Background
WelTel is a non-governmental organization committed to providing evidence-based, patient-centred mobile health solutions to support the management of HIV/AIDS and other health issues.
WelTel’s text-messaging support service was initially found to be effective at improving health outcomes for patients starting HIV treatment in Kenya (1). Although the prevalence of HIV is significantly lower in Canada than in many other parts of the world, HIV remains a significant burden of disease for vulnerable sub-populations such as injection drug users. In British Columbia, an estimated 12,000 individuals are HIV positive. One of the next steps for the program was to determine whether WelTel could help people being treated for HIV in Vancouver.
Oak Tree study
The WelTel HAART (Highly Active Antiretroviral Therapy) BC1 pilot study was recently completed at the Oak Tree Clinic at BC Women’s Hospital, in collaboration with Dr. Melanie Murray and the HIV care multidisciplinary team. The study involved 25 Oak Tree Clinic patients belonging to one of five different groups:
- Youth (aged 14-24),
- Mature (aged 50 and over),
- English as a second language,
- Remote from care (commuting 3 or more hours to appointments), and
- Advanced HIV with detectable HIV viral load.
Patients consenting to participate received a weekly SMS (short message service) with the message “How are you?”, sent from a computer platform. They were asked to respond to the message within 48 hours either that they were doing well or had a problem. Patients who responded with a problem and those who did not respond prompted follow-up by a clinician. At study end, patients and health care providers participated in interviews to assess the acceptability of using SMS to support HIV care and treatment.
Outcomes
Overall, participants responded positively to receiving SMS messages. The most significant benefit noted by patients is feeling that “somebody out there cares”, and that the weekly messages were “very helpful”. Texting also helped patients stay connected to care, mitigate side effects from antiretroviral therapy (ART) and remember to reorder medications. Although some participants expressed initial difficulty with texting or felt that texting could not completely replace a phone call, all respondents would recommend this program to a friend.
Next steps
Findings from the HAART BC1 pilot study suggest that text-messaging between patients and clinicians may be beneficial to patients receiving HIV treatment in British Columbia, especially to those who face other social and health challenges.
Dr. Murray and the Oak Tree team have now expanded this pilot study to recruit 100 more patients to help evaluate the program’s clinical effectiveness. They will compare pre- and post-intervention outcomes including treatment adherence, degree of viral load suppression, and quality of life prior to and during use of the SMS system. Findings will directly inform whether WelTel should be incorporated into the care of high-risk individuals on an ongoing basis.
For more information
For information about the WelTel HAART-BC 1 study, please contact Dr. Melanie Murray at Melanie.Murray(at)cw.bc.ca or (604) 875-2212. For more general inquires about WelTel, please contact Dr. Rich Lester at Richard.Lester(at)bccdc.ca.
References
- Richard T Lester, Paul Ritvo, Edward J Mills, Antony Kariri, Sarah Karanja, Michael H Chung, William Jack, James Habyarimana, Mohsen Sadatsafavi, Mehdi Najafzadeh. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. The Lancet, Volume 376, Issue 9755, Pages 1838-1845.