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

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