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，需要高的药物依从性，在撒哈拉以南非洲（SSA），这种依从性低于以前的假设，并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增加依从性的结果，很少有集中在青春期。设法提高青少年的坚持率尤为重要，因为这一群体的艾滋病毒/艾滋病新病例增长最快。这种干预措施在资源有限的情况下是重要的，在二线治疗往往过于昂贵或根本无法获得的情况下是重要的。同样，年轻人往往在接受抗逆转录病毒疗法前接受复方新诺明预防治疗，以推迟接受昂贵的抗逆转录病毒疗法的需要，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的电话覆盖率和拥有率迅速上升，催生了基于移动电话的干预措施，以改善卫生服务的提供;基于短信服务的干预措施已被发现可提高成年患者对抗逆转录病毒疗法的坚持率，但其在青少年人口中的有效性仍不清楚。这种干预措施可能对发展中国家移动的手机拥有量迅速增长的青少年特别有效。该提案建议开发和测试潜在的具有成本效益和可扩展的短信服务（SMS）为基础的干预措施，以提高坚持抗逆转录病毒治疗和抗逆转录病毒治疗前的预防，以及在乌干达的两个诊所15 - 24岁的艾滋病毒阳性年轻患者的护理保留。第一个目标是与主要利益攸关方举行焦点小组会议，使短信干预措施适合当地青年的需要。提出的第二个目标是一个为期两年的随机对照试验测试单向和双向短信（后者为客户提供了由诊所工作人员进行后续跟踪的健康问题信号的可能性）对照常规护理的控制条件，以确定哪种提醒和激励药物依从性的方法可以最好地实现其目标，以及在双向消息中实现的潜在更高的遵守是否证明它们增加的成本是合理的。第三个目标是总结经验教训，并与诊所和其他主要利益攸关方进行讨论。作为这一目标的一部分，还将对单向信息和双向信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.