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CTN 284: WelTel Retain

Promoting Engagement in Pre-ART HIV Care Through SMS

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About the study

Patient retention in care (continuing to see their medical professional) and adherence to treatment (following the treatment program) leads to better health outcomes for patients and is important to the success of HIV care programs. Unfortunately, many patients do not consistently remain in care. Furthermore, low-income settings pose extra challenges to maintaining treatment because of increased barriers to access health care.

Cell phones provide new opportunities for communication between medical professionals and their patients. The purpose of this study is to determine if the use of cell phone text-messaging between clinic staff and individuals infected with HIV helps people stay in HIV care.

About the disease/condition

Access to antiretroviral therapy (ART), the most common treatment for HIV, continues to expand throughout sub-Saharan Africa, and research has shown that high levels of patient retention and adherence to treatment programs are very important to the success of HIV care. Yet, after 6 months, over 20% of patients in low-income areas are no longer on consistent treatment, and after 3 years, 35% are no longer on consistent treatment. Retention is even lower for patients who have not yet begun treatment. New communication technologies like cell phones give us new opportunities to develop strategies to improve treatment and communication between medical professionals and patients.

Study Approach

This study will recruit 700 participants who will be followed-up for 12 months. It will take place at two large health centres in Nairobi that offer HIV care and treatment. The clinics serve low-income populations that have minimal access to basic services such as running water, sanitation, and electricity. The participants will be randomly placed into one of two groups.

The first group of patients will use a cell phone to stay in contact with the medical team. The second group will receive standard care. Each group will have the same number of patients. If the use of cell phones is found to be more effective than standard care at retaining patients, the participants in the group receiving standard care will gradually be moved into the other group after the first phase of the study.

For more information about the study, please refer to

Participating sites

Kibera Community Health Centre
Nairobi, Kenya

Baba Dogo Health Centre
Nairobi, Kenya


Main results for CTN 284 were published in Lancet Public Healthin January 2018. After a median intervention period of 54.3 weeks, no effect was found on retention in care or treatment outcomes. Participants in both groups attended an equivalent number of appointments and initiated ART over a similar time period. Overall retention in the trial population was 80% compared to 65% in the general clinic. In a separate publication, the WelTel Study group evaluated the use of two survey instruments (SF-12 and SF-6D) in this population and concluded that these instruments could be used to assess physical and mental health in people living with HIV in Kenya. Using a culturally adapted version of the SF-12, the team compared HIV-related quality of life in men and women enrolled in the study, published in AIDS Care at the end of 2017. Men and women reported similar mental health scores after receiving a positive HIV test — women reported greater physical health compared to men but this result was not considered clinically significant. Older age and unemployment were negatively correlated with physical health and higher CD4 count and level of education was positively correlated with physical health.


van der Kop ML, Muhula S, Nagide PI, Thabane L, Gelmon L, Awiti PO, Abunah B, Kyomuhangi LB, Budd MA, Marra C, Patel A, Karanja S, Ojakaa DI, Mills EJ, Ekström AM, Lester RT. Effect of an interactive text-messaging service on patient retention during the first year of HIV care in Kenya (WelTel Retain): an open-label, randomised parallel-group study. Lancet Public Health. 2018 Jan 17 epub ahead of print.

Bardosh KL, Murray M, Khaemba AM, Smillie K, Lester RT. Operationalizing mHealth to improve patient care: a qualitative implementation science evaluation of the WelTel texting intervention in Canada and Kenya. Global Health. 2017 Dec;13(1):87.

van der Kop ML, Muhula S, Patel A, Thabane L, Awiti P, Kyomuhangi L, Abunah B, Nagide PI, Smillie K, Ojakaa DI, Kimani J, Ekström AM, Lester RT. Gender differences in health-related quality of life at the time of a positive HIV test — a cross-sectional study in a resource-poor, high prevalence setting in Nairobi, Kenya. AIDS Care. 2017 Dec 19 epub ahead of print.

Patel AR, Lester RT, Marra CA, van der Kop ML, Ritvo P, Engel L, Karanja S, Lynd LD. The validity of the SF-12 and SF-6D instruments in people living with HIV/AIDS in Kenya. Health Qual Life Outcomes. 2017 Jul 17;15(1):143.

van der Kop ML, Muhula S, Ekström AM, Jongbloed K, Smillie K, Abunah B, Kinagwi K, Kyomuhangi LB, Gelmon L, Ojakaa DI, Lester RT, Awiti PO. Participation in a mobile health intervention trial to improve retention in HIV care: does gender matter? J Telemed Telecare. 2017 Feb;23(2):314-20.

Patel AR, Kessler J, Braithwaite RS, Nucifora KA, Thirumurthy H, Zhou Q, Lester RT, Marra CA. Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya. Medicine. 2017 Feb;96(7):e6078.

van der Kop ML, Thabane L, Awiti PO, Muhula S, Kyomuhangi LB, Lester RT, Ekström AM. Advanced HIV disease at presentation to care in Nairobi, Kenya: late diagnosis or delayed linkage to care? — a cross-sectional study. BMC Infect Dis. 2016 Apr;16(1):169.

Additional Information

If you would like more information on this clinical study, please refer to the principal investigator.

Principal Investigators

Dr. Richard Lester, MD
Clinical Assistant Professor, Faculty of Medicine, University of British Columbia
Clinic Physician, BCCDC
655 West 12th Avenue, Vancouver, BC, V5Z 4R4
1.604.707.5606 (office) or
1.604.789.2908 (mobile)

Mr. Samuel Muhula, MSc
Research Programme Manager
AMREF Health Africa

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