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J Biomed Inform. 2018 Apr;80:78-86. doi: 10.1016/j.jbi.2018.02.018. Epub 2018 Mar 6.

Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017).

Author information

1
University of California San Francisco, Department of Medicine, Center for AIDS Prevention Studies, San Francisco, CA, USA; Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, Health Communications Research Program, San Francisco, CA, USA; New York State Psychiatric Institute and Columbia University, HIV Center for Clinical and Behavioral Studies, New York, NY, USA. Electronic address: william.brown@ucsf.edu.
2
New York State Psychiatric Institute and Columbia University, HIV Center for Clinical and Behavioral Studies, New York, NY, USA.
3
New York State Psychiatric Institute and Columbia University, HIV Center for Clinical and Behavioral Studies, New York, NY, USA; Columbia University, Mailman School of Public Health, Sociomedical Sciences, New York, NY, USA.
4
New York State Psychiatric Institute and Columbia University, HIV Center for Clinical and Behavioral Studies, New York, NY, USA; Columbia University, College of Physicians and Surgeons, Psychiatry, New York, NY, USA.
5
Desmond Tutu HIV Foundation, Cape Town, South Africa.
6
Asociación Civil Impacta Salud y Educación, Lima, Peru.
7
Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
8
University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA.

Abstract

BACKGROUND:

We implemented a text message-based Short Message Service computer-assisted self-interviewing (SMS-CASI) system to aid adherence and monitor behavior in MTN-017, a phase 2 safety and acceptability study of rectally-applied reduced-glycerin 1% tenofovir gel compared to oral emtricitabine/tenofovir disoproxil fumarate tablets. We sought to implement SMS-based daily reminders and product use reporting, in four countries and five languages, and centralize data management/automated-backup.

METHODS:

We assessed features of five SMS programs against study criteria. After identifying the optimal program, we systematically implemented it in South Africa, Thailand, Peru, and the United States. The system consisted of four windows-based computers, a GSM dongle and sim card to send SMS. The SMS-CASI was, designed for 160 character SMS. Reminders and reporting sessions were initiated by date/time triggered messages. System, questions, responses, and instructions were triggered by predetermined key words.

RESULTS:

There were 142,177 total messages: sent 86,349 (60.73%), received 55,573 (39.09%), failed 255 (0.18%). 6153 (4.33%) of the message were errors generated from either our SMS-CASI system or by participants. Implementation challenges included: high message costs; poor data access; slow data cleaning and analysis; difficulty reporting information to sites; a need for better participant privacy and data security; and mitigating variability in system performance across sites. We mitigated message costs and poor data access by federating the SMS-CASI system, and used secure email protocols to centralize data backup. We developed programming syntaxes to facilitate daily data cleaning and analysis, and a calendar template for reporting SMS behavior. Lastly, we ambiguated text message language to increase privacy, and standardized hardware and software across sites, minimizing operational variability.

CONCLUSION:

We identified factors that aid international implementation and operation of SMS-CASI for real-time adherence monitoring. The challenges and solutions we present can aid other researchers to develop and manage an international multilingual SMS-based adherence reminder and CASI system.

KEYWORDS:

Adherence; Computer-assisted self-interview; HIV; PrEP; Short Message Service (SMS) text messaging; mHealth

PMID:
29501908
PMCID:
PMC5920551
DOI:
10.1016/j.jbi.2018.02.018
[Indexed for MEDLINE]
Free PMC Article

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