Browsing by Author "Shet, Anita"
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- ItemDesign of a randomized trial to evaluate the influence of mobile phone reminders on adherence to first line antiretroviral treatment in South India--the HIVIND study protocol.(2010-04-23) De Costa, Ayesha; Shet, Anita; Kumarasamy, Nagalingeswaran; Ashorn, Per; Eriksson, Bo; Bogg, Lennart; Diwan, Vinod K; ,BACKGROUND Poor adherence to antiretroviral treatment has been a public health challenge associated with the treatment of HIV Although different adherence supporting interventions have been reported their long term feasibility in low income settings remains uncertain Thus there is a need to explore sustainable contextual adherence aids in such settings and to test these using rigorous scientific designs The current ubiquity of mobile phones in many resource constrained settings make it a contextually appropriate and relatively low cost means of supporting adherence In India mobile phones have wide usage and acceptability and are potentially feasible tools for enhancing adherence to medications This paper presents the study protocol for a trial to evaluate the influence of mobile phone reminders on adherence to first line antiretroviral treatment in South India METHODS DESIGN 600 treatment na ve patients eligible for first line treatment as per the national antiretroviral treatment guidelines will be recruited into the trial at two clinics in South India Patients will be randomized into control and intervention arms The control arm will receive the standard of care the intervention arm will receive the standard of care plus mobile phone reminders Each reminder will take the form of an automated call and a picture message Reminders will be delivered once a week at a time chosen by the patient Patients will be followed up for 24 months or till the primary outcome i e virological failure is reached whichever is earlier Self reported adherence is a secondary outcome Analysis is by intention to treat A cost effectiveness study of the intervention will also be carried out DISCUSSION Stepping up telecommunications technology in resource limited healthcare settings is a priority of the World Health Organization The trial will evaluate if the use of mobile phone reminders can influence adherence to first line antiretrovirals in an Indian context
- ItemDesigning a mobile phone-based intervention to promote adherence to antiretroviral therapy in South India.(2010-05-07) Shet, Anita; Arumugam, Karthika; Rodrigues, Rashmi; Rajagopalan, Nirmala; Shubha, K; Raj, Tony; D'Souza, George; De Costa, AyeshaIntegration of mobile phone technology into HIV care holds potential particularly in resource constrained settings Clinic attendees in urban and rural South India were surveyed to ascertain usage of mobile phones and perceptions of their use as an adherence aid Mobile phone ownership was high at 73 26 reported shared ownership A high proportion 66 reported using phones to call their healthcare provider There was interest in weekly telephonic automated voice reminders to facilitate adherence Loss of privacy was not considered a deterrent The study presents important considerations in the design of a mobile phone based adherence intervention in India
- ItemIndia calling: harnessing the promise of mobile phones for HIV healthcare.(2011-03-04) Shet, Anita; De Costa, AyeshaThe technology that has been able to straddle the digital divide most effectively in resource constrained settings has been the mobile phone The tremendous growth seen in Africa and Asia in mobile phone use over the last half decade has spurred plans to integrate mobile phones with healthcare delivery globally A major challenge in HIV healthcare is sustaining good adherence to antiretroviral treatment This report focuses on specific applications of mobile phones in the area of HIV healthcare delivery It highlights the widespread use of mobile phones in developing areas of the world those which have a heavy burden of HIV and infectious diseases There is scope for exploiting existing mobile phone technology and infrastructure for healthcare enhancement in resource constrained settings
- ItemMobile phones to support adherence to antiretroviral therapy: what would it cost the Indian National AIDS Control Programme?(2014-09-04) Rodrigues, Rashmi; Bogg, Lennart; Shet, Anita; Kumar, Dodderi Sunil; De Costa, AyeshaINTRODUCTION 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
- ItemSupporting adherence to antiretroviral therapy with mobile phone reminders: results from a cohort in South India.(2012-09-06) Rodrigues, Rashmi; Shet, Anita; Antony, Jimmy; Sidney, Kristi; Arumugam, Karthika; Krishnamurthy, Shubha; D'Souza, George; DeCosta, AyeshaBACKGROUND 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 STUDY DESIGN 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 pUnder0 001 CONCLUSION 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
- ItemSupporting patient adherence to antiretrovirals using mobile phone reminders: patient responses from South India.(2012-05-02) Sidney, Kristi; Antony, Jimmy; Rodrigues, Rashmi; Arumugam, Karthika; Krishnamurthy, Shubha; D'Souza, George; De Costa, Ayesha; Shet, AnitaThere has been exponential growth in the use of mobile phones in India over the last few years and their potential benefits as a healthcare tool has raised tremendous interest We used mobile phone reminders to help support adherence to antiretroviral therapy ART among HIV patients at an infectious disease clinic in a tertiary hospital in Bangalore Between March and June 2010 139 adult HIV patients taking regular ART for at least a month received weekly reminders to support adherence These reminders consisted of a weekly interactive call and a non interactive neutral pictorial short message service SMS After four weeks of the intervention participants were interviewed to study perceptions on preference usefulness potential stigma and privacy concerns associated with this intervention Majority of the participants were urban 89 and had at least a secondary education 85 A total of 744 calls were made 545 76 of which were received by the participants In addition all participants received the weekly pictorial SMS reminder A month later 90 of participants reported the intervention as being helpful as medication reminders and did not feel their privacy was intruded Participants 87 reported that they preferred the call as reminders just 11 favoured SMS reminders alone Only 59 of participants viewed all the SMSs that were delivered while 15 never viewed any at all Participants also denied any discomfort or stigma despite 20 and 13 respectively reporting that another person had inadvertently received their reminder call or SMS Mobile phone interventions are an acceptable way of supporting adherence in this setting Voice calls rather than SMSs alone seem to be preferred as reminders Further research to study the influence of this intervention on adherence and health maintenance is warranted