title: Using no-cost mobile phone reminders to improve attendance for HIV test results: a pilot study in rural Swaziland.
abstract: BACKGROUND
  Mobile technology has great potential to improve adherence and treatment outcomes in healthcare settings. However, text messaging and phone calls are unaffordable in many resource-limited areas. This study investigates the use of a no-cost alternative mobile phone technology using missed calls ('buzzing') to act as a patient reminder. The use of missed calls as a patient reminder was evaluated for feasibility and effectiveness as an appointment reminder in the follow-up of newly-diagnosed human immunodeficiency virus (HIV) positive patients in an HIV testing and counselling department in rural Swaziland.
  
  
  METHODS
  This pilot study uses a before-and-after operational research study design, with all patients with mobile phones being offered the intervention. The primary outcome was the rate of attendance at the HIV testing and counselling department for collection of results in those with mobile phones before and after the introduction of the intervention.
  
  
  RESULTS
  Over two-thirds, 71.8% (459/639), of patients had a mobile phone. All patients with a mobile phone consented to being buzzed. There was no difference in attendance for follow-up at the clinic before and after the intervention was implemented (80.1% versus 83.3%, p = 0.401), or after adjusting for confounding factors (OR 1.13, p = 0.662).
  
  
  CONCLUSIONS
  This pilot study illustrates that mobile technology may be feasible in rural, resource-poor settings as there are high rates of mobile phone ownership and the intervention had a 100% uptake rate, with positive feedback from staff and patients. In this particular setting, the intervention did not improve attendance rates. However, further research is planned to investigate the impact on adherence to appointments and medications in other settings, such as HIV chronic care follow-up and as part of an enhanced package to improve adherence.
authors.affiliation: Nuffield Centre for International Health & Development, University of Leeds, Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK. meravkliner@nhs.net.
authors.forename: Merav
authors.initials: M
authors.lastname: Kliner
authors.forename: Abigail
authors.initials: A
authors.lastname: Knight
authors.forename: Canaan
authors.initials: C
authors.lastname: Mamvura
authors.forename: John
authors.initials: J
authors.lastname: Wright
authors.forename: John
authors.initials: J
authors.lastname: Walley