Real-Time Antiretroviral Therapy Adherence Intervention in Uganda

This study is currently recruiting participants. (see Contacts and Locations)
Verified September 2013 by Massachusetts General Hospital
Sponsor:
Collaborator:
Mbarara University of Science and Technology
Information provided by (Responsible Party):
Jessica Haberer, MD, Massachusetts General Hospital
ClinicalTrials.gov Identifier:
NCT01957865
First received: September 25, 2013
Last updated: October 7, 2013
Last verified: September 2013
  Purpose

Development of Real-Time Antiretroviral Therapy Adherence Intervention in Uganda (The Wisepill Study).


Condition Intervention
HIV/AIDS
Adherence
Device: SMS reminders, real-time adherence monitoring

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: Development of a Real-Time Antiretroviral Therapy Adherence Intervention in Uganda

Resource links provided by NLM:


Further study details as provided by Massachusetts General Hospital:

Primary Outcome Measures:
  • Antiretroviral therapy (ART) adherence levels [ Time Frame: real time (for 9 months) ] [ Designated as safety issue: No ]
    Difference in adherence among the study arms


Secondary Outcome Measures:
  • HIV RNA suppression [ Time Frame: After months 3 and 9 ] [ Designated as safety issue: No ]
    Difference in percent of participants with HIV RNA suppression among the study arms


Other Outcome Measures:
  • Mechanism by which SMS impact adherence [ Time Frame: Month 3 and between Months 4-9 ] [ Designated as safety issue: No ]
    Qualitative interviews will be conducted to understand the mechanisms by which SMS impact adherence (e.g., overcoming cognitive barriers, providing social support). All participants will have one interview at Month 3. The second interview will occur after the first 48+ hour gap in adherence between Months 4-9 (or at Month 9 if there is no 48+ hour gap in adherence).


Estimated Enrollment: 60
Study Start Date: September 2013
Estimated Study Completion Date: June 2015
Estimated Primary Completion Date: February 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Fixed SMS reminders, real-time adherence monitoring
SMS will be sent daily for one month, then weekly for two months. Participants will have real-time adherence monitoring and social supporters will be notified of gaps in adherence of 48+ hours in the last six months of the study.
Device: SMS reminders, real-time adherence monitoring
SMS reminders will be sent to intervention arm A and B to encourage adherence. The Wisepill system will automatically capture and report each time the device is opened as a proxy for the participant's adherence.
Other Name: Wisepill
Experimental: SMS reminders for missed doses, real-time adherence monitoring
Participants will have real-time adherence monitoring and social supporters will be notified of gaps in adherence of 48+ hours in the last six months of the study.
Device: SMS reminders, real-time adherence monitoring
SMS reminders will be sent to intervention arm A and B to encourage adherence. The Wisepill system will automatically capture and report each time the device is opened as a proxy for the participant's adherence.
Other Name: Wisepill
No Intervention: control
Real-time adherence monitoring only (no SMS)

Detailed Description:

In this study, the investigators propose to develop a real-time adherence intervention based on SMS (i.e., text messages), wireless adherence monitoring (with the Wisepill device), and engagement of social support that is tailored to rural sub-Saharan Africa. The investigators will build on research by others who have shown SMS reminders improve adherence and viral suppression in Kenya, albeit with relatively small effect sizes and suboptimal virologic failure rates even in the intervention arm. Moreover, little is known about which patients benefit from SMS, why they benefit, and what can be done to further improve adherence and treatment success rates. Understanding the mechanisms of effect will make it possible to design and test evidence-based interventions with the highest likelihood for efficacy.

In a cohort of HIV-infected individuals starting ART and being monitored with Wisepill, the investigators will test 1) daily SMS reminders, 2) weekly SMS reminders, 3) SMS reminders linked to real-time detection of missed doses, and 4) SMS reminders plus SMS notifications of 48+hour gaps in adherence to members of social support networks. The investigators will conduct qualitative interviews to learn the experiences of participants and members of their social support networks with the different types of SMS. This staged approach will allow us to fully understand and compare the additive effects and acceptability of SMS-based interventions. The investigators will also determine behavioral effect mechanisms, as well as compare the impact of each type of SMS with a control population receiving only Wisepill monitoring on adherence and HIV RNA.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Wisepill Participants:

Inclusion Criteria:

  • HIV-infected
  • Initiating ART within the next two weeks
  • Age 18 years and older
  • Owns a cell phone for personal use and has reliable cellular phone reception at home on a network supported by the technology used in this study
  • Lives in the Mbarara District (i.e, within 20 km of the ISS Clinic)
  • Has at least one person who could be named as a social supporter(see criteria below).

Exclusion Criteria:

  • Unable to use SMS
  • Unwilling to receive SMS reminders
  • Severe mental condition limiting the ability to provide consent
  • Cellular phone reception is not reliable

Social supporters (i.e., recipients of the SMS notifications for Wisepill participants in the intervention arms):

Inclusion criteria:

  • Knows Wisepill participant has HIV
  • Age 18 years or older
  • Reports having provided social support to the intervention participant at least once
  • Own a cell phone for personal use and have reliable cellular phone reception at home on a network supported by the technology used in this study
  • Lives in the Mbarara District

Exclusion criteria:

  • Unable to use SMS
  • Unwilling to receive SMS notifications regarding interruptions in the intervention participant's adherence
  • Severe mental condition limiting the ability to provide consent
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01957865

Contacts
Contact: Jessica Haberer, MD, MS jhaberer@partners.org

Locations
Uganda
Mbarara Immune Suppression Syndrome(ISS) Clinic Recruiting
Mbarara, Mbarara District, Uganda
Sponsors and Collaborators
Massachusetts General Hospital
Mbarara University of Science and Technology
Investigators
Principal Investigator: Jessica Haberer, MD, MS Massachusetts General Hospital
Principal Investigator: Angella Musiimenta, PhD Mbarara University of Science and Technology
  More Information

No publications provided

Responsible Party: Jessica Haberer, MD, Assistant Professor of Medicine, Massachusetts General Hospital
ClinicalTrials.gov Identifier: NCT01957865     History of Changes
Other Study ID Numbers: R34MH100940-01
Study First Received: September 25, 2013
Last Updated: October 7, 2013
Health Authority: United States: Institutional Review Board
Uganda: National Council for Science and Technology

Keywords provided by Massachusetts General Hospital:
HIV/AIDS
adherence
real time monitoring
SMS
mHealth
social support

ClinicalTrials.gov processed this record on September 18, 2014