Pilot RCT of bidirectional text messaging for ART adherence among nonurban substance users with HIV.

Abstract

Objective This pilot study tested the preliminary efficacy of a theory-based bidirectional text messaging intervention (TEXT) on antiretroviral (ART) adherence, missed care visits, and substance use among people with HIV. Methods Participants with recent substance use and ART nonadherence from 2 nonurban HIV clinics were randomized to TEXT or to usual care (UC). The TEXT intervention included daily queries of ART adherence, mood, and substance use. The system sent contingent intervention messages created by participants for reports of adherence/non-adherence, good mood/poor mood, and no substance use/use. Assessments were at pre-intervention, post-intervention, and 3-month post-intervention follow-up. Objective primary outcomes were adherence, measured by past 3-month pharmacy refill rate, and proportion of missed visits (PMV), measured by medical records. The rate of substance-using days from the timeline follow-back was a secondary outcome. Results Sixty-three patients participated, with 33 randomized to TEXT and 30 to UC. At pre-intervention, adherence was 64.0%, PMV was 26.9%, and proportion of days using substances was 53.0%. At post-intervention, adherence in the TEXT condition improved from 66% to 85%, compared to 62 to 71% in UC participants (p=.04). PMV improved from 23% to 9% for TEXT participants and 31% to 28% in UC participants (p =.12). There were no significant differences between conditions in substance-using days at post-intervention. At 3-month follow-up, differences were not significant. Conclusions Personalized bidirectional text messaging improved adherence and shows promise to improve visit attendance, but did not reduce substance using days. This intervention merits further testing and may be cost-efficient given its automation.

A Rapid Review of eHealth Interventions Addressing the Continuum of HIV Care (2007–2017)

“…Half (k = 7) of these efficacious, theory-based eHealth interventions were US-based [32] [33] [24, 30, 31, 34, 35]. Most (k = 11) of these efficacious, theory-based interventions implemented eHealth using electronic devices that were more technologically advanced (e.g., multimedia messaging) instead of or in conjunction with SMS texting.…”

Feasibility and Effects of Digital Interventions to Support People in Recovery From Substance Use Disorders: Systematic Review (Preprint)

“…Four of the papers on simple interventions reported on changes in use of other services. Gonzales [48] reported significantly higher attendance at self help meetings and recovery oriented activities among those in the experiment condition compared to controls, and Ingersoll [50] reported that the adherence to antiretroviral treatment increased by 19 percentage points in the experimental condition compared to a 9 percentage point increase in the treatment as usual condition. Bischof [80] reported a drop in face to face counseling time of 50% in the experimental condition, while Lucht [51] reported that the participants in the experimental condition spent significantly more days than the controls in psychiatric hospital.…”

“…The rest of the interventions were less intense and had a longer duration. In these, participants typically received and sent two messages each day for three months [35] or 10 months [50], one message each day for two to four months [39,42,45,55,56], or one each week for six months [49]. There is not much information in the papers documenting whether the participants actually read the messages they received.…”

“…For example, some studies reported that the participants were generally highly satisfied [36,43] or that they "felt connected" via the intervention [42]. Bradford [43], Gagnon [45], and Ingersoll [50] reported that 80-90% of the participants were satisfied, finding the interventions easy to use and being confident and comfortable in using them, while Gonzales [47] found that 70% were positive about the intervention (20% were ambivalent and 10% negative). In the intervention studied by Haug [78], the overall satisfaction was a bit lower: in general 63% of the participants found the intervention helpful but 75% wanted to do the program again, which suggests a somewhat higher level of satisfaction.…”

“…were a text messaging system [34,35], an integrated online counseling intervention [37], a computerized intervention for anger management (Cougle et al, 2017), integrated text messaging systems that included online counseling [49][50][51], a text messaging intervention that included medication monitoring and support [82], and a GPS based app designed to predict the location of heroin craving [52]. Three studies focused on alcohol only, while four addressed mixed or poly substance use.…”