title: Supporting adherence to antiretroviral therapy with mobile phone reminders: results from a cohort in South India.
abstract: BACKGROUND
  Adherence is central to the success of antiretroviral therapy. Supporting adherence has gained importance in HIV care in many national treatment programs. The ubiquity of mobile phones, even in resource-constrained settings, has provided an opportunity to utilize an inexpensive, contextually feasible technology for adherence support in HIV in these settings. We aimed to assess the influence of mobile phone reminders on adherence to antiretroviral therapy in South India. Participant experiences with the intervention were also studied. This is the first report of such an intervention for antiretroviral adherence from India, a country with over 800 million mobile connections.
  
  
  METHODS
  
  
  
  METHODS
  Quasi-experimental cohort study involving 150 HIV-infected individuals from Bangalore, India, who were on antiretroviral therapy between April and July 2010. The intervention: All participants received two types of adherence reminders on their mobile phones, (i) an automated interactive voice response (IVR) call and (ii) A non-interactive neutral picture short messaging service (SMS), once a week for 6 months. Adherence measured by pill count, was assessed at study recruitment and at months one, three, six, nine and twelve. Participant experiences were assessed at the end of the intervention period.
  
  
  RESULTS
  The mean age of the participants was 38 years, 27% were female and 90% urban. Overall, 3,895 IVRs and 3,073 SMSs were sent to the participants over 6 months. Complete case analysis revealed that the proportion of participants with optimal adherence increased from 85% to 91% patients during the intervention period, an effect that was maintained 6 months after the intervention was discontinued (p = 0.016). Both, IVR calls and SMS reminders were considered non-intrusive and not a threat to privacy. A significantly higher proportion agreed that the IVR was helpful compared to the SMS (p<0.001).
  
  
  CONCLUSIONS
  Mobile phone reminders may improve medication adherence in HIV infected individuals in this setting, the effect of which was found to persist for at least 6 months after cessation of the intervention.
authors.affiliation: Division of Global Health, Karolinska Institutet, Stockholm, Sweden. rashmijr@gmail.com
authors.forename: Rashmi
authors.initials: R
authors.lastname: Rodrigues
authors.forename: Anita
authors.initials: A
authors.lastname: Shet
authors.forename: Jimmy
authors.initials: J
authors.lastname: Antony
authors.forename: Kristi
authors.initials: K
authors.lastname: Sidney
authors.forename: Karthika
authors.initials: K
authors.lastname: Arumugam
authors.forename: Shubha
authors.initials: S
authors.lastname: Krishnamurthy
authors.forename: George
authors.initials: G
authors.lastname: D'Souza
authors.forename: Ayesha
authors.initials: A
authors.lastname: DeCosta
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D040421:Cell Phone; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007194:India; D008297:Male; D055118:Medication Adherence; D010349:Patient Compliance; D017010:Reminder Systems; D060145:Text Messaging
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents