One of the biggest challenges that public health systems face is reaching last-mile communities. And, for as large as that problem is in direct service provision - it can be even harder to stay in contact for researchers. Since 2017, Bloomberg School of Public Health, Johns Hopkins (JHU) has collaborated with the Thailand Ministry of Public Health and Center for Disease Control and Prevention (CDC) to conduct a 5-year research project in Bangkok and Pattaya. The study is targeting 1200 HIV-uninfected gay men (MSM) aged 18 to 26 with the aim of assessing the effectiveness of using pre-exposure prophylaxis (PrEP) therapy as a combative measure against the spread of the virus. This is where FrontlineSMS comes in; the system runs as a confidential local service and does not exclude any types of participants. It has also allowed the study to scale quickly over a short period of time.
Adherence to the PrEP therapy among this high-risk group has historically been insufficient due to privacy concerns, lifestyle inconveniences, and lack of an agreeable interactive support system. Participants are deemed to have adhered to the research project if they take at least four pills of PrEP within a week. Tailored SMS messages have effectively been demonstrated as a powerful adherence tool, and are optimal for harvesting real-time data, according to several studies. The researchers use FrontlineSMS’ highly automated software for two-way communication with the participants, to collect study data, and to improve uptake, retention and adherence to the PrEP medication.
FrontlineSMS designed a system that could handle large parts of the study 100% over SMS. The system dovetailed with what already existed in CDC databases, using a shared API, and provides logic when the research team needs it. This has saved time and costs associated with development of extra software. The design enables participants to subscribe to the study, receive reminders, and provide feedback on how the medicine is having an impact on their lives all through simple-to-use automated SMS. The researchers utilise FrontlineSMS to capture data, guarantee privacy and security for participants, offer adherence support, and communicate in Thai.
“Participant engagement can be challenging in any research study, and particularly so with younger participant demographics... Through FrontlineSMS’ highly customizable and streamlined platform, we have easily been able to do both. The outcome? Clean, timely data, and high study retention rates across the board!”
The research’s operation base is at Silom Community Clinic in Bangkok, and is connected to over 65 study centres. Every site has a coordinator who regularly relays information to a multisite controller. Final data is submitted to the head of study based at JHU’s Baltimore Campus for reviewing, cleaning, and analysis. The research team has been running large parts of the clinic trial using FrontlineSMS Activity automations, a local FrontlineSync gateway Android phone, and a comprehensive integration to the CDC database. The system has allowed the research study to increase the number of participants to 900 as of April 2020 without significant changes to the team or its processes.
Upon consent, participants that opt in for SMS reminders have their profiles configured within the FrontlineSMS workspace, and are provided with passwords to securely initiate future correspondence. They receive weekly brief behavioural studies, and SMS adherence prompts on medication, HIV testing, and counselling - all triggered based on their specific situation. With every interaction taking place automatically via two-way SMS, participants can continue to live their normal lives in private without interruptions, wherever they may be. They have full autonomy to discontinue with the program, or restart, at any point during the study.