Richard Lester
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Global digital health for patient engagement in care. Work in Canada, Africa and globally. Quantitative and qualitative studies, implementation research, and digital health policy and ethics. Especially among scaling interventions to benefit vulnerable populations.
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Supervision Enquiry
Postdoctoral Fellows
Great Supervisor Week Mentions
Thank you, Dr. Lester, for your friendly supervision and your dedication during the last years!
In our research group, Dr. Lester sparks innovative conversations between students from a wide range of backgrounds. From computer science students contributing to the development of a mobile health technology to public health researchers studying the implementation of this tech globally, he has a knack for translating information that serves a spectrum of interests. It really helps to bring together students who might otherwise work in silos. I've really appreciated his can-do attitude and the positive perspective he has when tackling complex problems in low-resource settings. He always makes his students feel capable and confident in their abilities and reminds us of the importance our research has in a broader context. As a student from a remote and isolated community, I value that Dr. Lester, his family, and the research group offer a sense of community I need to thrive. Thank you, Dr. Lester, for making anyone and everyone feel welcome in your lab. And I am so grateful for the accommodation of my dog as well; this helped me acclimatize to the city and make transitioning back into post-secondary an easier choice. Thank you!
Graduate Student Supervision
Doctoral Student Supervision (Jan 2008 - Nov 2020)
The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.
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Introduction: The World Health Organization has ambitious goals to eliminate AIDS and TB globally. However, the plan is expensive and financial commitment to achieve this goal is uncertain. Mobile phone-based short message service (SMS) interventions have demonstrated the ability to improve HIV drug therapy adherence. My objective was to evaluate the cost-effectiveness of SMS-based adherence interventions in three settings, which have unique epidemics and health systems, yet struggle with similar adherence barriers. In this thesis, I also consider the value of conducting a cost-effectiveness evaluation before, during and after a randomized trial.Method: This thesis has three parts. First, I evaluated the cost-effectiveness of SMS-based HIV drug adherence interventions in Kenya, where the interventions were first developed. Second, I evaluated the burden of non-adherence and cost sensitivity of SMS-based adherence interventions for latent tuberculosis infection (LTBI) drug therapy in British Columbia, where a trial of an SMS-based adherence intervention is underway. Finally, I evaluated 5,836 combinations of 15 HIV interventions, to understand the role of SMS interventions as part of a combination HIV intervention in India where a trial was being planned. Value was expressed in terms of incremental cost-effectiveness ratios (ICERs), which were a function of incremental costs and quality-adjusted life years (QALYs).Results: In Kenya, the SMS interventions were highly cost-effective in the base case (ICER=$1,389/QALY), and remained cost-effective across most sensitivity analyses. In British Columbia, hypothetical interventions that brought the population to full adherence to LTBI drug therapy could cost up to $450 per person per year and remain cost-effective. SMS interventions were least sensitive to cost and would likely be cost-effective if their efficacy were confirmed. Finally, in India, the SMS interventions were cost saving and were part of 4 of the 5 most efficient combination interventions out of 5,836 possible combinations.Conclusion: The SMS interventions are cost-effective or cost saving when compared to the standard of care in multiple settings. Findings support the implementation of SMS interventions as part of HIV and TB care and suggest they could play an essential role in global containment of these diseases.
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