Richard Lester
A Clinical Assistant Professor in the Division of Infectious Diseases, he was the lead author of a 2010 article in The Lancet describing how HIV patients in Kenya who received weekly text-message “check-ins” were 12 per cent more likely than a control group to have an undetectable level of the virus a year after starting antiretroviral (ART) treatment.
In the Nov. 7 edition of the New England Journal of Medicine, Dr. Lester, the Medical Head of the Division of STI/HIV at the BC Centre for Disease Control, responded to an update of HIV treatment guidelines from the World Health Organization. Here, he elaborates on that commentary:
We all know how it feels to be nagged – and how quickly we tune it out – even when we know the nagger means well and the information is good for us.
For the 34 million men and women worldwide living with HIV, sticking to the antiretroviral therapy (ART) can make the difference between life and death, and mobile devices are increasingly being explored as an ally to help achieve this.
This summer, the World Health Organization strongly recommended text messaging as a reminder tool to increase adherence to ART. A 2010 study my colleagues and I conducted in Kenya showed that a simple “Mambo” (“how are you?”) check-in message delivered weekly to HIV patients’ mobile phones, backed up by prompt follow-ups when participants require help, improved the outcomes of their treatment and the efficiency of the health care providers. But recent studies show that other types of medication reminders and motivational messages did little to keep patients on medication.
The fine – but critical – distinction, as we explain in the current issue of the New England Journal of Medicine, is when we tell someone what to do, they eventually get tired of it; but when we ask how they are doing, we engage and empower them to seek the help they need.
The ubiquity of mobile devices represents an unprecedented opportunity for health care providers to connect with patients when they need it the most.
We are now conducting clinical trials to see if the HIV mobile health model we used in Kenya may be effective in a Canadian setting and whether it can be applied to the management of other chronic conditions – but we must use this promising technology to convey our care – or risk being tuned out.