1. Supporting adherence to antiretroviral therapy with mobile phone reminders in South India Rashmi Rodrigues Jimmy Antony, Kristi Sidney, Karthika Arumugam, Shubha Krishnamurthy, George D’Souza, Ayesha DeCosta, Anita Shet St. John’s National academy of Health Sciences, Bangalore, India Karolinska Institutet, Stockholm, Sweden Abstract Number: 942

2. Introduction: Study Setting HIV prevalence in India : 0.3% 1 People living with HIV: 2.5 million HIV Patients on treatment: 0.3million 2 Not adherent to treatment: 40% 3 Karnataka 1,2 Population61 million HIV prevalence (antenatal clinic)0.5 % HIV prevalence (sex workers, MSM)5 %, 17 % Study siteSt. John’s Hospital, Bangalore: Private teaching hospital (1200 beds), with government- sponsored ART center UNAIDS. Global Report 2010 NACO Aug-2010 Cauldbeck MB, 2009, AIDS Research and Therapy

3. Introduction  Adherence to Anti Retroviral Therapy (ART) is critical for treatment success 4.  Contextually feasible interventions could promote adherence and prevent resistance.  India has 688 million mobile phone connections 5.  Mobile phone based interventions for improving adherence therefore hold promise 6. 4. Paterson, Ann Intern Med 2000 5. Telecom Regulatory Authority of India, September 2010 6. Shet A (2010) AIDS and Behavior

4. Objectives 1.To test the hypothesis that mobile phone reminders improve adherence to medication in HIV-positive patients on ART. 2.To assess participant experiences with the intervention over a period of 6 months.

5. Methodology Study Design: Quasi-experimental, time series design Study period: April to November 2010 Study subjects: 150 HIV positive patients Inclusion criteria:  Age: 18–60years  On ART for at least one month  Having a mobile phone

6. The intervention Weekly once Patient with mobile phone On Ry + Interactive Voice Response Call (IVR) Pictorial SMS Weekly once All participants received both components of the intervention

7. Methodology Adherence assessments: Method: Pill count When? At- Baseline, 1month then quarterly up-to 12months Adequate adherence: Adherence rate  95%

8. Methodology Outcome Measure: Change in adherence over time and sustainability of the change. Data Analysis: Descriptives: Frequencies, mean, median, range, standard deviation. Associations: Wilcoxon signed rank test and Cochran’s Q.

9. Demography Mean Age: 38.54±7.7yrs Frequency% Male sex 10973 Urban residence 13590 Formal education 14295 Employed 12382 Number of participants: 150

10. Disease Profile Time since HIV diagnosis (median and range) :28(1-182) Median months on ART (range) :14 (1-86) HIV Stage 3 & 4 :31 (21%) N=150

11. Proportions adherent Vs time Change in adherence over time, p<0.05 Pre Intervention Post Intervention N=150N=146N=143N=136N=141

12. Barriers to adherence  Forgetfulness  Change in treatment regimen  Acute illness  No pills

13. Participant experiences  IVRs were preferred over text messages (74% Vs 54%)  IVR considered more helpful than text messages (Wilcoxon signed rank test, p<0.001)  Both components considered non-intrusive  Participants were not ashamed if either the IVRs or SMS was accessed by others  Participants did try to ensure that the intervention was not accessed by others (N=136)

14. Conclusions  Proportion of participants adherent to medication increased during the study  Improvement in adherence persisted even after the cessation of the intervention  Interactive voice calls - preferred and considered more helpful than the picture messages  Mobile phone reminders were found acceptable for adherence support in the context of HIV in South India

15. Thank-you