3 mobile health 4-29-11-psg
TRANSCRIPT
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RTI International
RTI International is a trade name of Research Triangle Institute. www.rti.org
Beyond Reminders: Using Tailored Text-Messages to Promote Knowledge, Prevention, Social Support and Medication Adherence for
People Living with HIV
Project funded by the Agency for Healthcare Research and Quality, contractNumber HHSA290200600001I#7. Findings and conclusions are those of the authors and do not necessarily represent the views of AHRQ.
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RTI International
What really works is…
A tailored, SMS-based
intervention to increase knowledge,
change beliefs, reduce risk behaviors,
enhance social support, and
improve medication adherence
among HIV+ MSM.
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RTI International
Study Purpose
Develop, implement, and test a
tailored SMS-based intervention for HIV+
MSM to enhance outcomes
related to managing HIV
Messages addressed:– sexual risk reduction (tailored)– substance use risk reduction (tailored)– medication adherence (tailored)– social support (tailored/everyone)– general health and well-being (everyone)– patient involvement (everyone)
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RTI International
Evaluation Design
RecruitmentEnrollment
(n=52)
Medical Record Review
Pre-intervention Survey
Assignment to Message
Cluster
Exposure to Intervention
(90 Days)
Patient Interviews
(n=9)and
Clinic Staff Interviews
(n=5)
Medical Record Review
Post-intervention Survey(n=46)
Parallel Data Collection:Input from Study Implementation Team - Text Messaging Archives - Feedback from Site Study Coordinator
Message Cluster:· Medication Adherence· Sexual Risk Reduction· Substance Use Risk Reduction· Social Support
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RTI International
Positive Receptivity to Messages
0%
20%
40%
60%
80%
100%
120%
98%89% 87% 86% 82%
67%
(n=46)
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RTI International
HIV Knowledge, Attitudes and Beliefs
All Participants Participants Receiving Sex Risk Reduction
Messages
n=52 n=46 n=21 n=17HIV knowledge(% items correct)
Believe HIV-positive partnersdo not need to use condom
0%10%20%30%40%50%60%70%80%90%
100%
36%
58%
90%
18%
Baseline Follow-up
% o
f P
artic
ipan
ts
Notes:All differences are statistically significant.Differences between baseline and follow-up participants are due to loss at follow-up or missing data.Smaller n's reflect SMS sent only to those with risk behavior at baseline.
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RTI International
Reduction in Risk Behaviors
Had sex without condom in past 3 months
Rarely/never use alcohol/drugs before/during sex
0%10%20%30%40%50%60%70%80%90%
100%
73%
34%
48%55%
Baseline Follow-up
% o
f P
artic
ipan
ts
Notes:All differences are statistically significant.Differences between baseline and follow-up participants are due to loss at follow-up or missing data.Smaller n's reflect SMS sent only to those with risk behavior at baseline.
n=26 n=22 n=26 n=22
Participants Receiving Sexual Risk Reduction Messages
“I guess there are some things
subconsciously you internalize through
the messages. There has been some
benefit definitely.”
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RTI International
Enhanced Social Support
Social support(score > 3)
0%10%20%30%40%50%60%70%80%90%
100%
60%
82%Baseline Follow-up
% o
f P
artic
ipan
ts
Notes:All differences are statistically significant.Differences between baseline and follow-up participants are due to loss at follow-up or missing data.
Participants Receiving Social Support Messages
n=50 n=45
“I was recently diagnosed as HIV positive, and it’s a
pretty isolating disease…it was nice to receive messages
that are positive about people who are
HIV positive.”
“It wasn’t just information but more community support. You don’t get a lot of support…so it’s nice
to have that.”
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RTI International
Improved self-reported adherence
Missed dosein past7 days
Forgotto take
medication
Slept throughdose time
0%10%20%30%40%50%60%70%80%90%
100%100%
81%
62%53%
38%
23%
Baseline Follow-up
% o
f P
artic
ipan
ts
Notes:All differences are statistically significant.Differences between baseline and follow-up participants are due to loss at follow-up or missing data.Smaller n's reflect SMS sent only to those nonadherent at baseline.
n=21 n=17
Participants Receiving Medication Reminder Messages
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RTI International
Improved clinical outcomes
Measure
Baseline(n=41)
Mean (SD)
Follow-up(n=40)
Mean (SD) p-value
Viral Load 62650.34 (220896.82) 3196.85 (9454.04) .049
CD4 539.34 (301.13) 584.26 (306.57) .101
“It [the study] really helped. My last viral load was 85, which is next to undetectable. I wish
that this would continue.”
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RTI International
Summary of Findings
Among HIV+ MSM, intervention was associated with a statistically significant
increase in knowledge, change in beliefs, reduction in risk behaviors, increase in perceived social support, and improved medication adherence (self reported and
clinical data)
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RTI International
Limitations
Proof-of-concept study– small sample size – no control group– short follow-up period
Study enrollment limited to individuals aged 25 or older so as not to compete with another ongoing study
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RTI International
Directions for Future Research
Full scale study to confirm and expand upon findings– Larger sample size– Control group– Longer-term follow-up– Multiple sites– Younger participants
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RTI International
Contact Information
Jen Uhrig, PhD
RTI International
e-mail: [email protected]
office: 919-316-3311