20th International AIDS Conference - Melbourne, Australia


TUPE432 - Poster Exhibition

Per protocol analysis of MORE CARE trial, a randomized blinded controlled trial of effectiveness of mobile phone reminders on the follow-up medical care of HIV-exposed and HIV-infected children in Cameroon

J.J.R. Bigna1,2, J.J.N. Noubiap3, C. Kouanfack1,4, C.S. Plottel5, S. Koulla-Shiro1,4

1Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon, 2Goulfey District Hospital, Goulfey, Cameroon, 3Internal Medicine Unit, Edéa Regional Hospital, Edéa, Cameroon, 4Accredited Treatment Centre, Yaoundé Central Hospital, Yaoundé, Cameroon, 5Department of Medicine, New York University Langone Medical Center, New York, United States

Background: Missed opportunity for antiretroviral therapy increases the mortality, antiretroviral therapy resistance, and suboptimal virological response. MORE CARE trial concerns sub-Saharan Africa children HIV-infected/exposed.
Aim: To determine, in well condition (if there is no problem of communication), the most effective method between text message (SMS), mobile phone call, or concomitant SMS and phone call, sent to caregivers, for increase medical appointment presence of HIV-exposed/infected children, as compared to the usual standard of care.
Methods: We have done a per-protocol analysis in MORE CARE trial which was a multicenter, single-blind, randomized, factorial controlled trial. It includes urban, semi-urban, and rural settings, between January and May 2013 in Cameroon. Children''s caregivers were randomized using random block sizes electronically generated and centrally allocated sequentially in a 1:1:1:1 ratio. Randomization and analyses were done by investigators blinded to group assignment. SMS and calls were sent between 48 and 72 hours before the scheduled appointment. Primary outcome was the measure of effectiveness: the presence at a previously scheduled appointment. Interventions were considered unsuccessful:
(i) for SMS group if we did not received “message received” after sending of message;
(ii) for Call group if we had called in vain caregivers;
(iii) for SMS+Call group if these two conditions were fulfilled. This trial is registered with Pan-African Clinical Trials Registry, PACTR201011000261458.
Funding: Completely financed by personal funds of corresponding author.
Results: We randomly assigned 242 adult-child pairs into four groups. During trial, 35/61 (57.4%), 39/60 (65.0%), 50/60 (83.3%), received interventions respectively in SMS+Call, Call, and SMS. Participants assigned to Control group were 61. Presences at appointment were 82.9%, 84.6%, 80.0%, and 50.8% respectively for SMS+Call, Call, SMS, and Control. Table 1 presents comparison of effect. In synergistic analysis, effectiveness were: Call 1.67, SMS+Call 1.63, and SMS 1.57. There was no synergism between the two reminder methods.

Compared groupsCall - ControlSMS+Call -ControlSMS - ControlSMS - SMS+CallCall - SMS+CallSMS - Call
Comparison of effect: odds ratio (95% confidence interval)5?3 (1?9 ; 14?5) ; p < 0.0064?7 (1?7 ; 12?9) ; p < 0.0063?9 (1?6 ; 9?1) ; p = 0.0041?2 (0?39 ; 3?7) ; p = 0.950?88 (0?26 ; 3?0) ; p > 0.991?4 (0?45 ; 4?2) ; p > 0.99
[Comparison: effectiveness, per protocol analysis]

Conclusions: If there is no problem of communication, the most effective method to increase appointment presence at health care setting of HIV-exposed/infected children in sub-Sahara Africa was voice phone call alone.

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