Intro
mHealth
The practice of medicine and public health supported by mobile
devices has emerged in recent years for developing countries as a
means of providing greater access to larger segments of a population
and improving the capacity of health systems in such countries.
• Tool for HIV Adherence
Promotion
• 2 recent RCT
supporting mhealth &
ART adherence:
• Lester RT et al. Effects of a mobile phone short message
service on antiretroviral treatment adherence in Kenya (WelTel
Kenya1): a randomised trial. Lancet 2010
• Pop-Eleches C et al. Mobile phone technologies improve
adherence to antiretroviral treatment in a resource-limited
setting: a randomized controlled trial of text message
reminders. AIDS 2011;
WELTEL KENYA:
USING MOBILE
PHONES AS A
COST-EFFECTIVE
HEALTH
INTERVENTION
HIV/AIDS
SUPPORT
Richard.Lester@bccdc.ca
bella@weltel.org
Intro
Weltel Kenya1 (Lancet 2010)
Effects of a mobile phone short message service on antiretroviral
treatment adherence in Kenya
• 538 patient randomised control trial (RCT) initiating ART
• 2 arms: 1. SMS intervention 2. Control/Standard of Care
• SMS intervention arm:
• 1 weekly SMS for 1 year
• Respond within 48 hours
• Patients responding problem & non-responders called back
• Results:
• SMS intervention group: significant improvements in
adherence and viral suppression
• Viral Load Suppression: 57% intervention vs 48% control
• ART adherence (>95%): 62% intervention vs 50%
• Viral load suppression
NNT = 11
• ART adherence
NNT= 9
WELTEL KENYA:
USING MOBILE
PHONES AS A
COST-EFFECTIVE
HEALTH
INTERVENTION
HIV/AIDS
SUPPORT
Richard.Lester@bccdc.ca
bella@weltel.org
Methods & Results
Scale-up
Costs
2.
1. Kenya – approx. 500, 000 ART patients
PEPFAR (global) – approx. 2.5 million ART patients
WELTEL KENYA:
USING MOBILE
PHONES AS A
COST-EFFECTIVE
HEALTH
INTERVENTION
HIV/AIDS
SUPPORT
Activity Based Costing – SMS Intervention:
•$11.75 USD/year per patient – Kenya
•$10.21 USD/year per patient - PEPFAR
Cost Savings
Richard.Lester@bccdc.ca
bella@weltel.org
Methods & Results
Kenya (n= 500,000)
WELTEL KENYA:
USING MOBILE
PHONES AS A
COST-EFFECTIVE
HEALTH
INTERVENTION
HIV/AIDS
SUPPORT
Richard.Lester@bccdc.ca
bella@weltel.org
Methods & Results
PEPFAR (n=2.5 million)
WELTEL KENYA:
USING MOBILE
PHONES AS A
COST-EFFECTIVE
HEALTH
INTERVENTION
HIV/AIDS
SUPPORT
Richard.Lester@bccdc.ca
bella@weltel.org
Future Directions/Challenges • Scale up and Implementation
•
Funding:
1. Patient
2. Health Systems/Programs (** major funder)
3. Industry
• Pharma
• Mobile
WELTEL KENYA:
USING MOBILE
PHONES AS A
COST-EFFECTIVE
HEALTH
INTERVENTION
• Future Research
•
Implementation Science– Step Wedge Study
Thank You
.
www.weltel.org
HIV/AIDS
SUPPORT
Richard.Lester@bccdc.ca
bella@weltel.org
Richard.Lester@bccdc.ca
bella@weltel.org