amfAR, The Foundation for AIDS Research

Using Mobile Phone Technology to Improve Treatment Adherence in India

Half of the world’s 6 billion mobile phone and device subscriptions are in the Asia-Pacific region. Mobile technology has occasionally been used as part of HIV care to improve clinic attendance and adherence, but has been implemented as a standard of care. Investigators in Bangalore, India, conducted a study to explore how regular interactive voice response (IVR) calls and short message services (SMS) impacted adherence to first-line antiretroviral therapy (ART) at a private, nonprofit clinic.

indianmobile© Komar | DreamstimeRecipients of IVR calls heard an automated message asking them to respond to a single question about their adherence using the keypad on their mobile device, and the SMS was a representation of a lamp. Both reminders were sent once a week for six months, and patient adherence was assessed by counting antiretroviral pills at clinic visits. The study continued until six months after the mobile phone reminders were stopped. Adequate adherence was defined as taking >95 percent of ART medicines over one month.

Of the 150 patients who started the study, 141 had complete data that were analyzed. Adequate adherence significantly improved from 85 percent at the beginning of the study to 94 percent at the end of the first month, and remained high at 91 percent at month six and 94 percent at month 12 (p=0.016). Although 17 percent of participants reported that forgetfulness was a barrier to adherence at the beginning of the study, this fell to three percent by month six (p <0.001).

Surveyed at month 12, study participants reported that the IVR system was easy to use and somewhat more helpful than the SMS (p <0.001): 34 percent preferred only the IVR, 11 percent only the SMS, 44 percent liked having both at the same time, and 11 percent did not have a preference. Only 16 percent reported that they would “feel ashamed” if another person used their phone and received the IVR or the SMS.

Overall, the study participants were comfortable receiving and using the mobile phone interventions, which led to significant improvements in adherence and reductions in forgetfulness. The study added to the scientific evidence confirming that mobile phones can be used as tools to promote adherence, delaying treatment failure and the need for second-line ART regimens.

  1.        Rodrigues R, Shet A, Antony J, Sidney K, Arumugam K, Krishnamurthy S, D’Souza G, Decosta A. Supporting adherence to antiretroviral therapy with mobile phone reminders: results from a cohort in South India. PLoS One. 2012;7(8):e40723. Epub 2012 Aug 27.