SMS Interventions Improve Medication Adherence in AIDS Patients

In the afternoon session "mHealth at the Point of Care" at the mHealth Summit in National Harbor, MD, Bella Hwang spoke about an SMS program in Kenya that not only helped improve medication in AIDS patients, but also promised to do so in a highly economical way.

The mHealth Summit in National Harbor Maryland has several focus points. After all, there are several sectors of the health care industry that must buy into mobile health technologies in order for them to transform health care. But a burgeoning field of technology is just the beginning when it comes to successfully implementing mHealth programs; there needs to be relevant data on effectiveness and cost for every mHealth app and program. This involves major work in the area of research. Once there is enough data to show that any particular mHealth device or application is beneficial to a subset of patients, there must be more research to establish the economic benefit if implementation. Then, finally, it requires change on a political or organizational level in order to encourage mass adoption in a way that is affordable for whichever patient population that is being targeted.

In the afternoon session “mHealth at the Point of Care,” a panel of thought leaders gathered to provide interesting points of view (and data) from these different viewpoints. Unfortunately, the panel was so large that speakers only had 10 minutes to speak about very complex studies and interventions, which meant that numerous data were flashed in a blitzkrieg style at the audience. Nonetheless, the speakers’ points resonated.

First up was Bella Hwang of WelTel.org. Hwang falls into the “research” sector of mHealth and she presented information on an SMS (text messaging) study that took place in Kenya and focused on AIDS medication adherence.

Hwang began to collect data in smaller sets of patients and then took those results and began applying them to larger patient populations. At first, her study included 538 Kenyan patients. These patients were divided into two groups; one group received the text message intervention and the other did not. The intervention consisted of a message as simple as “Are you ok?” and requested that patients respond within 48 hours. The study was carried out for one year. Upon completion, Hwang has the evidence she needed to support her program.

The data showed that the SMS intervention was very effective when it came to viral load suppression and Antiretroviral Therapy adherence.

The next step for Hwang was to apply her findings to a larger subset; in this case, she chose the entire national cohort of Kenya (~500,000 people). She said that she specifically chose Kenya because of the rapid adoption of mobile health adherence. In short, Hwang found that the cost of the program (airtime costs, technological requirements in clinics, time, etc) were much less that the money that would be saved if the program were initiated on a national level. In fact, the first three years would yield savings of $1.2, $5.5, and $14 million dollars, respectively. Additionally, added Hwang, these numbers would drastically increase if the program were applied on a global PEPFAR level. The amount of money that would be saved in the first three years when considering the cost of second-line therapy, the cost saved of opportunistic infections, and nurses’ time, would be $5.5, $12.6, and $35, respectively.

The next step, said Hwang, is to focus on who would actually fund this program. Should it be funded by the health care industry? Patients? A combination of the two? Answering those questions and coming up with the best possible economic plan will bring Hwang one step closer to her goal of widespread SMS intervention in assisting AIDS patients. Aside from reinforcing the body of evidence that shows just how effective SMS intervetnions can be, Hwang's efforts are an excellent representation of the vast amount of time and effort that must be applied to an mHealth project. It's a good thing that there are passionate people like Hwang out there who are willing to go the distance to truly revolutionize and improve the delivery of health care to populations that need it most.