Adherence to HIV/AIDS Drugs in Africa Explored
Weekly but not daily text messages help Africans with HIV/AIDS stay on their drug regimes, according to a study by Georgetown’s James Habyarimana, assistant professor of public policy.
Adherence to a medication schedule is important because not taking the drugs can create mutations in the virus that are resistant to the treatments.
A Costly Risk
While a first line of treatment costs $100 to $300 a year in Africa, the second line is $6,000 to $10,000 annually, making the latter a costly risk for policymakers.
The study, which involved a team of researchers from Georgetown and other universities, also found that encouraging text messages fared no better than impersonal reminders.
“We discovered the encouraging messages had no effect at all on adherence,” explains Habyarimana. “Daily messages, whether they were short reminders or encouraging messages, had no statistically significant effect either.
“I was very surprised by that because you’d think if this is about forgetfulness or even social pressure, daily reminders would work best.”
The research took place in West Kenya and was funded by the World Bank.
Sending a message once a week improved adherence, he says. About 55 percent of those getting the weekly message were 90 percent adherent, compared with 40 percent in the control group that received no message.
“Cell phone technology has already been used [in the United States] for adherence programs for a variety of illnesses,” Habyarimana says. “But this study addresses design questions that can be beneficial to both industrialized and developing countries.”
Habyarimana’s study in Africa examined adherence over about 15 months.
“For the first six months of taking the drugs, patients are usually very enthusiastic and good about adherence,” he says. “They came to the clinic very sick and these drugs help provide a huge increase in their health. … As they get better, people often stop taking the medications with the same frequency.”
When asked why weekly rather than daily reminders worked better and why encouraging messages don’t work, he says, “Sending high-frequency messages could be conceived as patronizing, or it could be that a high frequency stimulus has a declining response. Message fatigue, a well-known phenomenon in marketing, could also explain these results.”
The factors involved in adherence are both psychological and economic, he says, and sometimes people just forget to take their medications.
“Some patients face large direct and indirect costs of getting to the clinic to receive the drugs,”” he explains. “Particularly in Africa, programs maximize attendance and retention in care by only disbursing a month’s worth of medication. While that’s a good way to make sure resources are allocated efficiently, it creates a financial burden for patients, who may live 20 miles away from the clinic.”
Economics and Content
Further studies are warranted, Habyarimana says.
Even with reminders, he says, there are economic constraints that make it harder for people to adhere to medication schedules and which should be addressed.
“We need to think both about content, frequency and how often you refresh the message” he adds. “Information campaigns are very cheap, so if we can find the right combination of these design features, we can establish sustainable AIDS treatment programs.”Source: Office of Communications
“Information campaigns are very cheap, so if we can find the right combination of these design features, we can establish sustainable AIDS treatment programs,' says James Habyarimana.