Project Title

Effect of a customized digital adherence tool on retention in care and adherence to antiretroviral treatment for children and adolescents living with HIV in Tanzania and Rwanda (REMIND-KID)

EDCTP Project Call

Senior Fellowship Plus (SFP)

Project Objectives

Broad objective The objective of this study is to gain insight in the needs and contents for an SMS-based DAT among children, adolescents and pregnant/breastfeeding women living with HIV in Kilimanjaro, Tanzania with the aim to customize an existing DAT. Specific objectives. 1. To identify enablers and barriers for using DAT among children and their caregivers/parents, adolescents and breastfeeding women with presumptive HIV-negative infants living with HIV in Kilimanjaro, Tanzania 2. To identify the needed content of SMS schemes for reminding participants to take medication, to give feedback on weekly adherence patterns and come for clinic visits based on the participants’ preferences. 3. To identify the preferred timing, wording, and frequency for SMS for DAT 4. To understand the needs of additional information in the DAT (e.g., education on sexual and reproductive health, importance of breastfeeding) for different study groups. 5. To understand the needs for tailored feedback on DAT adherence behavior reports during clinic consultations. 6. To customize the existing DAT based on the results from objective 1-5

Study Design

Mixed Methods Design

Project Summary

Aim & Objectives REMIND-KID has the aim to develop and test a customized digital adherence tool (DAT) for children and adolescents living with HIV in Tanzania and youth living with HIV in Rwanda. The objectives of REMIND-KID are: I) To develop a customized digital adherence tool through mixed-methods-research to inform contents and timing of short message service (SMS) texts used together with an internet enabled medication dispenser II) To test the effectiveness of the customized DAT on retention in care and adherence to antiretroviral treatment through a randomized clinical trial and III) to increase research capacity in Tanzania and Rwanda through supporting two junior researchers in obtaining their MSc degree, two mid-career researchers, including the trainee fellow, in obtaining their PhD degree and two post doc researchers, including the senior fellow, in becoming leaders in the field of digital health and mixed methods research. How these objectives will be achieved REMIND-KID will be a two-stage research project comprising of (1) formative mixed methods research and (2) clinical trials in different target groups. These groups are HIV-uninfected children and their breastfeeding mothers, children living with HIV and their caregivers and adolescents (in Tanzania) and youth (in Rwanda) living with HIV. In the formative part we will conduct in-depth interviews, focus group discussions and semi- structured interviews with breastfeeding women, caregivers of children aged 0-14 and adolescents aged 15-19. In Rwanda, we will include adolescents and youth till age 24. The results of this part will inform customization of the DAT. Subsequently, the DAT will be tested on its effectivity in a non-blinded randomized two-armed clinical trial in the different subgroups. Further, we will build research capacity in Tanzania by having the senior fellow leading a team of junior to mid-career researchers, mentoring post doc, PhD and MSc students and the trainee fellow in Rwanda obtaining a PhD degree. The activities of REMIND-KID are arranged in 6 work packages which are (1) management and coordination, (2) formative mixed-methods research, (3) clinical trial, (4) mentoring a trainee fellow in Rwanda, (5) capacity building and training in Tanzania and (6) communication and dissemination. Relevance to the call topic REMIND-KID will increase research capacity in Tanzania and Rwanda. It will increase the number of highly qualified researchers at a junior and senior level, especially in social sciences. It will decrease the gender gap in research capacity as both the senior fellow and the trainee are female researchers. It will also contribute to decreasing regional disparity in research capacity by increasing the currently limited research capacity in Rwanda. Furthermore, it will decrease the burden of PRD, through improving the management of HIV treatment of children and youth living with HIV contributing to SDG3.

Host Organisation

Sites

Project Title

Effect of reminder cues and tailored feedback on adherence to antiretroviral drug treatment among HIV positive individuals in the Kilimanjaro region, Tanzania

EDCTP Project Call

Career Development Fellowship (CDF)

Project Objectives

Primary objective To investigate the effect of reminder cues and tailored feedback, using SMS and RTMM, on adherence to treatment among HIV positive adults in Kilimanjaro region, Tanzania. Secondary objectives 1. To determine the effect of both Mhealth-strategies on virological outcome among HIV positive individuals 2. To determine factors that influence adherence to treatment such as quality of life and co-morbidities 3. To determine costs of the Mhealth-strategies 4. To assess feedback of patients and patient preferences with respect to the Mhealth-strategies 5. To assess feasibility of RTMM and SMS in Kilimanjaro region, Tanzania

Study Design

Clinical Trial

Project Summary

REMIND The REMIND-project was funded through a career development fellowship at the Kilimanjaro Clinical Research Institute (KCRI) in Moshi, Tanzania. The fellowship holder was a Dutch midcareer researcher who has resided in Tanzania since 2010 and has a background in epidemiology and medical anthropology. Furthermore, the fellowship contained a PhD position which has been taken by a Tanzanian junior researcher with a background in ICT. The core of the project entailed a clinical trial to improve adherence to ARV treatment among people living with HIV (PLHIV) using mHealth strategies. REMIND had two main objectives which were (1) to investigate whether two innovative mHealth strategies improve adherence to ARV treatment among PLHIV and (2) to build capacity in research in Tanzania by training a postdoctoral researcher, the fellow, and a PhD researcher who are both based at KCRI. In a three-armed randomized clinical trial we investigated whether Wisepill, a real time medication monitoring (RTMM) device, and short message service (SMS) texts used for reminder cues and tailored feedback on adherence patterns, improve adherence to treatment. The fellow, through the clinical trial, increased her knowledge on clinical research, supervised a PhD student and led a research team. Furthermore, she deepened her knowledge on qualitative research and mHealth through short course trainings. The PhD student was able to do a full PhD track during the course of this fellowship. A research team consisting of the PI, study coordinator, research assistant, pharmacists, study doctor and nurses has been established. In December 2017, we started recruiting patients and in February 2020, we finalized follow-up of all patients. Data has been analysed and results show that both RTMM and SMS did not improve adherence to treatment and treatment outcome. However, we found that participants who had a suppressed viral load at study entry, maintained higher levels of adherence in the RTMM and SMS group compared to the control group. We also found that both RTMM and SMS were found to be acceptable by PLHIV despite challenges such as network problems, risk of unwanted disclosure of the HIV status and traveling. Furthermore, the PhD candidate who registered at the University of Amsterdam in the Netherlands has visited the Netherlands twice for attending PhD courses, meeting with Supervisors and working on manuscripts (part of PhD thesis) that we submitted to scientific journals. Apart from this, the fellow and the PhD student have attended several meetings and presented preliminary results of REMIND Study. • Social Behavioral Sciences Symposium, 2019 • EACCR2 Annual scientific meeting, Entebbe Uganda 2019 and Kilifi Kenya 2019 • Tanzania Health Summit in Dodoma 2019 and 2020 • ICASA2019, Kigali, Rwanda

Host Organisation

Sites

Results & Outcomes

Current Organisation

Kilimanjaro Clinical Research Institute

Current Job Title

Senior Researcher

Biography