Implementation of Text Messaging and Brief Phone Counseling to Improve Medication Adherence

Abstract

Problem & Purpose: Among persons infected with human immunodeficiency virus (HIV), suboptimal adherence to antiretroviral therapy (ART) decreased treatment efficacy, increased hospital admissions, delayed viral suppression, and increased subsequent onward transmission. As of March 2020, of the approximately 350 HIV-positive patients receiving continuity HIV care at an urban public sexual health and wellness clinic, 41 (13.1%) were not virally suppressed. The purpose of this Quality Improvement (QI) project was to implement and evaluate the effectiveness of weekly medication reminder text messaging and brief phone-based counseling on adherence to ART among HIV-positive adults seen at this clinic. Methods: Implementation, led by Registered Nurse Case Managers (RN-CMs) trained on project procedures, was conducted among a sample of new and existing HIV-positive patients aged 18 years or older who were newly initiating treatment, had sub-optimal medication adherence, had an unsuppressed viral load, had a functioning cell phone, and who agreed to participate. Following ethical approval, the intervention was conducted over 14 weeks (August 31, 2020-December 4, 2020). Data were collected and tracked weekly using a specially designed audit sheet, projected into run charts, and analyzed using Microsoft Excel. Results: Twenty-two (n=22) HIV-positive patients, including four new and 18 existing patients, participated in this project. All 22 (100%) patients received weekly medication reminder text messages, but only seven of the 22 (31.8%) patients agreed to also receive weekly phone-based adherence counseling sessions. Adherence was measured through phone-based unannounced pill counts at weeks four, eight, and 12. The proportion of the total participants who completed pill count with an adherence level of >95% was 71.4% (n=10 of the 14 patients) at four weeks, 86.7% (n=13 of the 15 patients) at eight weeks, and 85.7% (n=12 of the 14 patients) at 12 weeks. Conclusion: Reminder text messages and phone-based adherence counseling were feasible and potentially effective interventions to improve ART adherence. Pill count adherence completion was highly dependent on participants’ availability. However, weekly phone-based counseling sessions were less acceptable to participants.