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WelTel at Oak Tree: mHealth to improve health
Oct 1, 2014 by Karen Friesen, RN(C), Oak Tree Clinic, Melanie Murray, MD, PhD, FRCPC, Oak Tree Clinic, Sara O’Shaughnessy, PhD
Oak Tree Clinic is studying the clinical effectiveness of a weekly text messaging intervention for improving the care and support of vulnerable and hard-to-reach HIV positive patients on antiretroviral therapy (cART).
The study is based upon the WeltelKENYA study , a randomized control trial demonstrating that weekly text messages to patients from nurses results in significantly higher rates of treatment adherence and viral suppression than standard care alone. In a pilot study examining intervention acceptability and feasibility (WeltelBC1), participants reported improved engagement, medication adherence and psychosocial health .
Using a repeated measures design, 85 HIV+ high risk participants with detectable HIV viral loads (VL) from the Oak Tree Clinic were enrolled in the intervention. Study participants receive a weekly text message asking “How are you?” Data on appointment attendance (engagement), cART adherence, CD4 counts, and VL are collected at each visit from the year before, during and after the intervention.
Intervention cost effectiveness and cost benefit will be studied to assess feasibility of transferring the intervention to a programmatically funded facet of patient care. Total cost will be tabulated based on the intervention costs, including cost of the platform, texting, phones, nursing and other staff time.
Benefits of the study will be determined in both monetary and non-monetary units using an HIV-specific model to estimate number of transmissions averted, morbidity averted, quality of life improvement, and systematic costs saved.
Preliminary data from the first 30 participants that reached six months on the intervention demonstrated a 0.52 log10 decrease in VL (e.g., mean group viral load dropped from 44,629 to 22, 656 copies/ml) . Of these, 9/30 patients were newly undetectable from an HIV standpoint.
With the goal of translating the intervention to clinical practice, we continue to build a business case for programmatic funding of the intervention in the next 1-2 years. Our intention is to expand engagement of our most vulnerable patients at Oak Tree, and to support initiation and adherence to ARV therapy.
For more information
For more general inquires about the WelTel platform, please contact Dr. Rich Lester.
- 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.
- Smillie K, Van Borek N, Abaki J, Pick N, Maan EJ, Friesen K, Graham R, Levine S, van der Kop ML, Lester RT, Murray M. A qualitative study investigating the use of a mobile phone short message service designed to improve HIV adherence and retention in care in Canada (WelTel BC1). J Assoc Nurses AIDS Care. 2014 Apr 23. pii: S1055-3290(14)00040-5. doi: 10.1016/j.jana.2014.01.008.
- Friesen K, O’Shaughnessy S, Maan EJ, Makela N, Pickering B, Lester R, Pick N, Murray M. How R U? WelTelOAKTREE: Text messaging and nursing support to improve care for HIV positive patients taking antiretroviral therapy (cART) in British Columbia. (Oral Presentation), 2014 Canadian Association of Nurses in AIDS Care (CANAC) Conference, April 24-26, 2014.
Categories: Program updates