The use of mobile phone-based interventions to support adherence to antiretroviral therapy in sub-Saharan Africa: is it acceptable, feasible and sustainable?
Background
HIV/AIDS remains a challenge. Achieving the last 90% in UNAIDS’ 90-90-90 targets – viral suppression – requires optimal adherence to antiretroviral treatment (ART).1
Mobile phone-based interventions (MPBIs) promote adherence.2–7 Scale-up of these necessitates a wider appreciation of the beneficiaries’ likes and values, and cost implications. This study reviews and summarises the literature on acceptability, feasibility and sustainability of MPBIs for improving ART adherence in sub-Saharan Africa.
Methods
This is a narrative review of the published literature that included elements of a systematic review process.8 The search strategy retrieved articles that combined 1) mobile phone use and 2) ART and 3) adherence and 4) sub-Saharan Africa. Findings are presented as a narrative synthesis.
Results
The included studies were conducted in seven countries. User subgroups including adolescents and pregnant women were included. The studies assessed short messages (SMS) and/or voice calls as reminders, or with additional messaging.
Regarding acceptability, patients found SMS and voice calls beneficial as reminders, tools for consultation and as conduits for encouragement. They would be most useful among those starting ART to help them get into a routine. Patients prefer two-way SMS to one-way SMS. The fear of breach of confidentiality is a major barrier.
Regarding feasibility, phone ownership was relatively high. Most participants could read and write SMS. There were conflicting concerns about the affordability. Technical challenges such as poor network, high mobile phone turnover and certain phone habits were barriers to feasibility.
On sustainability, information was very limited. Patients’ concerns were related to SMS fatigue when they get bored and fear of dependency on the SMS, yet they were unsure about the longevity of SMS programmes.
Conclusion
In promoting adherence, MPBIs are considered acceptable. Fear of breach of confidentiality is a major concern. Technical challenges and some individual phone habits are barriers. Information about costing and sustainability is limited and inconclusive. There are concerns about maintaining such interventions in the long term and addressing SMS fatigue among users. During scale-up, MPBIs could be prioritised for some patient groups among whom they would be most useful, such as those starting ART.
Conflicts of interest
None declared.
- © Royal College of Physicians 2020. All rights reserved.
References
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- Joint United Nations Programme on HIV/AIDS
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- Mills EJ
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- Horvath T
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- Wald DS
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