Appointment reminders to increase uptake of HIV retesting by at‐risk individuals: a randomized controlled study in Thailand

Abstract

Introduction Frequent HIV testing of at‐risk individuals is crucial to detect and treat infections early and prevent transmissions. We assessed the effect of reminders on HIV retesting uptake. Methods The study was conducted within a programme involving four facilities providing free‐of‐charge HIV, syphilis and hepatitis B and C testing and counselling in northern Thailand. Individuals found HIV negative and identified at risk by counsellors were invited to participate in a three‐arm, open‐label, randomized, controlled trial comparing: (a) “No Appointment & No Reminder” (control arm); (b) “No Appointment but Reminder”: short message service (SMS) sent 24 weeks after the enrolment visit to remind booking an appointment, and sent again one week later if no appointment was booked; and (c) “Appointment & Reminder”: appointment scheduled during the enrolment visit and SMS sent one week before appointment to ask for confirmation; if no response: single call made within one business day. The primary endpoint was a HIV retest within seven months after the enrolment visit. The cost of each reminder strategy was calculated as the sum of the following costs in United States dollars (USD): time spent by participants, counsellors and hotline staff; phone calls made; and SMS sent. The target sample size was 217 participants per arm (651 overall). Results Between April and November 2017, 651 participants were randomized. The proportion presenting for HIV retesting within seven months was 11.2% (24/215) in the control arm, versus 19.3% (42/218) in “No Appointment but Reminder” (p = 0.023) and 36.7% (80/218) in “Appointment & Reminder” (p < 0.001). Differences in proportions compared to the control arm were respectively +8.1% (95% CI: +1.4% to +14.8%) and +25.5% (+17.9% to +33.2%). The incremental cost‐effectiveness ratios of “No Appointment but Reminder” and “Appointment & Reminder” compared to the control arm were respectively USD 0.05 and USD 0.14 per participant for each 5% increase in HIV retesting uptake within seven months. Conclusions Scheduling an appointment and sending a reminder one week before was a simple, easy‐to‐implement and affordable intervention that significantly increased HIV retesting uptake in these at‐risk individuals. The personal phone call to clients probably contributed, and also improved service efficiency.

Appointments: A More Effective Commitment Device for Health Behaviors

“…Appointments have been shown to improve efficiency in clinics (Steenland et al 2019). They have also been shown to increase HIV testing rates in a lower-prevalence setting (Salvadori et al 2020); by focusing on high-risk men in a high-prevalence region, we show that appointments are effective even when stakes are high. Appointments can be viewed as a bundle of different behavioral nudges, some of which have been studied extensively, including in the context of HIV testing.…”

“…Although this evidence suggests reminders play an important role, they are not the only mechanism at play. Salvadori et al (2020) find that reminders explain about a third of the increase in HIV testing induced by appointments. In our study, conditional on receiving a reminder, 67 percent of participants who get tested do so on their exact appointment date (two days after the reminder), and we observe a clear spike in testing on that date.…”

Appointments: A More Effective Commitment Device for Health Behaviors

“…39 This explanation mirrors the findings of randomized experiments that study the effects of phone call or message reminders directly, and show that that they increase attendance at medical appointments (Gurol-Urganci et al 2013, Altmann andTraxler 2014). In the particular context of HIV testing, Salvadori et al (2020) find that reminders explain one third of the increase in testing caused by an appointment.…”

“…13 See for example, Tenthani et al (2014), Nyondo et al (2015a), Rana et al (2015), Mugo et al (2016), Mayer and Fontelo (2017), Taylor et al (2019), Salvadori et al (2020), Friedman and Wilson (2021), and Macis et al (2021).…”

Time trends in the risk of HIV infection among men who have sex with men in Chiang Mai, Thailand: an observational study

“…7,8 Numerous projects were implemented to cope with HIV infection in MSM, including rapid testing with same-day results, community-led health workers model, 9,10 and implementing the operational research unit. 11 Chiang Mai is the leading implementation site of pre-exposure prophylaxis (PrEP) focusing on MSM from November 2010. 12 Recently, the program providing reimbursed PrEP concurrently with free HIV testing twice a year, by Thailand's universal coverage scheme, is rolling out nationally.…”