Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Background: Mobile text messages are a widely recognized communication method in societies, as the global penetration of the technology approaches 100% worldwide. Systematic knowledge is still lacking on how the mobile telephone text messaging (short message service, SMS) has been used in health care services. Objective: This study aims to review the literature on the use of mobile phone text message reminders in health care. Methods: We conducted a systematic literature review of studies on mobile telephone text message reminders. The data sources used were PubMed (MEDLINE), CINAHL, Proquest Databases/ PsycINFO, EMBASE, Cochrane Library, Scopus, and hand searching since 2003. Studies reporting the use of SMS intended to remind patients in health services were included. Given the heterogeneity in the studies, descriptive characteristics, purpose of the study, response rates, description of the intervention, dose and timing, instruments, outcome measures, and outcome data from the studies were synthesized using a narrative approach. Results: From 911 initial citations, 60 studies were included in the review. The studies reported a variety of use for SMS. Mobile telephone text message reminders were used as the only intervention in 73% (44/60) of the studies, and in 27% (16/60) of the remaining studies, SMS was connected to another comprehensive health intervention system. SMS reminders were sent to different patient groups: patients with HIV/AIDS (15%, 9/60) and diabetes (13%, 8/60) being the most common groups. The response rates of the studies varied from 22-100%. Typically, the text message reminders were sent daily. The time before the specific intervention to be rendered varied from 10 minutes (eg, medication taken) to 2 weeks (eg, scheduled appointment). A wide range of different evaluation methods and outcomes were used to assess the impact of SMS varying from existing databases (eg, attendance rate based on medical records), questionnaires, and physiological measures. About three quarters of the studies (77%, 46/60) reported improved outcomes: adherence to medication or to treatment reportedly improved in 40% (24/60) of the studies, appointment attendance in 18% (11/60) of the studies, and non-attendance rates decreased in 18% (11/60) of the studies. Other positive impacts were decreased amount of missed medication doses, more positive attitudes towards medication, and reductions in treatment interruptions. Conclusions: We can conclude that although SMS reminders are used with different patient groups in health care, SMS is less systematically studied with randomized controlled trial study design. Although the amount of evidence for SMS application recommendations is still limited, having 77% (46/60) of the studies showing improved outcomes may indicate its use in health care settings. However, more well-conducted SMS studies are still needed. [J Med Internet Res 2014;16(10):e222]

Use of Mobile Phone Text Message Reminders in Health Care Services: A Narrative Literature Review

The Lancet Infectious Diseases

Using text message reminders in health care services: A narrative literature review

Objective Digital innovations with internet/mobile phones offer a potential cost-saving solution for overburdened health systems with high service delivery costs to improve efficiency of HIV/STI (sexually transmitted infections) control initiatives. However, their overall evidence has not yet been appraised. We evaluated the feasibility and impact of all digital innovations for all HIV/STIs. Design Systematic review. Setting/participants All settings/all participants. Intervention We classified digital innovations into (1) mobile health-based (mHealth: SMS (short message service)/phone calls), (2) internet-based mobile and/or electronic health (mHealth/eHealth: social media, avatar-guided computer programs, websites, mobile applications, streamed soap opera videos) and (3) combined innovations (included both SMS/phone calls and internet-based mHealth/eHealth). Primary and secondary outcome measures Feasibility, acceptability, impact. Methods We searched databases MEDLINE via PubMed, Embase, Cochrane CENTRAL and Web of Science, abstracted data, explored heterogeneity, performed a random effects subgroup analysis. Results We reviewed 99 studies, 63 (64%) were from America/Europe, 36 (36%) from Africa/Asia; 79% (79/99) were clinical trials; 84% (83/99) evaluated impact. Of innovations, mHealth based: 70% (69/99); internet based: 21% (21/99); combined: 9% (9/99). All digital innovations were highly accepted (26/31; 84%), and feasible (20/31; 65%). Regarding impacted measures, mHealth-based innovations (SMS) significantly improved antiretroviral therapy (ART) adherence (pooled OR=2.15(95%CI: 1.18 to 3.91)) and clinic attendance rates (pooled OR=1.76(95%CI: 1.28, 2.42)); internet-based innovations improved clinic attendance (6/6), ART adherence (4/4), self-care (1/1), while reducing risk (5/5); combined innovations increased clinic attendance, ART adherence, partner notifications and self-care. Confounding (68%) and selection bias (66%) were observed in observational studies and attrition bias in 31% of clinical trials. Conclusion Digital innovations were acceptable, feasible and generated impact. A trend towards the use of internet-based and combined (internet and mobile) innovations was noted. Large scale-up studies of high quality, with new integrated impact metrics, and cost-effectiveness are needed. Findings will appeal to all stakeholders in the HIV/STI global initiatives space.

https://bmjopen.bmj.com/content/bmjopen/7/11/e017604.full.pdf

Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017)

Background: Clients diagnosed and treated for Chlamydia trachomatis are a recognised high-risk group for subsequent infection. An estimated 8% of clients treated for chlamydia at Cairns Sexual Health Service return for re-testing within the recommended 3–4-month period. There is no recall or reminder system in place. This study assesses the effectiveness of using short messaging service (SMS) reminders with and without incentive payments to increase re-testing rates.

Methods: Eligible consenting clients were randomly allocated to one of three groups. Group 1 (controls) received the standard advice from the clinician to return for re-testing in 3–4 months. Group 2 received the standard advice and an SMS reminder at 10–12 weeks post-treatment. Group 3 received the standard advice and the SMS reminder, which also offered an incentive payment on clinic attendance.

Results: 32 participants were recruited to groups 1 and 2 and 30 participants to group 3. 62 SMS reminders were sent with 13 (21.0%) reported as undelivered. Re-testing rates were 6.3%, 28.1% and 26.7% for groups 1, 2 and 3, respectively.

Conclusion: SMS reminders with or without an incentive payment increased re-testing rates in our clients who were diagnosed and treated for chlamydia. However, re-testing remained less than ideal, and the high rate of undelivered SMS reminders suggest that this intervention alone will not achieve desired re-testing rates and that a range of strategies will be required to increase re-testing in this population.

https://sti.bmj.com/content/sextrans/89/1/16.full.pdf

Increasing chlamydia test of re-infection rates using SMS reminders and incentives

Objectives: The aim of this study was to describe the long-term changes in CD4 cell counts beyond 5 years of combination antiretroviral therapy (cART). If natural ageing leads to a long-term decline in the immune system via low-grade chronic immune activation/inflammation, then one might expect to see a greater or earlier decline in CD4 counts in older HIV-positive patients with increasing duration of cART.

Methods: Retrospective and prospective data were examined from long-term virologically stable HIV-positive adults from the Australian HIV Observational Database. We estimated mean CD4 cell count changes following the completion of 5 years of cART using linear mixed models.

Results: A total of 37 916 CD4 measurements were observed for 892 patients over a combined total of 9753 patient-years. Older patients (> 50 years old) at cART initiation had estimated mean (95% confidence interval) changes in CD4 counts by year-5 CD4 count strata (  750 cells/μL) of 14 (7 to 21), 3 (–5 to 11) and –6 (–17 to 4) cells/μL/year. Of the CD4 cell count rates of change estimated, none were indicative of long-term declines in CD4 cell counts.

Conclusions: Our results suggest that duration of cART and increasing age do not result in decreasing mean changes in CD4 cell counts for long-term virologically suppressed patients, indicating that the level of immune recovery achieved during the first 5 years of treatment is sustained through long-term cART.

Ageing and long-term CD4 cell count trends in HIV-positive patients with 5 years or more combination antiretroviral therapy experience

Background: Emergency contraception (EC) has been available as a Schedule 3 (over-the-counter, OTC) medication through Australian pharmacies since 2004. This study aimed to describe OTC EC dispensing services in pharmacies in the Cairns and Hinterland Health Service District and to explore the knowledge and attitudes of pharmacy staff. The study findings will assist in developing resources to support pharmacy staff in their OTC EC provision role.

Study Design: We conducted semi-structured interviews with pharmacy managers and pharmacists to determine the availability, cost, dispensing processes and distribution estimates of EC and anonymous surveys of pharmacy staff to examine their knowledge and attitudes.

Results: Forty-six (88%) of the 52 local pharmacies participated; 43 (93%) provide OTC EC at an average cost of $28.95. One hundred and forty-five staff surveys were completed. Few pharmacists identified Family Planning Queensland (FPQ) or the Cairns Sexual Health Service (CSHS) as referral options for women not meeting the dispensing criteria. A range of written information is provided to EC customers by 23 (53%) of pharmacies.

Conclusions: This study has documented OTC EC dispensing services in the District and identified areas for improvement. A working group has been established to oversee the development and distribution of customer information packs and information for pharmacists on referral options.

Emergency contraception over-the-counter: Practices and attitudes of pharmacists and pharmacy assistants in far North Queensland

Hepatitis B is highly endemic in Papua New Guinea (PNG). Vaccination at birth is a key mother-to-child transmission prevention strategy. Despite recommendations for newborns to be vaccinated within 24 hours of delivery, a 2005 survey showed 23% coverage among children born in health facilities. Our study examined hepatitis B birth-dose coverage and knowledge, practices and barriers to vaccine delivery in five major PNG hospitals. Data on births and vaccines administered were sourced from the National Department of Health (NDoH) and directly from the five hospitals. A maternity unit audit and staff survey were undertaken. Across the five hospitals, the hospital-level data of hepatitis B birth-dose coverage was 79% (range: 40-96%) compared to 19% from national data (range: 0-106%). Despite hospitals having adequate vaccine supply, access to appropriately stored vaccine in maternity units was compromised with only one unit having a vaccine-specific temperature-monitored refrigerator. In interviews of 25 staff, incorrect reasons given for delaying vaccination were prematurity (60%), low birthweight (48%) and difficult birth (36%). This study found encouraging birth-dose coverage rates in five major hospitals but 20% of babies still missed receiving the recommended vaccine. The NDoH Immunization Unit will use the results of this study to inform strategies to improve hepatitis B birth-dose coverage in hospitals.

Barriers to the delivery of the hepatitis B birth dose: a study of five Papua New Guinean hospitals in 2007.

Access to abortion services is often limited in parts of regional Australia, including north Queensland. Since March 2006, the Cairns Sexual Health Service (CSHS) has provided medical termination of pregnancy (MToP) services for women up to 9 weeks gestation, using a regimen of methotrexate and misoprostol. We conducted a retrospective chart audit of all women undergoing an MToP at the CSHS between 1 March 2006 and 31 March 2009. In total, 147 medical terminations in 136 women were performed during this 3-year period. At the time of first presentation, the mean age was 27 years, 77 (57%) of the 136 women were of less than 7 weeks gestation and 86 (63%) had not had a previous termination. A successful medical termination of pregnancy was achieved in 69 of 85 (81%, 95% confidence interval (CI): 72, 88) women at less than 7 weeks gestation and in 43 of 62 (69%, 95% CI: 57, 80) women with gestation between 7 and 9 weeks. Provision of medical termination of pregnancy through sexual health services is one strategy to address access inequity in regional areas. Demand for this service in Cairns continues to rise; however, since late August 2009 MToP in Queensland is no longer available pending legal reform.

Sandra Downing

Papers

Increasing chlamydia test of re-infection rates using SMS reminders and incentives

Ageing and long-term CD4 cell count trends in HIV-positive patients with 5 years or more combination antiretroviral therapy experience

Emergency contraception over-the-counter: Practices and attitudes of pharmacists and pharmacy assistants in far North Queensland

Barriers to the delivery of the hepatitis B birth dose: a study of five Papua New Guinean hospitals in 2007.

Ten years on: a review of medical terminations of pregnancy performed in a sexual health clinic.