WelTel Retain: Promoting Engagement in Pre-ART HIV Care through SMS (Administrative Supplement)

WelTel Retain：通过 SMS 促进对 ART 前 HIV 护理的参与（行政补充）

• 批准号: 9000356
• 负责人: Richard T Lester
• 金额: $ 13.77万
• 依托单位: UNIVERSITY OF BRITISH COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-11 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9000356
• 关键词: AIDS/HIV problem; Adherence; Administrative Supplement; Africa; African; Anti-Retroviral Agents; CD4 Lymphocyte Count; Car Phone; Caring; Cells; Cellular Phone; Chi-Square Tests; Clinic; Clinical; Collaborations; Communication; Community Health Centers; Cost Analysis; Cost Effectiveness Analysis; Cotrimoxazole; Data Analyses; Economics; Effectiveness; Effectiveness of Interventions; Emergency Situation; Emerging Technologies; Enrollment; Evaluation; Failure; Foundations; Funding; Goals; HIV; HIV Seropositivity; Health; Health Personnel; Health system; Hour; Individual; Intention; Intervention; Kenya; Lead; Life; Link; Mann-Whitney U Test; Medical Research; Methods; Notification; Outcome; Participant; Patients; Policy Maker; Proliferating; Public Health; Randomized Controlled Trials; Recommendation; Recruitment Activity; Relative (related person); Reporting; Research; Research Personnel; Risk; Services; Staging; Subgroup; Technology; Telecommunications; Testing; Text; Triage; Viral Load result; Work; World Health Organization; antiretroviral therapy; arm; authority; cost; cost effective; cost effectiveness; critical period; follow-up; improved; mHealth; patient oriented; primary outcome; programs; response; satisfaction; service intervention; standard care; standard of care; success; therapy adherence; transmission process

DESCRIPTION (provided by applicant): Patient retention in care is critical to the success of programs funded by the President's Emergency Relief Plan for HIV/AIDS (PEPFAR). High levels of patient retention after first clinical contact contribute to the timely initiation of antiretroviral therapy (ART) and better health outcomes for patients. With the dramatic proliferation of cell phone use in Africa, telecommunications technology offers new opportunities to improve retention using a low-cost, culturally appropriate format. Our long-term research goal is to capitalize on the almost ubiquitous use of cellular phones to implement a sustainable mHealth service that improves health outcomes and supports patient engagement in care. In Kenya (WelTel Kenya1), a weekly short message service (SMS) text message led to improved ART adherence and viral load suppression. This study, WelTel Retain, will evaluate the effect of WelTel on retaining pre-ART patients in care and determine the cost- effectiveness of the intervention. Specific Aims: 1) To determine if the WelTel SMS intervention improves patient retention in the first stage of HIV care. 2) To determine whether the WelTel SMS intervention improves 12-month retention. 3) To evaluate the cost-effectiveness of the WelTel SMS intervention. Research Strategy: We will conduct a randomized controlled trial at the Kibera Community Health Centre in Nairobi, Kenya. Over one year, HIV positive individuals newly enrolling at the clinic will be recruited and randomly allocated to an intervention or control arm t a 1:1 ratio. Intervention arm participants will receive a weekly SMS 'check-in' to which they will be required to respond within 48 hours. An HIV clinician will follow-up and triage any problems that are identified. The control arm will receive standard of care. Patients will be followed for oe year, with a primary endpoint of retention in care at 12 months. Analysis: Enrolling 686 participants provides 80% power to detect a proportionate difference of 15% in the primary outcome (alpha=0.05). We will analyze data according to intention to treat principles. Chi-squared tests will be used for categorical outcomes; t-tests or Mann-Whitney U tests for continuous outcomes, and regression methods with appropriate interaction terms for subgroup analyses. Economic estimates include the incremental cost-effectiveness ratio per extra patient retained and the cost per life-year gained. Significance: The WelTel Retain study will contribute critical information on the effectiveness of an mHealth program to engage patients in care during the first year of HIV care. This research has the potential to demonstrate that the WelTel SMS intervention is an effective, feasible retention strategy, which can contribute significantly t the long-term success of PEPFAR-funded programs and towards a sustainable global HIV/AIDS response.

描述(由申请人提供)：留住病人对总统艾滋病紧急救济计划(PEPFAR)资助的计划的成功至关重要。首次临床接触后患者留存的高水平有助于及时开始抗逆转录病毒治疗(ART)，并为患者提供更好的健康结果。随着手机在非洲的使用急剧增加，电信技术提供了新的机会，可以使用低成本、适合文化的格式来提高留存率。我们的长期研究目标是利用几乎无处不在的移动电话使用来实施可持续的mHealth服务，以改善健康结果并支持患者参与护理。在肯尼亚(Weltel Kenya1)，每周一次的短信服务(短信)导致了抗逆转录病毒治疗依从性的改善和病毒载量的抑制。这项名为Weltel Retain的研究将评估Weltel在保留接受抗逆转录病毒治疗前患者方面的效果，并确定干预措施的成本效益。具体目标：1)确定Weltel短信干预是否改善了患者在艾滋病毒护理的第一阶段的留存情况。2)确定Weltel短信干预是否提高了12个月的保留率。3)评价Weltel短信干预的成本效益。研究策略：我们将在肯尼亚内罗毕的基贝拉社区卫生中心进行一项随机对照试验。在一年多的时间里，诊所将招募新登记的艾滋病毒阳性者，并按1：1的比例随机分配到干预或对照小组。干预ARM参与者将收到每周一次的短信“签到”，他们将被要求在48小时内回复。艾滋病毒临床医生将对发现的任何问题进行跟踪和分类。控制臂将得到标准护理。患者将接受为期一年的随访，主要终点是在12个月内留存护理。分析：招募686名参与者提供了80%的力量来检测主要结果中15%的比例差异(阿尔法=0.05)。我们将根据意向治疗原则分析数据。分类结果将使用卡方检验；连续结果将使用t检验或Mann-Whitney U检验，亚组分析将使用带有适当交互条件的回归方法。经济估算包括每多保留一名患者的增量成本-效果比和每一生命年获得的成本。重要意义：Weltel RETAIN研究将提供有关mHealth计划在HIV护理的第一年让患者参与护理的有效性的关键信息。这项研究有可能证明，Weltel短信干预是一种有效、可行的保留战略，可以为PEPFAR资助的项目的长期成功和可持续的全球艾滋病毒/艾滋病应对做出重大贡献。

项目成果

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.

• DOI: 10.1016/s2468-2667(17)30239-6
• 发表时间: 2018-03
• 期刊: The Lancet. Public health
• 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
• 通讯作者: Lester RT

Gender differences in health-related quality of life at the time of a positive HIV test - a cross-sectional study in a resource-poor, high prevalence setting in Nairobi, Kenya.

HIV 检测呈阳性时健康相关生活质量的性别差异 - 在肯尼亚内罗毕资源匮乏、患病率高的环境中进行的一项横断面研究。

• DOI: 10.1080/09540121.2017.1417970
• 发表时间: 2018
• 期刊: AIDS care
• 影响因子: 1.7
• 作者: vanderKop,MiaL;Muhula,Samuel;Patel,Anik;Thabane,Lehana;Awiti,Patricia;Kyomuhangi,Lennie;Abunah,Bonface;Nagide,PatrickI;Smillie,Kirsten;Ojakaa,DavidI;Kimani,Joshua;Ekström,AnnaMia;Lester,RichardT
• 通讯作者: Lester,RichardT

Mobile health for early retention in HIV care: a qualitative study in Kenya (WelTel Retain).

移动医疗促进艾滋病毒护理早期保留：肯尼亚的一项定性研究 (WelTel Retain)。

• DOI: 10.2989/16085906.2014.961939
• 发表时间: 2014
• 期刊: African journal of AIDS research : AJAR
• 作者: Smillie,Kirsten;VanBorek,Natasha;vanderKop,MiaL;Lukhwaro,Abigael;Li,Neville;Karanja,Sarah;Patel,AnikR;Ojakaa,David;Lester,RichardT
• 通讯作者: Lester,RichardT

Retention in clinic versus retention in care during the first year of HIV care in Nairobi, Kenya: a prospective cohort study.

肯尼亚内罗毕艾滋病毒护理第一年的临床保留与护理保留：一项前瞻性队列研究。

• DOI: 10.1002/jia2.25196
• 发表时间: 2018
• 期刊: Journal of the International AIDS Society
• 影响因子: 6
• 作者: vanderKop,MiaL;Nagide,PatrickI;Thabane,Lehana;Gelmon,Lawrence;Kyomuhangi,LennieB;Abunah,Bonface;Ekström,AnnaMia;Lester,RichardT
• 通讯作者: Lester,RichardT

Advanced HIV disease at presentation to care in Nairobi, Kenya: late diagnosis or delayed linkage to care?--a cross-sectional study.

• DOI: 10.1186/s12879-016-1500-8
• 发表时间: 2016-04-18
• 期刊: BMC infectious diseases
• 影响因子: 3.7
• 作者: van der Kop ML;Thabane L;Awiti PO;Muhula S;Kyomuhangi LB;Lester RT;Ekström AM
• 通讯作者: Ekström AM