CTN 284: WelTel Retain

About The Study

Patient retention in care (continuing to see their medical professional) and adherence to treatment (following the treatment program) leads to better health outcomes for patients and is important to the success of HIV care programs. Unfortunately, many patients do not consistently remain in care. Furthermore, low-income settings pose extra challenges to maintaining treatment because of increased barriers to access health care.

Cell phones provide new opportunities for communication between medical professionals and their patients. The purpose of this study is to determine if the use of cell phone text-messaging between clinic staff and individuals infected with HIV helps people stay in HIV care.

About The Disease

Access to antiretroviral therapy (ART), the most common treatment for HIV, continues to expand throughout sub-Saharan Africa, and research has shown that high levels of patient retention and adherence to treatment programs are very important to the success of HIV care. Yet, after 6 months, over 20% of patients in low-income areas are no longer on consistent treatment, and after 3 years, 35% are no longer on consistent treatment. Retention is even lower for patients who have not yet begun treatment. New communication technologies like cell phones give us new opportunities to develop strategies to improve treatment and communication between medical professionals and patients.

Study Approach

This study aimed to recruit 700 participants, to be followed-up for 12 months. It took place at two large health centres in Nairobi that offer HIV care and treatment. The clinics serve low-income populations that have minimal access to basic services such as running water, sanitation, and electricity. The participants were randomly placed into one of two groups.

The first group of patients used a cell phone to stay in contact with the medical team. The second group received standard care. Each group had the same number of patients. If the use of cell phones was found to be more effective than standard care at retaining patients, the participants in the group receiving standard care were gradually be moved into the other group after the first phase of the study.

Results

Main results for CTN 284 were published in Lancet Public Health in January 2018. After a median intervention period of 54.3 weeks, no effect was found on retention in care or treatment outcomes. Participants in both groups attended an equivalent number of appointments and initiated ART over a similar time period. Overall retention in the trial population was 80% compared to 65% in the general clinic. In a separate publication, the WelTel Study group evaluated the use of two survey instruments (SF-12 and SF-6D) in this population and concluded that these instruments could be used to assess physical and mental health in people living with HIV in Kenya. Using a culturally adapted version of the SF-12, the team compared HIV-related quality of life in men and women enrolled in the study, published in AIDS Care at the end of 2017. Men and women reported similar mental health scores after receiving a positive HIV test — women reported greater physical health compared to men but this result was not considered clinically significant. Older age and unemployment were negatively correlated with physical health and higher CD4 count and level of education was positively correlated with physical health.

Conclusion

This weekly text-messaging service did not improve retention of people in early HIV care. The intervention might have a modest role in improving self-perceived health-related quality of life for people in HIV care in similar settings.