JMIR Publications

ABSTRACT

Background:

Following the successful scale-up of antiretroviral therapy (ART) globally, the focus should now be aimed at ensuring good quality of life (QoL) and sustained viral suppression (VS) in people living with HIV (PLHIV). With the increasing access to mobile technology in most burdened countries, mobile health technologies could be leveraged to support PLHIV and improve QoL. However, there is limited evidence on the impact of mHealth tools on QoL in PLHIV, especially in LMICs. The available evidence is limited to the evaluation of short message service (SMS), which may not be feasible in settings with high illiteracy rates. We present a randomised control trial to determine the impact of interactive voice technology (IVRT) response on QoL in an HIV cohort.

Objective:

The primary and secondary outcomes were difference in the changes in QoL scores at 12 months and VS (6 and 12 months) respectively

Methods:

Within the CFLU study, ClinicalTrials.gov NCT02953080, ART-experienced and ART naïve patients commencing ART were randomised (1:1 ratio) to either control (no IVRT support) or intervention arm (daily adherence and pre-appointment reminders, and health tips, all delivered via automated IVRT. There was also an option for SMS. To increase adoption, replication, and impact of the intervention, we used the Information-Motivation-Behavioral Skills Model as the theoretical basis. The software evaluated is Call for Life Uganda (CFLU)TM (www.callforlifeuganda.com), an IVRT that is based on the MOTECH open-source application. Eligibility for participation included access to a phone, fluency in local languages and providing consent. The primary and secondary outcomes were the difference in the changes in QoL scores at 12 months and VS, respectively. The differences in difference (DID) 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, 298 (99.3%) opted for IVR and only 2 (0.7%) SMS. During follow-u, 46.8% participants picked >50% of calls. There was no overall difference in QoL between intervention and control arms (DID 0.0; standard error (SE),1.030; P = .988), or HIV RNA (mean log change ± standard error -0.338 ± 1.04 vs. -0.355±1.05; F = 0.04; P = .851). Compared to low-users (received <25% of call reminders) participants who received >75% (high-users) of their automated call reminders had overall higher QoL (91.9±3.2 vs 88.4±6.4, p=.018). High users also had higher mental status and physical health scores.

Conclusions:

In this study, there was high uptake and acceptability of the IVR tool. While we found no overall difference in QoL and VS, PLHIV with high use of the tool showed greater improvement in QoL and VS. With the declining resources available to HIV programs in Africa and the increasing number of PLHIV accessing ART, IVRT could be useful to enhance patient. The tool could also be helpful in situations where PLHIV cannot access physical support, for example, during this COVID epidemic. Clinical Trial: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080,