MGHD 2018

Background: Type 1 Diabetes Mellitus (T1DM) is an emerging epidemic in sub-Saharan Africa. The Rwandan Diabetic Association (RDA) is a non-governmental organization helping pediatric and young adult T1DM patients, through the support in public district hospitals in rural Rwanda. TIDM patients are required to come back every quarter for their clinic follow-up, insulin refill and plasma glucose concentration monitoring (HbA1C). They are reminded about their clinic visits through radio communication. However, adherence to the quarterly visits was low. We explore the impact of a mobile health (mHealth) intervention on adherence to clinic visits and HbA1C check-up through a pilot study, in three rural sites in Rwanda. Objectives: To determine the effectiveness of phone calls and SMS reminders in improving attendance to follow-up visit. Methods: Multicenter non-randomized three-arms pilot study: i) using SMS and radio communication as a reminder; ii) using phone calls by clinic staff, in addition to radio communication, to remind patients of their visit and iii) relying exclusively on the radio announcements RDA makes prior to every visit (control group). The data, pre and postintervention, was analyzed using Excel to describe patients’ demographics and clinical status using percentages, frequencies, and medians with their interquartile ranges. Fisher’s Exact Test was conducted to assess the difference in outcomes between the three groups. The primary measure is the attendance to clinic visits and change in HbA1C level among the intervention study arms. A cost assessment of the budget needed to conduct the outreach visits was also performed, adding the cost of the interventions. A multilevel logistic analysis was also performed to compare the odds of attending in the different groups. Results: A total of 49 patients were enrolled in the study. Attendance rates of control, SMS messaging and phone calls groups were 71.4%, 91.6% and 100%, respectively. The attendance rates of the interventions groups were not statistically significant (0.11 for the phone calls group and 0.17 for the SMS group). There was an increase in HbA1c between baseline and follow-up visits (9.5% versus 10.3%). The cost of SMS messaging was lower compared to phone calls reminders (US$ 0.06 per text versus US$ 0.35 per phone call). Conclusions: Associating phone calls reminders and SMS reminders to the usual RDA’s procedure of radio announcements is more effective than radio announcements only in increasing attendance to follow-up visits. SMS reminders involve lower costs. Limitations to this study included duration of the study, sample size and funding. Keywords: Type 1 Diabetes Mellitus, sub-Saharan Africa, follow-up, mHealth.