JMIR Publications

ABSTRACT

Background:

Following the successful scale-up of antiretroviral therapy (ART) globally, the focus is now on ensuring good quality of life (QoL) and sustained viral suppression in people living with HIV (PLHIV). With the increasing access to mobile technology in the countries with the highest burden of HIV, mobile health (mHealth) technologies could be leveraged to support PLHIV and improve QoL. However, there is limited evidence on the impact of mHealth tools on the QoL in PLHIV, especially in low- and middle-income countries. The available evidence is limited to the evaluation of short message service (SMS), which may not be feasible in settings with high illiteracy rates.

Objective:

The primary objective was to determine the impact of interactive voice response (IVR) technology on the QoL, HIV treatment outcomes and appointment keeping among PLHIV within a randomized HIV trial.

Methods:

Within the Call for Life (CFL) study, ART-experienced and ART naïve PLHIV commencing ART were randomized (1:1 ratio) to either a control (no IVR support) or intervention arm (daily adherence and pre-appointment reminders, health information tips and option to report symptoms). All reminders and health tips were delivered via automated IVR or SMS to simple feature phones. The software evaluated was called Call for Life Uganda (CFL), an IVR technology that is based on the MOTECH open-source application. Eligibility for participation included access to a phone, fluency in local languages and provision of consent. The primary and secondary outcomes were the differences in the differences (DID) in Medical Outcomes Study (MOS-HIV) QoL scores at 12 months and viral suppression, respectively. The differences in differences were computed, adjusting for baseline HIV RNA and CD4.

Results:

Overall, 600 participants (413 [68.8%] female) were enrolled and followed-up for 12 months. In the intervention arm (n=300), 298 (99.3%) opted for IVR and two (0.7%) chose SMS, as the mode receiving reminders and health tips. At 12 months, 124 of the 256 (46.8%) active participants had picked at least 50% of the calls. Additionally, there was no overall difference in the QoL between the intervention and control arms (DID 0.0; P = .988) or HIV RNA (DID 0.01 , P = .942). Among the participants in the intervention who were active at 12 months, those who received >75% of the reminders (high users) had overall higher QoL (92.2 versus 87.8, P =.018). Similarly, high-users also had higher QoL scores in the mental health domain (93.1 versus 86.8, P = .008) as well as better appointment keeping compared to low-users (received less than 25% of reminders). Similarly, participant with moderate use (51 - 75%) had better virological suppression at 12 months compared to the low users (85.1% [80/94] versus 57.9% [11/19], P = .006).

Conclusions:

In this study, there was high uptake and acceptability of the IVR technology in PLHIV. While we found no overall difference in the QoL and viral suppression between the control and intervention arms, there were higher mental health scores in those high use of the tool. In addition, PLHIV with higher usage of the tool showed greater improvement in QoL, viral suppression and appointment keeping. With the declining resources available to HIV programs in Africa and the increasing number of PLHIV accessing ART, IVR technology could be used to support patient care. The tool may also be helpful in situations where PLHIV cannot access face-to-face healthcare, for example, during the current COVID epidemic. Clinical Trial: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080