Cost Savings; Counseling; Data; Detection; Disclosure; Drug resistance; Education; Engineering; Enrollment; Evaluation; Evidence based intervention; Face; Failure; Frequencies; Future; Guidelines; HIV; HIV Infections; Health; Health Personnel; Health Technology; Health system; Human immunodeficiency virus test; Individual; Infant; Infant Health; Intervention; Investments; Kenya; Literature; Malawi; Maternal Health; Maternal and Child Health; Mother-to-child HIV transmission; Mothers; Outcome; Outcome Measure; Perception; Postpartum Period; Pregnancy; Pregnant Women; Prevention; Preventive; Program Effectiveness; Program Efficiency; Provider; Qualitative Research; Randomized Clinical Trials; Regimen; Reminder Systems; Research; Resistance; Risk; Sexual Partners; System; Technology; Testing; Time; Treatment Failure; Universities; Washington; Woman; antiretroviral therapy; arm; cohort; computer science; cost; cost effective; cost effectiveness; flexibility; follow-up; improved; infant outcome; innovation; mHealth; prevent; programs; randomized trial; therapy adherence; therapy development; therapy outcome; transmission process; treatment program; trial comparing; virtual

DESCRIPTION (provided by applicant): In 2013, WHO recommended that all HIV-infected women receive ART for PMTCT (PMTCT-ART). This approach provides treatment benefits for mothers and preventive benefits for their infants and sexual partners, and implementation advantages. However, there are valid concerns about risks of this approach if maternal retention or adherence falters. PMTCT programs have demonstrated remarkable flexibility to incorporate new HIV-specific counseling, testing and educational messages in maternal child health (MCH) clinics. PMTCT programs now need to add adherence and retention support for all women initiating lifelong ART in settings where health care workers are already overburdened. mHealth messaging is an evidence- based intervention that is attractive for this purpose. mHealth strategies have been shown to significantly decrease treatment failure in adult ART adult treatment programs in Africa and may provide an inexpensive, feasible approach to enhance PMTCT-ART outcomes without burdening health care workers. Our overarching hypothesis is that investment in mHealth for retention and adherence in PMTCT-ART will provide cost-effective benefit in sustaining antiretroviral regimen efficacy and durability. We have collaborated with the UW Department of Computer Sciences and Kenyan cell-phone providers to develop both inexpensive automated personalized SMS messaging and an innovative two-way SMS messaging system, currently in use MCH clinics in Kenya. In qualitative research, women in Kenya have expressed a strong desire for mHealth support to provide additional education, counseling and reminders to supplement counseling by health workers. We hypothesize that mHealth strategies will improve PMTCT-ART maternal and infant outcomes. We also posit that both one-way and two-way SMS approaches will be cost-effective, and that two-way SMS may be superior to one-way SMS. We propose a 3-arm randomized trial comparing one-way SMS vs, two-way SMS vs. control (no SMS) among HIV-infected Kenyan mothers in Kenyan PMTCT-ART programs. In AIM 1 we will compare trial arms for impact on maternal retention, adherence, virologic failure and resistance and infant HIV or HIV-free survival. In AIM 2, we will determine correlates of maternal loss to follow-up and virologic failur and correlates of infant HIV in the overall and stratified by trial arm. In the two-way SMS arm, we will determine rate of SMS interactivity, impact of critical time-points, and characteristics of high and low 'interactors'. In AIM 3, we will determine cost-effectiveness of one-way and two-way SMS interventions. These data will contribute a potential scale-able strategy to improve PMTCT-ART as programs aspire to 'virtual elimination' of infant HIV.

描述（由申请人提供）：2013 年，世界卫生组织建议所有感染艾滋病毒的妇女接受抗逆转录病毒疗法（ART）以预防母婴传播（PMTCT-ART）。这种方法为母亲提供治疗益处，为婴儿和性伴侣提供预防益处，并具有实施优势。然而，如果母亲保留或依从性动摇，人们对这种方法的风险存在合理的担忧。 PMTCT 计划表现出了非凡的灵活性，可以将针对艾滋病毒的新咨询、检测和教育信息纳入妇幼保健 (MCH) 诊所。 PMTCT 计划现在需要为所有在医护人员已经负担过重的环境中开始终身接受 ART 的女性提供坚持和保留支持。移动医疗信息传递是一种基于证据的干预措施，对此目的很有吸引力。事实证明，移动医疗策略可以显着减少非洲成人 ART 成人治疗计划的治疗失败，并可能提供一种廉价、可行的方法来增强 PMTCT-ART 的结果，而不会给医护人员带来负担。我们的总体假设是，对 mHealth 的投资以保留和坚持 PMTCT-ART 将为维持抗逆转录病毒治疗方案的功效和持久性提供具有成本效益的效益。我们与华盛顿大学计算机科学系和肯尼亚手机提供商合作，开发了廉价的自动个性化 SMS 消息传递和创新的双向 SMS 消息传递系统，目前已在肯尼亚的妇幼保健诊所使用。在定性研究中，肯尼亚妇女表示强烈希望获得移动医疗支持，以提供额外的教育、咨询和提醒，以补充卫生工作者的咨询。我们假设移动医疗策略将改善 PMTCT-ART 孕产妇和婴儿的结局。我们还认为单向和双向 SMS 方法都具有成本效益，并且双向 SMS 可能优于单向 SMS。我们提出了一项三臂随机试验，比较肯尼亚 PMTCT-ART 项目中感染 HIV 的肯尼亚母亲的单向 SMS 与双向 SMS 与对照（无 SMS）。在 AIM 1 中，我们将比较试验组对孕产妇保留、依从性、病毒学失败和耐药性以及婴儿艾滋病毒或无艾滋病毒生存的影响。在 AIM 2 中，我们将确定孕产妇死亡与随访和病毒学失败的相关性，以及总体上按试验组分层的婴儿 HIV 的相关性。在双向短信臂中，我们将确定短信交互率、关键时间点的影响以及短信的特征。 高和低“交互者”。在 AIM 3 中，我们将确定单向和双向短信干预的成本效益。这些数据将为改善 PMTCT-ART 提供潜在的可扩展策略，因为项目旨在“虚拟消除”婴儿艾滋病毒。