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.

Public Health Relevance

Engaging HIV-infected individuals in care is critical to the long-term success of programs funded by the President's Emergency Relief Plan for HIV/AIDS (PEPFAR). By retaining patients in care before they start treatment, the WelTel cell phone text messaging intervention could improve the health outcomes of people infected with HIV/AIDS and even reduce the risk of HIV transmission. Establishing the cost-effectiveness of WelTel could ultimately lead to health system efficiencies that save millions of dollars.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH097558-03
Application #
8644944
Study Section
Special Emphasis Panel (ZMH1-ERB-D (01))
Program Officer
Gordon, Christopher M
Project Start
2012-06-11
Project End
2015-03-31
Budget Start
2014-04-01
Budget End
2015-03-31
Support Year
3
Fiscal Year
2014
Total Cost
$175,522
Indirect Cost
$13,002
Name
University of British Columbia
Department
Type
DUNS #
251949962
City
Vancouver
State
BC
Country
Canada
Zip Code
V6 1-Z3
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van der Kop, Mia L; Muhula, Samuel; Ekström, Anna M et al. (2017) Participation in a mobile health intervention trial to improve retention in HIV care: does gender matter? J Telemed Telecare 23:314-320
van der Kop, Mia Liisa; Thabane, Lehana; Awiti, Patricia Opondo et al. (2016) Advanced HIV disease at presentation to care in Nairobi, Kenya: late diagnosis or delayed linkage to care?--a cross-sectional study. BMC Infect Dis 16:169
Jongbloed, Kate; Parmar, Sunjit; van der Kop, Mia et al. (2015) Recent Evidence for Emerging Digital Technologies to Support Global HIV Engagement in Care. Curr HIV/AIDS Rep 12:451-61
Smillie, Kirsten; Van Borek, Natasha; van der Kop, Mia L et al. (2014) Mobile health for early retention in HIV care: a qualitative study in Kenya (WelTel Retain). Afr J AIDS Res 13:331-8
van der Kop, Mia L; Ojakaa, David I; Patel, Anik et al. (2013) The effect of weekly short message service communication on patient retention in care in the first year after HIV diagnosis: study protocol for a randomised controlled trial (WelTel Retain). BMJ Open 3: