COMPUTER ALERT SYSTEM AND TELEPHONE SUPPORT TO IMPROVE ANTIRETROVIRAL THERAPY ADHERENCE
COMPUTER ALERT SYSTEM AND
TO IMPROVE ANTIRETROVIRAL
Kasparas, Gustavo Guillermo (1); Iannella, María del Carmen
(2);Bugarin, Gabriela (1); Miro, Roxana (1); Belforte, Marcela (1);
Visciglio, Hugo (3); Bologna, Rosa (1); Cassetti, Isabel (1)
Organization(s): 1: Helios Salud, Argentina; 2: Universidad de Buenos
Aires; 3: Infhos. Contact e-mail: firstname.lastname@example.org
• Poor adherence to antiretroviral therapy (ART) is a major
obstacle to successful treatment outcomes
• There is evidence that telephone support improves
adherence in several medical areas
• In developing countries mobile phones are widely used
• The registry of medication dispensed is an indirect method
to assess adherence with acceptable sensitivity and
• To evaluate the efficacy of an adherence
strategy based on a computer alarm system
and telephone support intervention
Design: This is a retrospective intervention comparative cohort study.
The comparator referred to is year 2006. In 2007 a newly installed computer alert
system began to identify any delay of ART dispensing. Adherence strategies of
telephone support were applied. Results for 2007, 2008 and 2009 were compared
The rates of dispensed ART were compared as indirect indicators of adherence.
Setting: This study was done at a private specialized medical center in Buenos Aires
City and affiliates in the provinces where interdisciplinary HIV/AIDS attention is
Study population: The whole population in follow up was retrospectively studied
from 2006 to 2009. At baseline, year 2006, there were 3,319 patients being followed
up, mean age (SD) 37.0 (11.5) years, male 67.8%, ART 75.5%. In 2007 3,430 patients
37.3 (11.3) years, male 66.9%, ART 77.5%, in 2008 4,040 patients 37.7(11.2) years,
male 67.7%, 76.5% on ART and in 2009 there were 4,584 patients, 38.4 (11.4) years,
male 67.5%, ART 77.2%.
A computer program was designed to alert health
staff about a delay in patient’s visit for
medication dispense for the following period.
Psychologists, social workers and peer support
were trained to contact those patients by phone.
• Outcome Measure:
To assess efficacy of intervention in yearly rate of
pharmacy dispensing with respect to the
METHODS (II): Study Population
TABLE 1. Medical Monitoring Population: 2006 to 2009
N° of Patients
Age, mean years 37.0 (SD11.5)
Year 2006: Baseline comparator
b Year 2007: Start of the warning computer system and telephone support adherence to ART
• The rate of medication dispensing visit showed a
statistically significant increase with respect to baseline
in 2007 (81.4%; 95% CI: 80.97-81.88; p = 0.001), 2008
(81.0%; 95% CI: 80.52 - 81.37; p = 0.004), 2009 (83.2%;
95% CI: 82.85-83.60, p < 0.001) and 2010 (88.9%; 95%
CI: 88.33-89.40, p < 0.0001).
• The rate of viral load < 50 copies/mL lab results
showed a statistically significant increase with respect
to the baseline.
• The rate of CD4 T-cell count remained stable or slightly
increased with no statistical significance.
Figure 2. Percentage of studies with VL <50 copies / mL
POLICY IMPLICATION & CONCLUSION
Our findings show that centralized data of pharmacy dispensing, with a computer
alarm for any delay and telephone support improves long-term adherence to ART
and clinical outcomes.
Health policies that centralize computerized data and encourage the training of
personnel may promote the replication of these interventions tailored to each
This experience requires the work of members of different areas, which involves
the development of teamwork skills. Supervision, coordination and training of the
executors are necessary for this intervention in order to avoid losing the essence of
"health intervention" to prevent becoming a purely administrative task without
Mobile telephones are widespread, even in the poorest countries in the world.
This gives health workers the opportunity to communicate with patients and thus
strengthen adherence to treatment.
Gustavo G. Kasparas
Contact e-mail: email@example.com