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
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
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.
[Comparison: effectiveness, per protocol analysis]
|Compared groups||Call - Control||SMS+Call -Control||SMS - Control||SMS - SMS+Call||Call - SMS+Call||SMS - Call|
|Comparison of effect: odds ratio (95% confidence interval)||5?3 (1?9 ; 14?5) ; p < 0.006||4?7 (1?7 ; 12?9) ; p < 0.006||3?9 (1?6 ; 9?1) ; p = 0.004||1?2 (0?39 ; 3?7) ; p = 0.95||0?88 (0?26 ; 3?0) ; p > 0.99||1?4 (0?45 ; 4?2) ; p > 0.99|
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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