Effect of mobile phone reminders on follow-up medical care of children exposed to or infected with HIV in Cameroon (MORE CARE): a multicentre, single-blind, factorial, randomised controlled trial

Summary Background Missed scheduled HIV appointments lead to increased mortality, resistance to antiretroviral therapy, and suboptimum virological response. We aimed to assess whether reminders sent to carers by text message, mobile phone call, or concomitant text message and mobile phone call incre...

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Published in:The Lancet infectious diseases 2014-07, Vol.14 (7), p.600-608
Main Authors: Bigna, Jean Joel R, Dr, Noubiap, Jean Jacques N, MD, Kouanfack, Charles, MD, Plottel, Claudia S, MD, Koulla-Shiro, Sinata, Prof
Format: Article
Language:English
Subjects:
Adult
Appointments and Schedules
Biological and medical sciences
Cameroon
Cell Phone
Cellular telephones
Child, Preschool
Drug resistance
Female
HIV
HIV Infections - drug therapy
Human immunodeficiency virus
Human viral diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infant
Infectious Disease
Infectious diseases
Male
Medical sciences
Middle Aged
Mortality
Reminder Systems
Single-Blind Method
Text Messaging
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:Summary Background Missed scheduled HIV appointments lead to increased mortality, resistance to antiretroviral therapy, and suboptimum virological response. We aimed to assess whether reminders sent to carers by text message, mobile phone call, or concomitant text message and mobile phone call increase attendance at medical appointments for HIV care in a population of children infected with or exposed to HIV in Cameroon. We also aimed to ascertain the most cost-effective method of mobile-phone-based reminder. Methods MORE CARE was a multicentre, single-blind, factorial, randomised controlled trial in urban, semi-urban, and rural settings in Cameroon. Carers of children who were infected with or had been exposed to HIV were randomly assigned electronically in blocks of four and allocated (1:1:1:1) sequentially to receive a text message and a call, a text message only, a call only, or no reminder (control). Investigators were masked to group assignment. Text messages were sent and calls made 2 or 3 days before a scheduled follow-up appointment. The primary outcomes were efficacy (the proportion of patients attending a previously scheduled appointment) and efficiency (attendance/[measures of staff working time × cost of the reminders]), as a measure of cost-effectiveness. The primary analysis was by intention to treat. This study is registered with the Pan African Clinical Trials Register, number PACTR201304000528276. Findings The study took place between Jan 28 and May 24, 2013. We randomly assigned 242 adult–child (carer–patient) pairs into four groups: text message plus call (n=61), call (n=60), text message (n=60), and control (n=61). 54 participants (89%) in the text message plus call group, 51 (85%) in the call group, 45 (75%) in the text message group, and 31 (51%) in the control group attended their scheduled appointment. Compared with control, the odds ratios for improvement in the primary efficacy outcome were 7·5 (95% CI 2·9–19·0; p
ISSN:1473-3099
1474-4457
DOI:10.1016/S1473-3099(14)70741-8