Economic and epidemiological evaluation of text message-based interventions in patients with the Human Immunodeficiency Virus.
Wendel Mombaque Dos Santos, Marcelo Ribeiro Primeira, Larissa Garcia de Paiva and 1 others
PMID 33027403WHAT IT FOUND
Weekly HIV care text messages lowered viral load more than appointment reminders alone; biweekly messages did not.
A 20-year model projected fewer infections and lower treatment costs, but that long-term saving is not directly observed.
Key findings
01Patients receiving weekly text messages were 1.26 times more likely to have a viral load below 50 copies/ml than the control group.
02In a 20-year model, weekly SMS was projected to avoid 286,538 new HIV infections and save R$ 14 billion in treatment costs.
03At the population level, SMS had a cost-effectiveness ratio of R$28.24 versus R$31.48 for standard treatment and was lower cost and more effective.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The trial was done at one hospital in Brazil, so it may not apply to other settings or populations. Participants had to be able to understand and express themselves and could not be in prison, so people with communication difficulties or incarcerated patients were not studied. Some participants did not complete the trial, and the analysis used only those who completed. The biweekly message group did not show a significant viral-load change, so message frequency matters. The long-term cost and infection projections come from a model that extrapolates a short trial over decades using published parameters. The model did not consider possible outbreaks.
Declared interests
The paper reports funding from CAPES grant 408709/2016-2. It does not report other conflicts of interest.
The easy way to misread this
Do not conclude that text messages of any frequency work for all patients or that the projected savings are proven. Only weekly messages lowered viral load in this trial, and the economic results are model extrapolations from a short study.