Mobile phone intervention for improving ART adherence

A randomised control trial was done to determine the effect of mobile phone intervention on adherence in a two groups (Intervention and Control). Respondents (n = 362) age 18-60 years, HIV seropositive, with access to mobile phone were recruited and followed-up for six months. The Control group received standard care while the Intervention group received standard care, alarm prompting, weekly text messages and monthly voice calls. Primary (overall adherence: Self-report, visual analogue, pill identification, pill count) and secondary (CD4 count and Body Mass Index) outcomes were measured at baseline (B), month three (F1) and month six (F2). Series of data transformation and computations were done to derive final outcome. Data comprises nominal, ordinal and scale computations.
-BMI= Weight in kilogram divided by height in meter square

Scoring multimethod adherence tool
1.Self-reporting (Sr) There are four questions with Yes/No responses.
Response Interpretation Code % Score
No to all items Highly Adherent 3 95 or more
Yes to 1 item Moderately adherent 2 75-94
Yes to 2 or more items Low adherence 1 75 or less

2.Visual Analogue Scale (VAS)
Responses 0 1 2 3 4 5 6 7 8 9 10
Score (%) 0 10 20 30 40 50 60 70 80 90 100

3.Pill identification test (PIT)
Response Interpretation % Score
Ability to remember dose, time and instruction Highly Adherent 95 or more
Ability to remember dose and time Moderately adherent 75-94
Ability to remember dose only Low adherence 75 or less

4. Pill Count (PC)
% Adherence = Dispensed –Returned x 100 divided by Expected to be taken

5. Overall Adherence scores (OAS)More than 95 % (High) 75-95% (Moderate) Less than 75% (Low)

Other Variables such as demographic profile, use of mobile phone and factors influencing adherence were also measure and categorised in data set.

Mixed modeling requires data restructuring and use of the following syntax (replace variable to estimate other relationships.

MIXED OAS BY Index1 id GROUP WITH age sex Ledu Mstatus employment Rel
/CRITERIA=CIN(95) MXITER(100) MXSTEP(10) SCORING(1) SINGULAR(0.000000000001) HCONVERGE(0,
ABSOLUTE) LCONVERGE(0, ABSOLUTE) PCONVERGE(0.000001, ABSOLUTE)
/FIXED= time GROUP age sex Ledu Mstatus employment Rel time*GROUP
/REPEATED = time | SUBJECT(id) COVTYPE(arh1)
/emmeans = tables(GROUP*time) compare(GROUP)
/emmeans = tables(GROUP*time) com

MIXED BMIres BY id GROUP time
/CRITERIA=CIN(95) MXITER(100) MXSTEP(10) SCORING(1) SINGULAR(0.000000000001) HCONVERGE(0,
ABSOLUTE) LCONVERGE(0, ABSOLUTE) PCONVERGE(0.000001, ABSOLUTE)
/FIXED= time GROUP time*GROUP
/REPEATED = time | SUBJECT(id) COVTYPE(arh1)
/emmeans = tables(GROUP*time) compare(GROUP)
/emmeans = tables(GROUP*time) compare(time).

本研究开展随机对照试验（randomised control trial），以评估手机干预措施对两组（干预组与对照组）受试者治疗依从性的影响。共招募362名年龄18~60岁的HIV血清阳性且可使用移动电话的受试者，随访时长为6个月。对照组仅接受标准治疗，干预组则在标准治疗基础上，额外接收闹钟提醒、每周短信及每月语音通话干预。
主要结局指标（整体依从性：自我报告、视觉模拟量表、药片识别测试、药片计数）与次要结局指标（CD4计数与身体质量指数（Body Mass Index））分别在基线（B）、第3个月（F1）及第6个月（F2）进行采集。研究通过一系列数据转换与计算得到最终结局数据，数据集涵盖名义型、有序型与计量型数据。
——身体质量指数计算公式：体重（千克）除以身高（米）的平方。
多维度依从性评估工具评分规则
1. 自我报告法（Self-reporting, Sr）：共包含4道二分类（是/否）问题，评分规则如下：
|作答情况|依从性等级|编码|对应百分制得分|
|----|----|----|----|
|所有问题均作答“否”|高度依从|3|≥95|
|作答1项“是”|中度依从|2|75~94|
|作答2项及以上“是”|低度依从|1|≤75|
2. 视觉模拟量表（Visual Analogue Scale, VAS）：评分对应关系如下：
|作答分值|0|1|2|3|4|5|6|7|8|9|10|
|----|----|----|----|----|----|----|----|----|----|----|----|
|对应得分(%)|0|10|20|30|40|50|60|70|80|90|100|
3. 药片识别测试（Pill identification test, PIT）：评分规则如下：
|作答情况|依从性等级|对应百分制得分|
|----|----|----|
|可记住服药剂量、时间与指导|高度依从|≥95|
|可记住服药剂量与时间|中度依从|75~94|
|仅可记住服药剂量|低度依从|≤75|
4. 药片计数法（Pill Count, PC）：
依从率(%) = （发放药片数 - 回收药片数）/ 预计服药总药片数 × 100
5. 整体依从性评分（Overall Adherence scores, OAS）分级：＞95%为高度依从，75%~95%为中度依从，＜75%为低度依从。
数据集同时收录人口学特征、移动电话使用情况及影响依从性的相关因素等其他变量，均已完成测量与分类。
混合效应模型分析需先对数据进行重构，采用以下语法格式（可替换变量以估算其他关联关系）：
MIXED OAS BY Index1 id GROUP WITH age sex Ledu Mstatus employment Rel
/CRITERIA=CIN(95) MXITER(100) MXSTEP(10) SCORING(1) SINGULAR(0.000000000001) HCONVERGE(0,
ABSOLUTE) LCONVERGE(0, ABSOLUTE) PCONVERGE(0.000001, ABSOLUTE)
/FIXED= time GROUP age sex Ledu Mstatus employment Rel time*GROUP
/REPEATED = time | SUBJECT(id) COVTYPE(arh1)
/emmeans = tables(GROUP*time) compare(GROUP)
/emmeans = tables(GROUP*time) com

MIXED BMIres BY id GROUP time
/CRITERIA=CIN(95) MXITER(100) MXSTEP(10) SCORING(1) SINGULAR(0.000000000001) HCONVERGE(0,
ABSOLUTE) LCONVERGE(0, ABSOLUTE) PCONVERGE(0.000001, ABSOLUTE)
/FIXED= time GROUP time*GROUP
/REPEATED = time | SUBJECT(id) COVTYPE(arh1)
/emmeans = tables(GROUP*time) compare(GROUP)
/emmeans = tables(GROUP*time) compare(time).