Short Message Service (SMS)-Based Intervention to Improve Treatment Adherence among HIV-Positive Youth in Uganda: Focus Group Findings

This paper presents one of the first qualitative studies to discuss programmatic barriers to SMS-based interventions for HIV-positive youth and discusses pathways through which youth perceive them to work. We conducted six focus groups with 20 male and 19 female HIV-positive youths in two clinics in Kampala, Uganda. We find that youth commonly use SMS as over 90% of this study’s youths knew how to read, write and send messages and almost three-fourths of them had phones. Youth strongly felt that the success of this intervention hinged on ensuring confidentiality about their HIV-positive status. Key programmatic challenges discussed where restrictions on phone use and phone sharing that could exclude some youth. Participants felt that the intervention would improve their adherence by providing them with needed reminders and social support. Youths’ suggestions about intervention logistics related to content, frequency, timing and two-way messages will be helpful to practitioners in the field

What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions

Background Mobile health (mHealth) is often reputed to be cost-effective or cost-saving. Despite optimism, the strength of the evidence supporting this assertion has been limited. In this systematic review the body of evidence related to economic evaluations of mHealth interventions is assessed and summarized. Methods Seven electronic bibliographic databases, grey literature, and relevant references were searched. Eligibility criteria included original articles, comparison of costs and consequences of interventions (one categorized as a primary mHealth intervention or mHealth intervention as a component of other interventions), health and economic outcomes and published in English. Full economic evaluations were appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist and The PRISMA guidelines were followed. Results Searches identified 5902 results, of which 318 were examined at full text, and 39 were included in this review. The 39 studies spanned 19 countries, most of which were conducted in upper and upper-middle income countries (34, 87.2%). Primary mHealth interventions (35, 89.7%), behavior change communication type interventions (e.g., improve attendance rates, medication adherence) (27, 69.2%), and short messaging system (SMS) as the mHealth function (e.g., used to send reminders, information, provide support, conduct surveys or collect data) (22, 56.4%) were most frequent; the most frequent disease or condition focuses were outpatient clinic attendance, cardiovascular disease, and diabetes. The average percent of CHEERS checklist items reported was 79.6% (range 47.62–100, STD 14.18) and the top quartile reported 91.3–100%. In 29 studies (74.3%), researchers reported that the mHealth intervention was cost-effective, economically beneficial, or cost saving at base case. Conclusions Findings highlight a growing body of economic evidence for mHealth interventions. Although all studies included a comparison of intervention effectiveness of a health-related outcome and reported economic data, many did not report all recommended economic outcome items and were lacking in comprehensive analysis. The identified economic evaluations varied by disease or condition focus, economic outcome measurements, perspectives, and were distributed unevenly geographically, limiting formal meta-analysis. Further research is needed in low and low-middle income countries and to understand the impact of different mHealth types. Following established economic reporting guidelines will improve this body of research

Susceptibility-Weighted Angiography for the Follow-Up of Brain Arteriovenous Malformations Treated with Stereotactic Radiosurgery

International audienc

Symptomatic Radionecrosis after AVM Stereotactic Radiosurgery

The purpose of our study was to analyze the outcome of symptomatic radionecrosis following stereotactic radiosurgery for brain arterio venous malformations. Of 225 patients treated by linear accelerator radiosurgery for brain AVM, 16 (7, 1%) presented post-radiosurgery symptomatic radionecrosis on a mean follow-up period of 50 months (range 1–123 months). Once diagnosed with radionecrosis, 14 of 16 patients were subjected to high dose corticotherapy consisting of escalating doses of dexamethasone for several weeks. The mean interval of occurrence of new symptoms was 11.6 months post-radiosurgery (range 6–20 months). The mean time of follow-up was 2.9 years post radiotherap y ranging from seven months to eight years. Of the 16 patients with symptomatic radionecrosis, 11 (68, 75%) showed complete resolution of symptoms while five (31, 25%) showed improvement but still presented a neurological deficit at the closing date of the study. At the closing date, 11 patients (68.75%) had angiographically completely obliterated arterio venous malformations while another two patients had an obliteration of 95% to 98% and one patient had a 98% obliteration with development of a new contralateral AVM. In our series, symptomatic radionecrosis occurred in 7.1% of patients treated with stereotactic radiosurgery for brain AVM. These patients where subjected to a prompt, high dose corticosteroid treatment and most presented symptom resolution or improvement with a fair obliteration rate, offering protection from bleeding. Permanent neurologic deficits attributable to radionecrosis occurred in 2.2% of our patient population treated with stereotactic radiosurgery for brain AVM. </jats:p