Sebastian Linnemayr1, Haijing Huang1, Jill Luoto1, Andrew Kambugu1, Harsha Thirumurthy1, Jessica E Haberer1, Glenn Wagner1, Barbara Mukasa1. 1. Sebastian Linnemayr, Jill Luoto, and Glenn Wagner are with the RAND Corporation, Santa Monica, CA. Haijing Huang is with the Pardee RAND Graduate School, Santa Monica. Andrew Kambugu is with Infectious Diseases Institute and Makerere University, Kampala, Uganda. Harsha Thirumurthy is with Department of Health Policy and Management and Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Jessica E. Haberer is with Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, MA. Barbara Mukasa is with Mildmay Uganda, Kampala.
Abstract
OBJECTIVES: To assess the effectiveness of Short Message Service (SMS) reminder messages on antiretroviral and cotrimoxazole prophylaxis adherence among HIV-positive youths as well as the relative effectiveness of SMS with and without a response option. METHODS:Eligible HIV-positive patients aged 15 to 22 years at 2 HIV clinics in Kampala, Uganda, participated in a year-long parallel individual-randomized controlled trial and were assigned in a 1-to-1-to-1 ratio to a weekly SMS message group, weekly SMS message with response option group, or a usual-care control group. RESULTS:We enrolled 332 participants. Electronically measured mean adherence was 67% in the control group, 64% in the 1-way SMS group (95% confidence interval [CI] = 0.77, 1.14), and 61% in the 2-way SMS group (95% CI = 0.75, 1.12) in an intent-to-treat analysis. Results for secondary outcomes and complete-case analysis were similarly statistically insignificant across groups. CONCLUSIONS: Despite previous evidence that interventions using SMS reminders can promote antiretroviral therapy adherence, this study shows that they are not always effective in achieving behavior change. More research is needed to find out for whom, and under what conditions, they can be beneficial. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00830622.
RCT Entities:
OBJECTIVES: To assess the effectiveness of Short Message Service (SMS) reminder messages on antiretroviral and cotrimoxazole prophylaxis adherence among HIV-positive youths as well as the relative effectiveness of SMS with and without a response option. METHODS: Eligible HIV-positive patients aged 15 to 22 years at 2 HIV clinics in Kampala, Uganda, participated in a year-long parallel individual-randomized controlled trial and were assigned in a 1-to-1-to-1 ratio to a weekly SMS message group, weekly SMS message with response option group, or a usual-care control group. RESULTS: We enrolled 332 participants. Electronically measured mean adherence was 67% in the control group, 64% in the 1-way SMS group (95% confidence interval [CI] = 0.77, 1.14), and 61% in the 2-way SMS group (95% CI = 0.75, 1.12) in an intent-to-treat analysis. Results for secondary outcomes and complete-case analysis were similarly statistically insignificant across groups. CONCLUSIONS: Despite previous evidence that interventions using SMS reminders can promote antiretroviral therapy adherence, this study shows that they are not always effective in achieving behavior change. More research is needed to find out for whom, and under what conditions, they can be beneficial. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00830622.
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