Text Message Intervention Designs to Promote Adherence to Antiretroviral Therapy (ART): A Meta-Analysis of Randomized Controlled Trials

Abstract

BackgroundThe efficacy of antiretroviral therapy depends on patient adherence to a daily medication regimen, yet many patients fail to adhere at high enough rates to maintain health and reduce the risk of transmitting HIV. Given the explosive global growth of cellular-mobile phone use, text-messaging interventions to promote adherence are especially appropriate. This meta-analysis synthesized available text messaging interventions to promote antiretroviral therapy adherence in people living with HIV.MethodsWe performed Boolean searches of electronic databases, hand searches of recent year conference abstracts and reverse searches. Included studies (1) targeted antiretroviral therapy adherence in a sample of people living with HIV, (2) used a randomized-controlled trial design to examine a text messaging intervention, and (3) reported at least one adherence measurement or clinical outcome.ResultsEight studies, including 9 interventions, met inclusion criteria. Text-messaging interventions yielded significantly higher adherence than control conditions (OR = 1.39; 95% CI = 1.18, 1.64). Sensitivity analyses of intervention characteristics suggested that studies had larger effects when interventions (1) were sent less frequently than daily, (2) supported bidirectional communication, (3) included personalized message content, and (4) were matched to participants’ antiretroviral therapy dosing schedule. Interventions were also associated with improved viral load and/or CD4+ count (k = 3; OR = 1.56; 95% CI = 1.11, 2.20).ConclusionsText-messaging can support antiretroviral therapy adherence. Researchers should consider the adoption of less frequent messaging interventions with content and timing that is individually tailored and designed to evoke a reply from the recipient. Future research is needed in order to determine how best to optimize efficacy.

The Impact of Cell Phone Reminders on Uptake of Medical Male Circumcision in Rakai, Uganda

“…These results are in line with recent systematic reviews that have demonstrated evidence based on the use of text message reminders to improve medication adherence in diabetes and hypertension patients [23]. Studies also have showed that mobile phone text-messaging is effective in promoting adherence to medications among different patient populations; these results are in accordance with previous systematic reviews, highlighting that interventions were efficacious in improving medication adherence in particular subjects [19][20][21].…”

“…In a trial conducted in Kenya, comparing only short weekly messages to standard care, text messaging was associated with a lower risk of non-adherence at 12 months (RR 0.77, 95% CI 0.63 to 0.93) and with the non-occurrence of virologic failure at 12 months (RR 0.83, 95% CI 0.69 to 0.99) [20]. Participants who received text messages' support were more likely to maintain adherence thresholds at follow up and meet the clinical goals of lower viral load and higher CD4+ count [21] and it was also reported that SMC reminders in terms of adherence, 62% of the intervention groups participants had greater than 95% compliance, compared to 50% compliance in the control group [22]. Among 90 patients (76% male, mean age 59.2 years), Medication Event Monitoring System revealed patients who received text messages for anti-platelets had a higher percentage of correct doses taken (p=0.02), percentage number of doses taken (p=0.01), and percentage of prescribed doses taken on schedule (p=0.01), text messages response rates were higher for antiplatelets than statins (p=0.005).…”

Mobile Phone Communication for Improving Uptake of Antiretroviral Therapy in HIV-infected Pregnant Women: Review

“…Indicating then the need for effective adherence interventions as well as in prenatal and postpartum period. A recent systematic review found high-quality evidence of efficacy in intervention using short weekly message (Horvath 2012;Finitsis 2014) and World Health Organization guidelines include a strong recommendation to consider text messaging "for promoting adherence to ART as part of a package of adherence interventions (WHO 2013; Finitsis 2014)". We did not find any review that evaluated the effects of mobile phone communication for improving PMTCT outcomes.…”

Theory-Based Digital Interventions to Improve Asthma Self-Management Outcomes: Systematic Review (Preprint)

“…Digital adherence interventions, from electronic monitoring to short message service (SMS)-based programmes, have been evaluated across long-term conditions with varying degrees of success [26][27][28]. However, the literature has been dominated by small-scale feasibility and exploratory studies and pilot evaluations that lack statistical power [26,29].…”

“…However, the literature has been dominated by small-scale feasibility and exploratory studies and pilot evaluations that lack statistical power [26,29]. For patients with asthma, digital support services may provide a highly accessible and effective means of monitoring and improving adherence to treatment and disease control.…”