title: Mobile phones to support adherence to antiretroviral therapy: what would it cost the Indian National AIDS Control Programme?
abstract: BACKGROUND
  Adherence to antiretroviral treatment (ART) is critical to maintaining health and good clinical outcomes in people living with HIV/AIDS. To address poor treatment adherence, low-cost interventions using mobile communication technology are being studied. While there are some studies that show an effect of mobile phone reminders on adherence to ART, none has reported on the costs of such reminders for national AIDS programmes. This paper aims to study the costs of mobile phone reminder strategies (mHealth interventions) to support adherence in the context of India's National AIDS Control Program (NACP).
  
  
  METHODS
  The study was undertaken at two tertiary level teaching hospitals that implement the NACP in Karnataka state, South India. Costs for a mobile phone reminder application to support adherence, implemented at these sites (i.e. weekly calls, messages or both) were studied. Costs were collected based on the concept of avoidable costs specific to the application. The costs that were assessed were one-time costs and recurrent costs that included fixed and variable costs. A sequential procedure for costing was used. Costs were calculated at national-programme level, individual ART-centre level and individual patient level from the NACP's perspective. The assessed costs were pooled to obtain an annual cost per patient. The type of application, number of ART centres and number of patients on ART were varied in a sensitivity analysis of costs.
  
  
  RESULTS
  The Indian NACP would incur a cost of between 79 and 110 INR (USD 1.27-1.77) per patient per year, based on the type of reminder, the number of patients on ART and the number of functioning ART centres. The total programme costs for a scale-up of the mHealth intervention to reach the one million patients expected to be on treatment by 2017 is estimated to be 0.36% of the total five-year national-programme budget.
  
  
  CONCLUSIONS
  The cost of the mHealth intervention for ART-adherence support in the context of the Indian NACP is low and is facilitated by the low cost of mobile communication in the country. Extending the use of mobile communication applications beyond adherence support under the national programme could be done relatively inexpensively.
authors.affiliation: Division of Global Health, Department of Public Health Sciences, 17177 Karolinska Institutet, Stockholm, Sweden; St. John's National Academy of Health Sciences, Bangalore, India; rashmijr@gmail.com.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Rodrigues
authors.affiliation: Division of Global Health, Department of Public Health Sciences, 17177 Karolinska Institutet, Stockholm, Sweden; School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Bogg
authors.affiliation: Division of Global Health, Department of Public Health Sciences, 17177 Karolinska Institutet, Stockholm, Sweden; St. John's National Academy of Health Sciences, Bangalore, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Shet
authors.affiliation: National AIDS Control Organisation, New Delhi, India; Karnataka AIDS Prevention Society, Bangalore, India.
authors.forename: Dodderi Sunil
authors.initials: DS
authors.lastname: Kumar
authors.affiliation: Division of Global Health, Department of Public Health Sciences, 17177 Karolinska Institutet, Stockholm, Sweden; Karnataka AIDS Prevention Society, Bangalore, India.
authors.forename: Ayesha
authors.initials: A
authors.lastname: De Costa
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D040421:Cell Phone / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D007194:India; D055118:Medication Adherence; D017010:Reminder Systems / Q000191:economics / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers
chemical_list: D044966:Anti-Retroviral Agents
keywords: India; National AIDS Control Program; adherence reminders; costing; mHealth; mobile phones