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In HIV prevention and care, rural communities are often left out of the mix. But the Oregon Health Authority, in partnership with the YTH (Youth Tech Health) Initiative at ETR, is engaging rural communities in taking charge of their HIV prevention and treatment via Oregon Reminders.
Oregon Reminders is a free service, allowing patients to set customized text messages, email, and voice reminders for regular HIV testing, daily medication reminders (including PrEP), prescription refill reminders and weekly health tips and life advice. Oregon Reminders is free, private, and HIPAA compliant. It is part of the End HIV Oregon strategy and information about it is disseminated to the provider community through Oregon AETC training events to increase patient access to this resource and support positive outcomes along the HIV care continuum.
Oregon Reminders allows users to customize the delivery method and time, content, and type of reminder. We know that rural communities are often underserved by technology[1] and healthcare industries.[2] Oregon Reminders bridges the digital divide through low-tech compatibility. Messages don’t require a smartphone, and voice reminders can be sent to a landline. Additionally, Oregon Reminders is available 24/7, preventing users from needing to travel to a clinic or speak to a provider, issues that are often barriers to care for rural patients due to challenges around access.[3]
Oregon Reminders is an evidence-based program. The World Health Organization (WHO) conducted a review of studies and randomized control trials of short message service (SMS) interventions for antiretroviral therapy (ART) adherence. The review found that the majority of the studies improved ART adherence.[4] Customizable programs that allow individuals to write personalized reminders may be particularly impactful.[5],[6] Interventions that allowed participants to generate personalized message reminders had even greater positive effects on medication adherence than individuals who received pre-developed and uniform messages.[7] These findings suggest that HIV management is particularly complex and should be treated as such in interventions, something Oregon Reminders does well.
In a survey of Oregon Reminders users, we found that Oregon Reminders is helping users maintain or improve healthy behaviors, which improve health outcomes (such as viral suppression) at the individual and community level. It is particularly notable that nearly three-fourths (33/49 or 67%) of respondents receiving refill reminders reported missing a dose of their medication less frequently since registering. Most encouraging is that the majority (32/61 or 52%) of respondents receiving HIV/STD test reminders found the service to be helpful, and some (16/61 or 26%) have tested more frequently since registering.
The main driver of enrollment to Oregon Reminders comes from providers. YTH has engaged the provider community throughout Oregon, in both rural and urban settings, to increase their capacity to enroll clients in the system via webinars, video tutorials on the Oregon Reminders website, and in-person training. Rural users often hear about the service via a provider when being prescribed PrEP, PEP, or ART. We see that, across the map, once a user is enrolled in the system, they rarely leave, highlighting the ease of this supportive system to clients regardless of their tech-savviness or access.
Oregon Reminders can be accessed regardless of location.
References:
- Schaffhauser, D. Lack of Tech Access Hampers Rural Student Outcomes. 2019-03-19. https://thejournal.com/articles/2019/03/19/lack-of-tech-access-hampers-rural-student-outcomes.aspx
- Rosenblatt RA, Andrilla HA, Curtin T, Hart LG. Shortages of medical personnel at community health centers: Implications for planned expansion J Am Med Assoc 2006;295:1042-1049. [PubMed] [Google Scholar]
- Sarasohn-Kahn, J. Digitizing the Safety Net: Health Tech Opportunities for the Underserved. February 2016. https://www.chcf.org/wp-content/uploads/2017/12/PDF-DigitizingSafetyNet.pdf
- Horvath T; Azman H; Kennedy GE; Rutherford GW. Mobile phone text messaging to help patients with HIV infection take their antiretroviral medications every day. Cochrane. 2015-08-28. (Archived by WebCite® at http://www.webcitation.org/6b80nN5MH)
- Rodrigues R1, Shet A, Antony J, Sidney K, Arumugam K, Krishnamurthy S, D'Souza G, DeCosta A. Supporting Adherence to Antiretroviral Therapy with Mobile Phone Reminders: Results from a Cohort in South India. PLoS One. 2012;7(8):e40723. PMID:22952574
- Finitsis DJ, Pellowski JA, Johnson BT. Text Message Intervention Designs to Promote Adherence to Antiretroviral Therapy (ART): A Meta-Analysis of Randomized Controlled Trials. PLoS One. 2014 Feb 5;9(2):e88166.PMID:24505411
- Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized Controlled Trial of a Personalized Cellular Phone Reminder System to Enhance Adherence to Antiretroviral Therapy. AIDS Patient Care STDS. 2011 Mar;25(3):153-61. PMID:21323532
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About Laiah Idelson
Laiah Idelson has worked in the U.S. and abroad in the areas of mobile health, health education, and youth empowerment. As the Strategic Partnerships and Innovation Lead for YTH, Laiah supports new business development and provides leadership for YTH in innovative digital health programming. Prior YTH, Laiah worked at the Center for Interfaith Action, FHI 360, the Bill and Melinda Gates Foundation, and the Johns Hopkins Center for Communication Programs on a variety of health behavior change programs in sub-Saharan Africa related to family planning, maternal health, HIV, and malaria. She has also worked at the Alameda County Public Health Department leading health equity projects and communications and has served as a public health consultant for Glow, a US-based mobile application designed to help women track and understand their fertility. She received her MSPH from the Johns Hopkins Bloomberg School of Public Health.