Walter H. Curioso

HIV is one of the biggest infectious killers worldwide. To prevent disease progression and avoid development of resistant strains to HIV, people living with HIV must adhere to complicated antiretroviral therapy (ART). Yet, in Peru, where ART has recently been introduced, adherence to HIV treatment has not yet been addressed properly, and no systematic approaches to evaluate or promote adherence to ART exist. For people living with HIV, innovative approaches using information technologies, such as mobile phones, are needed to increase adherence to ART. In my thesis, I proposed the following specific aims: (1) To conduct formative research to assess culturally-specific behavioral messages to be included in the computer-based system; (2) To develop and test an interactive computer-based system using cell phones both to enhance adherence to ART and to deliver HIV transmission risk reduction messages; and (3) To evaluate the impact of the system on ART adherence. To achieve these aims, I conducted a randomized controlled trial of a 12-month intervention, comparing (1) standard-of-care with (2) standard-of-care plus my mobile phone-based system among patients receiving ART at Via Libre, a non-governmental organization established to help people with HIV, and Hospital Nacional Cayetano Heredia, a governmental hospital; both in Lima, Peru. This novel trial adds important evidence to the field of mHealth—the provision of health-related services via mobile communications. The trial is potentially scalable as a prevention strategy by the Ministry of Health, and the results could be applied in other settings, not only for ART, but also to encourage patients to follow long-term treatment plans for other chronic diseases. Furthermore, because the intervention is automated using available information and communication technology, it can be scaled up widely without requiring proportionate and expensive staff resources.