WelTelOAKTREE: Text Messaging to Support Patients with HIV/AIDS in British Columbia

WelTelOAKTREE: Text Messaging to Support Patients with HIV/AIDS in British Columbia

Principal Investigator: Dr. Melanie Murray

Primary Contact: Evelyn Maan, Research Program Manager, 604-767-5044, emaan@cw.bc.ca

About the study: WelTel Oak Tree is a study that enrolled 80 HIV+ individuals from the Oak Tree Clinic at BC Women’s Hospital. Participants received a cell phone and/or unlimited text messaging capability if they did not have it already, and for one year received a weekly text message stating “How are you”. Participant problems and non-responses were followed up by a nurse. Data on demographics, CD4 counts, HIV viral loads, HIV medication adherence and attendance at appointments were collected for the year prior to the intervention and during the intervention for comparison. Data assessing quality of life was also collected at three points during the one year study period. Cost effectiveness and cost benefit of the intervention were looked at to assess feasibility of transferring the intervention to a programmatically funded facet of patient care.

Why is this research important? In Canada, around 65,000 people are living with HIV/AIDS, approximately 14,300 of whom are women. AntiRetroviral Therapy (ART) has led to enormous improvements in the health and survival of individuals with HIV. Moreover, by decreasing the amount of virus circulating in the body (viral load), HAART offers the possibility of treatment as a preventative measure. However, high levels of engagement in care, timely initiation of ARVs, and adherence to medication are required to maximize the benefits of HAART in order to prevent resistance, progression to AIDS, transmission or mortality. Unfortunately, engagement in ongoing HIV care can be poor, with one study from the United States (US) showing only 52% retention in care over 1 year. Further, adherence among high-risk populations is low, with women being less adherent partly due to their role as care providers for children and partners, potential abuse in partner relationships, fear of stigma, homelessness, and concerns regarding side effects. Conversely, active drug use (especially cocaine), lack of social supports, and depression are just a few of the variables that affect both men and women alike. Current methods of engagement in care have failed to overcome these barriers to adherence, which makes finding an effective adherence intervention critically important. Mobile health (mHealth), the use of mobile phone technology to deliver health care, is an emerging area of disease management that can assist in patient adherence to prolonged chronic treatment regimens and monitoring of care. A randomized controlled trial (WelTelKenya1), conducted by Dr. Richard Lester et. al, tested the clinical effectiveness of text message support for HIV treatment adherence in Kenya. WelTelKenya1, of which 67% were women, showed that patients receiving text message support had significantly higher rates of treatment adherence and viral suppression than patients who received standard care alone. In Canada, cell phone penetration exceeds 70% and is expected to reach 100% within the next decade. The WelTel system offers a clinical management model that can be carried out using standard services offered by cellular network providers with minimal additional infrastructure and is both flexible and scalable.

Study status: The study is no longer enrolling participants. Data analysis and manuscript preparation is underway.

Study results/publication:

Mean ART adherence improved from 61.7% to 68.3% (p<0.0001), and median population HIV log10VL declined by 0.70 log (p=0.007) from pre-intervention to intervention years.

Median VL decline for responders (response rate ≥50%) was 1.03 log (vs. 0.39 log, p=-.03), and adherence increase 13.7% (vs. 0.8%, p=0.008) versus non-responders (response rate <50%).

Managing “problem” responses required 53 minutes of Health Care Practitioner time per high-risk, vulnerable participant enrolled per year, for a cost per patient of $45.20.

Total intervention cost (including phones, plans, staff time) was $375.74 per patient per year.

Friesen K, Qiu AQ, Goktepe O, Maan EJ, Pick N, Alimenti A, Kestler M, Money D, Lester R, Murray MCM. Weekly text-messaging (Weltel) to engage vulnerable HIV+ populations: It works, what does it cost? (Oral Presentation, 25th Annual CAHR Conference, Winnipeg, MB.  May 12-15, 2016).

Friesen K, Qiu A, Goktepe O, Maan EJ, Pick N, Alimenti A, Kestler M, Smillie K, Money D, Lester R, Murray MCM and the WelTel OAKTREE Study Team. mHealth to Improve Health:  Effectiveness of a weekly text messaging intervention to improve ART adherence and HIV Viral Load in a Canadian Context: WelTel OAKTREE.” (Oral presentation), The 6th International Workshop on HIV and Women, Boston, February 21-22, 2016.

Murray, MCM, Friesen K, O’Shaughnessy S, Albert A, Maan EJ, Pick N, Alimenti A, Kestler M, Smillie K, Money D, Lester R, and the WelTel OAKTREE Study Team.  mHealth to Improve Health:  Effectiveness of a weekly text messaging intervention to improve ART adherence and HIV Viral Load in a Canadian Context: WelTel OAKTREE. (Poster Presentation), International AIDS Society Meeting, July 19-22, 2015. Abstract WEPED849, http://www.ias2015.org/WebContent/File/IAS_2015__MED2.pdf.

Friesen K, O’Shaughnessy S, Maan EJ, Makela N, Pickering B, Lester R, Pick N, Murray M.   How R U?  WelTelOAKTREE: Text messaging and nursing support to improve care for HIV positive patients taking antiretroviral therapy (cART) in British Columbia.  (Oral Presentation), 2014 Canadian Association of Nurses in AIDS Care (CANAC) Conference, April 24-26, 2014.

Co-Investigators: Dr. Ariane Alimenti, Karen Friesen, Dr. Richard Lester, Dr. Deborah Money, Dr. Neora Pick, and Dr. Laura Sauve.

Funded by: Gilead Sciences Inc. and Bristol-Myers Squibb

Prospective study of an interdisciplinary pelvic pain & endometriosis clinic (Etiology of dyspareunia in endometriosis)

Principal Investigator: Dr. Paul Yong

Primary Contact: Heather Noga, Research Coordinator, WHRI, 604-875-2424 ext 4924, Heather.Noga@cw.bc.ca

About the study: BC Women’s Centre for Pelvic Pain and Endometriosis is a tertiary referral centre in British Columbia dedicated to managing chronic pelvic pain (CPP) and endometriosis. The Centre offers a unique interdisciplinary approach that includes pain education workshops, pelvic floor physiotherapy, counselling, and medical and surgical management. The purpose of this study is to prospectively collect data from patients at the clinic to investigate long-term patient outcomes, and the etiology and treatment of CPP. Participants in the study will have their clinical intake questionnaires, physical exam, surgery, and pathology data included in the research and answer follow-up questionnaires at 6 months and 1-5 years.

Why is this research important? Chronic pelvic pain (CPP) (pelvic pain that lasts at least 3-6 months in duration) affects 15% of reproductive-aged women. It is a condition that can involve many physical, psychological, and behavioural consequences and have a devastating impact on quality-of-life. One of the most common origins of CPP is endometriosis, a condition in which endometrial tissue that usually lines the uterus grows outside of the uterus. However, pelvic pain may also result from numerous other gynaecological, musculoskeletal, gastrointestinal, or urological conditions, and can be difficult to manage. Therefore, there is benefit to an interdisciplinary approach in the management of CPP compared to standard treatment.

Study status: Recruitment, data collection, data analysis, and manuscript development is ongoing.

Who can participate: All patients referred for chronic pelvic pain and/ or endometriosis to the BC Women’s Centre for Pelvic Pain and Endometriosis.

Study results/publications:

Yosef, A., Allaire, C., Williams, C., Ahmed, G., Al-Hussaini, T., Abedellah, M., Wong, W., Lisonkova, S., Yong, P. (2016). Multifactorial contributions to the severity of chronic pelvic pain in women. American Journal of Obstetrics & Gynecology, epub ahead of print.

Co-Investigators: Dr. Catherine Allaire, Dr. Christina Williams, Dr. Mohamed Bedaiwy.

Funded by: Canadian Institutes of Health Research (CIHR), Vancouver Coastal Health Research Institute (VCHRI), University of British Columbia (UBC), Women’s Health Research Institute (WHRI).

Clinic website: http://www.womenspelvicpainendo.com/

Clinic page on research: http://www.womenspelvicpainendo.com/research/

Research Newsletter:

October 2016 Research Newsletter

Endometriosis – Determinants of Oncogenesis (ENDO-ONC) Full Scale Study

Principal Investigator: Dr. Paul Yong

Primary Contact: Heather Noga, Research Coordinator, 604-875-2424 ext 4924, Heather.Noga@cw.bc.ca 

About the study: The aim of this study is to determine whether there are unique genetic changes in endometriosis that may play a role in malignant transformation to ovarian cancer or in the symptoms of pelvic pain and infertility. This will be done by comparing surgical tissue samples from women with endometriosis to women without endometriosis.

Participants in this study agree to provide for research purposes: a saliva sample, tissue removed from their surgery, endometrial biopsy (a sample from the lining of the uterus – only if a sample is not already being removed for clinical purposes).

Why is this research important? Endometriosis affects 10% of reproductive aged women, causes pain and infertility, and is now known to also be associated with ovarian cancer. Studying gene mutations and expression changes in surgical tissue samples of women with or without endometriosis will help us understand how it can lead to pain, infertility, ovarian cancer, and other associated symptoms.

Study status: Recruitment and data collection is ongoing.

Who can participate: You have (or are suspected to have) endometriosis OR another benign gynaecological condition, You have chosen surgical treatment.

Co-Investigators: Dr. Catherine Allaire, Dr. Christina Williams, Dr. Mohamed Bedaiwy, Dr. Jessica McAlpine, Dr. David Huntsman.

Funded by: Canadian Institutes of Health Research (CIHR), Canadian Cancer Society Research Institute (CCSRI), Women’s Health Research Institute (WHRI)

Partners: Ovarian Cancer Research Group (OvCaRe), Centre for Translational and Applied Genomics (CTAG).

Clinic website: http://www.womenspelvicpainendo.com/

Clinic Research Page: http://www.womenspelvicpainendo.com/research/

Does a Women’s Heart Center Change Clinical Outcomes?

Does a Women’s Heart Center Change Clinical Outcomes?

Principal Investigator: Dr. Tara Sedlak

Primary Contact: Emma Branch, Research Assistant, WHRI, 604-875-2424 ext 4796, Emma.Branch@cw.bc.ca

About the study: This study has two aims: firstly, to create a database of patients attending the VGH/BCWH Women’s Heart Center (WHC) to facilitate the ability of future investigators to conduct research on a number of different of issues surrounding women and heart disease. The second aim is to examine whether attendance at a WHC improves outcomes of patients with heart disease or at risk for heart disease. We will collect clinical information and some basic demographic information and store this in a de-identified database. We will also ask participants to complete a total of 4 questionnaires over a 5 year period.

Why is this research important? It is not yet known whether specialized care centers like the Women’s Heart Center improves outcomes in women compared to usual care. Through this study we hope to better understand how gender specific care can impact the outcome for woman with a range of different cardiac conditions.

Study status: Ethics approval in progress.

Who can participate? Any woman who is being seen within the Women’s Heart Center at Vancouver General Hospital and/or BC Women’s Hospital will be invited to participate in this study who is fluent in English.

Co-Investigators: Natasha Prodan-Bhalla, Dr. Karin H. Humphries.

Mitochondrial and Telomere Studies in a Prospective Cohort AND Measuring Mitochondrial Aging, Application to HIV Infection and Therapy AND Cellular Aging and HIV Comorbidities in Women and Children

Principal Investigator: Dr. Helene Cote

Primary Contact: Evelyn Maan, Research Program Manager, 604-875-2000 ext. 2463, emaan@cw.bc.ca

About the study: CARMA-2-CORE is studying the effects of HIV and anti-HIV medications on cellular aging among children and adults living with, or exposed to HIV. As people with HIV are living longer, there is increasing evidence that HIV may cause a type of “early aging”.  CARMA-2-CORE is trying to better understand the impact of HIV and the anti-HIV medications on aging by looking at two markers of cellular aging: the length of DNA at the ends of chromosomes (“telomeres”) and the energy producing parts of the cell (“mitochondrial DNA”).

Why is this research important? As people with HIV are now living much longer, it is important to better understand the ways in which HIV or anti-HIV medications may contribute to the aging process. Additionally, there is a shortage of research in the field of HIV on the impact of anti-HIV medications in women and in children, making the CARMA-2-CORE study very important.

Study status: Recruiting

Who can participate: 

CARMA-2-CORE is currently actively recruiting women and children living with or exposed to HIV. CARMA-2-CORE is particularly looking for women and girls who fit the following criteria:

Age Misc.
12+ who have had their first menstrual period Fasting for at least 12 hours
19+ Have a scheduled Bone Density at BC Women’s Hospital

CARMA-2-CORE is also recruiting women and children who are not living with HIV, to act as study controls.  CARMA-2-CORE is particularly looking for women who fit the following criteria:

Ethnicity Age
Aboriginal/Indigenous 20-25


African/Caribbean/Black 15-60+
Caucasian/White 40-60+

Study results/publications: 

Zanet D, Thorne A, Singer J, Maan E, Sattha B, Pick N, Murray M, Money D, Cote H. Shorter leukocyte telomere length in HIV-infected individuals is unrelated to antiretroviral treatment or time since HIV diagnosis. Clin Infect Dis. 2014 May;58(9):1322-32. doi: 10.1093/cid/ciu051. Epub 2014 Jan 22. CA (IF 9.416, ranked 2/70 among Infectious Disease journals; Citations 7, 10/2015).

Zanet, D.L., Thorne, A., Singer, J., Maan, E.J., Sattha, B., Le Campion, A., Soudeyns, H., Pick, N., Murray, M., Money D,M,, Côté, H.C. (2014). Association between short leukocyte telomere length and HIV infection in a cohort study: No evidence of a relationship with antiretroviral therapy. CIHR Emerging Team Grant on HIV Therapy and Aging: CARMA. Clin Infect Dis 58(9):1322-32. doi: 10.1093/cid/ciu051. Epub 2014 Jan 22.

Côté HC, Soudeyns H, Thorne A, Alimenti A, Lamarre V, Maan EJ, Sattha B, Singer J, Lapointe N, Money DM, Forbes J; CIHR Emerging Team in HIV therapy, aging (CARMA), Wong J, Bitnun A, Samson L, Brophy J, Burdge D, Pick N, van Schalkwyk J, Montaner J, Harris M, Janssen P.  Leukocyte telomere length in HIV-infected and HIV-exposed uninfected children: shorter telomeres with uncontrolled HIV viremia.  PLoS One. 2012;7(7):e39266. Epub 2012 Jul 16

Co-Investigators: Dr. Neora Pick, Dr. Deborah Money, Dr. Melanie Murray, Dr. Ariane Alimenti.

Funded by: CIHR

Partners: Positive Women’s Network (PWN), Canadian Multicentre Osteoporosis Study (CaMOS)

Consent forms:

CARMA-2 Participant Consent form

CARMA-2 Control Consent Form