Using SMS to Promote HCV Testing and Linkage to Care

Background:  Nearly 4 million Americans and 150,000 New York City (NYC) residents may have chronic hepatitis C (HCV). HCV is a leading cause of end-stage liver disease and liver transplant, and the number of deaths associated with HCV now exceeds deaths associated with HIV in the U.S. Highly effective HCV treatments are now available, resulting in cure in more than 90% of patients treated. Approximately 7,000 NYC residents are newly reported to the NYC Health Department with a positive HCV test each year. A recent study showed that a third lack a HCV RNA test to determine infection status, indicating that they are not in HCV medical care. Funding for HCV surveillance, testing, linkage to care and treatment is limited. Health departments must identify cost-efficient practices to promote HCV testing, linkage to care and treatment.

Program background:  The NYC Health Department spearheads surveillance, research and programmatic initiatives to educate providers and the public and promote HCV testing, linkage to care and treatment. Since 2004, the Health Department has mailed educational materials to individuals reported with a positive HCV test, and recently began including a HCV medical care referral list. The cost of postal mailings is high, and it is unknown how many letters are received or opened. Ninety percent of Americans own a mobile phone, offering new ways to provide interactive health interventions. In July 2014, the Health Department launched a pilot opt-in short message service (SMS) campaign (Text LIVER to 877877), offering participants HCV risk assessment, testing, and linkage to care resources through an automated interactive text dialog. The service was listed on 4 health education materials for patients. Funding was not available for marketing to promote the campaign.

Evaluation Methods and Results:  The campaign was evaluated by analyzing user data in the SMS vendor admin portal. As of April 2015, 60 participants opted-in, with the majority seeking: treatment sites (28%), testing sites (22%), and risk assessment (15%). Anecdotal feedback was positive; one user commented “Easy to use, easy questions, no hassle.” Marketing and additional strategies, such as proactively texting patients who are not in care, are planned to increase utilization of this resource, and findings from these activities will be presented.

Conclusions:  Few, if any, public health programs offer HCV testing and treatment information via SMS. NYC Health Department mailings to people with positive hepatitis tests can cost up to $30,000 a year. The cost of SMS is significantly less, while offering the same information in a more interactive, tailored fashion. Because many SMS vendors provide real-time data on user activity, this method also offers more detailed utilization metrics than postal mailings.

Implications for research and/or practice:  Growing research demonstrates the acceptability and effectiveness of SMS campaigns to promote disease management and health seeking behaviors. Given the rapid adoption of mobile technologies across the U.S., and data indicating that low-income, vulnerable populations use cellphones at higher rates than higher-income populations, SMS-based interventions are a promising area for health communication research and practice.