Mobile phone communication and health system strengthening: a pilot study of telephonic warmline consultation in HIV care and support in South India.

INTRODUCTION: I-TECH India established a warmline pilot in the year 2008 to provide mobile-based technical support on clinical management to doctors caring for HIV patients in antiretroviral therapy (ART) centers. METHODS: Warmline was piloted from May to August 2008. Standardized call records were analyzed. Statistical analyses were performed using SPSS. RESULTS: The service was used by 38 doctors. The study demonstrated the frequency of calls and the nature of questions raised by them. Of the calls, 139 were new calls (90.3%) and 15 were follow-up calls. The average number of calls per day was 2.6 (SD 1.6). Of the total number, 81% of the calls were from high-volume centers. Most of the calls were related to ARV toxicities, ART initiation, and the management of opportunistic infections (OI). CONCLUSION: The South Indian warmline pilot demonstrated a potential model of ongoing technical assistance to ART doctors in times of need. AIDS-control organizations may consider expanding this model of expert distance-mentoring clinical support as a resource in India and other countries.

Determinants of condom uptake among HIV voluntary counselling and testing clients: experiences from a hospital-based study in south India.

BACKGROUND: HIV voluntary counselling and testing was a key HIV prevention strategy brought to scale by India's National AIDS Control Organization. Condom uptake is an essential metric of intervention impact given the expansion of the epidemic into an increasingly diverse population. With only 20% of first-time counselling and testing clients at the largest HIV treatment hospital in south India reporting previous condom use, the question of intervention impact on condom use deserves investigation. In this study, we track intervention impact across various demographic groups and identify the added value of more thorough counselling. METHODS: Data were collected from 8,865 individuals who attended counselling multiple times at the Tamil Nadu Government Hospital of Thoracic Medicine over the years 2004-2009. Counsellors recorded client demographic characteristics, HIV risk behaviours reported, and counselling services provided after each counselling session. Matching and regression methods were used to determine the probability of condom uptake by serostatus, gender, and receipt of personalized risk reduction counselling while controlling for other characteristics. RESULTS: HIV counselling and testing was associated with condom uptake among 29.2% of HIV positive women (CI 24.5-34.4%), 31.7% of HIV positive men (CI 27.8-35.4%), 15.5% of HIV negative women (CI 11.2-20.8%), and only 3.6% of HIV negative men (CI 1.9-5.9%) who had previously never used condoms. Personalized risk reduction counselling increased impact in some groups; for example an additional 18% of HIV negative women (CI 11.3-24.4%) and 17% of HIV positive men (CI 10.9-23.4%) started using condoms. The number of sexual partners was not associated with the impact of counselling completeness. CONCLUSIONS: Because the components of testing and counselling impact the condom use habits of men and women differently, understanding the dynamics of condom use negotiation between partners is essential to optimizing impact on Indian couples. Clients' predicted condom uptake ranged between 4% and 47% depending on factors like gender, serostatus, and services provided. Personalized risk reduction counselling is associated with increased chance of condom use, with larger gains in HIV negative women and HIV positive men. HIV negative men are least likely to start using condoms and least impacted by additional counselling.