Improving Drug Adherence Among Adolescents in Uganda using SMS Reminders

描述（由申请人提供）：为了实现艾滋病毒护理的好处，需要高度的药物依从性，在撒哈拉以南非洲（SSA），这种依从性比以前假设的要低，并且随着时间的推移而下降。情感和认知能力仍在发展的青少年在坚持服药方面面临着特殊和独特的挑战。尽管有大量的干预措施旨在提高依从性结果，但很少有人关注青春期。制定提高青少年服药率的方法尤为重要，因为这一群体的新艾滋病毒/艾滋病病例增长最快。这种干预措施在资源有限的环境中很重要，在二线治疗往往过于昂贵或完全无法获得的情况下很重要。同样，年轻人经常接受抗逆转录病毒治疗前联合新诺明预防，以推迟接受昂贵的抗逆转录病毒治疗的需要，但大多数干预措施没有考虑到这一现实。最近发展中国家人口中移动电话覆盖率和拥有量的迅速增加，催生了基于移动电话的干预措施，以改善卫生服务的提供；基于短信服务（SMS）的干预措施已被发现可提高成年患者对抗逆转录病毒治疗的依从率，但其在青少年人群中的有效性尚不清楚。这种干预措施可能对青少年特别有效，因为他们是发展中国家移动电话拥有量快速增长的核心。该建议建议开发和测试具有潜在成本效益和可扩展的基于短信服务（SMS）的干预措施，以改善对抗逆转录病毒治疗和抗逆转录病毒治疗前预防的依从性，并在乌干达的两个诊所改善15-24岁艾滋病毒阳性年轻患者的护理。第一个目标是与主要持份者举行焦点小组，以调整短信干预措施，以适应当地青少年的需要。第二个目标是一项为期两年的随机对照试验，测试单向和双向短信（后者为客户提供了向诊所工作人员发出健康问题信号的可能性）与常规护理的对照条件，以确定哪种提醒和激励药物依从性的方法最能实现其目标，以及双向短信中潜在的更高依从性是否证明其增加的成本是合理的。第三个目标是综合吸取的经验教训，并与诊所和其他关键利益攸关方进行讨论。作为这一目标的一部分，还将对单向与双向消息进行成本效益分析。

DESCRIPTION (provided by applicant): To realize the benefits of HIV care requires high medication adherence that has been found lower than previously assumed and declining over time in sub-Saharan Africa (SSA). Youths with still developing emotional and cognitive capacities face special and unique challenges to adherence. Despite a wealth of interventions designed to increase adherence outcomes, few have focused on the period of adolescence. Developing ways to increase adherence rates among adolescents is particularly important as this group experiences the fastest growth in new HIV/AIDS cases. Such interventions are important in resource-limited settings important where second-line therapy is often too expensive or altogether unavailable. Similarly, youths are often on pre-ART co-trimoxazole prophylaxis to defer the need to take costly ART, yet most interventions do not take this reality into account. The recent rapid rise in mobile phone coverage and ownership among developing country populations has spawned the advent of mobile-phone based interventions to improve health service delivery; short message service (SMS)-based interventions have been found to increase adherence rates to ART among adult patients, yet their effectiveness among an adolescent population remains unknown. Such interventions are likely particularly effective for adolescents who have been central to the rapid growth in mobile phone ownership in developing countries. This proposal suggests to develop and test potentially cost-effective and scalable short message service (SMS)-based interventions to improve adherence to ART and pre-ART prophylaxis, as well as retention in care among HIV positive young patients aged 15-24 at two clinics in Uganda. The first aim is to hold focus groups with key stakeholders to tailor the SMS-intervention to the local needs of youths. The second aim proposed is a two-year randomized controlled trial testing one- way and two-way SMS messages (the latter offer the possibility for clients to signal health problems for follow-up by clinic staff) against a control condition of usual care to determine which method of reminding and motivating drug adherence can best achieve its goals, and whether the potentially higher adherence achieved in the two-way messages justify their increased cost. The third aim is to synthesize lessons learned and discuss them with the clinics and other key stakeholders. A cost-effectiveness analysis of one- versus two-way messages will also be performed as part of this aim.