Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders

TLDR

There is limited evidence that expanding mobile phone use in sub‑Saharan Africa can improve antiretroviral therapy adherence. The study tested the efficacy of SMS reminders on ART adherence among patients at a rural Kenyan clinic. A randomized controlled trial with 431 adults on ART compared four SMS reminder schedules (short/long, daily/weekly) over 48 weeks, measuring adherence via medication event monitoring and assessing 90 % adherence per 12‑week period. Weekly SMS reminders increased 90 % adherence to 53 % versus 40 % in controls and lowered 48‑hour treatment interruptions from 90 % to 81 % (P = 0.03), indicating SMS reminders can improve ART outcomes in resource‑limited settings.

Abstract

There is limited evidence on whether growing mobile phone availability in sub-Saharan Africa can be used to promote high adherence to antiretroviral therapy (ART). This study tested the efficacy of short message service (SMS) reminders on adherence to ART among patients attending a rural clinic in Kenya. A randomized controlled trial of four SMS reminder interventions with 48 weeks of follow-up. Four hundred and thirty-one adult patients who had initiated ART within 3 months were enrolled and randomly assigned to a control group or one of the four intervention groups. Participants in the intervention groups received SMS reminders that were either short or long and sent at a daily or weekly frequency. Adherence was measured using the medication event monitoring system. The primary outcome was whether adherence exceeded 90% during each 12-week period of analysis and the 48-week study period. The secondary outcome was whether there were treatment interruptions lasting at least 48 h. In intention-to-treat analysis, 53% of participants receiving weekly SMS reminders achieved adherence of at least 90% during the 48 weeks of the study, compared with 40% of participants in the control group (P = 0.03). Participants in groups receiving weekly reminders were also significantly less likely to experience treatment interruptions exceeding 48 h during the 48-week follow-up period than participants in the control group (81 vs. 90%, P = 0.03). These results suggest that SMS reminders may be an important tool to achieve optimal treatment response in resource-limited settings.