. Parkes-Ratanshi R. 03/04/19; 258863; 1037 Topic: Other
Dr. Rosalind Parkes-Ratanshi
Dr. Rosalind Parkes-Ratanshi
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Title- Call for Life Uganda TM: An RCT using interactive voice response for PLHIV on ART

Authors - Rosalind Parkes-Ratanshi, Sarah Nabaggala, Agnes Bwanika, Mohammed Lamorde, Rachel King, Noela Owarwo, Eva Laker, Richard Orama, Barbara Castelnuovo, Agnes Kiragga.

Background The WHO recommends use of mobile phone health technologies (mHealth) to support adherence in HIV. Studies on text messages show promise but with limited rigorous evaluations. The Call for Life UgandaTM (CfLUU) study is a randomized controlled trial (RCT) using an interactive voice response (IVR) calls system designed to support PLHIV on ART. The primary study objective was determine the effect of CfLU on quality of life (QOL) of people living with HIV (PLHIV) in Uganda.

Methods MOTECH software-based Connect for LifeTM (Janssen, Johnson & Johnson) was adapted for Ugandan setting, in collaboration with Infectious Diseases Institute (IDI). Between August 2016 and February 2018 in an urban and a rural site in Kampala, 1031 PLHIV accessing care were screened and 600 enrolled on the study (n=300/site). The participants were randomized 1:1 to receive either CfLU or standard of care (SoC). In English or 2 local languages, the CfLU arm received daily/weekly pill reminder calls or SMS messages, visit reminders, health information advice and symptom reporting. At 6, 12 and 24 months of follow up QOL assessments (HIV Medical Outcomes Survey, MOS-HIV including physical health score [PHS] and mental health score [MHS]) and viral loads are performed. Qualitative and tool update data is also collected. Data from 6m are presented here.

Sixty-nine percent were female and median age was 32 (IQR25-40). Eight four participants were ART naïve, remaining ART experienced. At baseline, 97% chose IVR over SMS. There was no difference in arms for education level, marital status, employment status, previous TB or alcohol use. 277 in each arm attended at 6m. There is no statistical observed difference in mean percentage score of MOS-HIV, MHS and PHS at baseline and 6m between CfLU and SoC arms. In those starting first line ART or switching to second line, there was a significant improvement in PHS (ANACOVA 4.01, p=0.048). There was no significant difference between CfLU versus the SoC in the proportion of patients with viral load <50 copies at 6m (21% vs 18%: p-value=0.372).

This is the first RCT incorporating options for IVR and SMS options as well as symptom reporting and health tips. Strong preference was shown for IVR over SMS. In this mixed group of patients, there was no statistical effect of CfLU observed on QOL at 6m. Within this study, a higher than expected QOL and baseline virological supression was encountered at 6m for both sites.
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