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


METHODS
A randomized controlled trial of four SMS reminder interventions with 48 weeks of follow-up.


METHODS
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.


RESULTS
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).


CONCLUSIONS
These results suggest that SMS reminders may be an important tool to achieve optimal treatment response in resource-limited settings.
School of International and Public Affairs, Columbia University, New York, New York, USA.
Cristian
C
Pop-Eleches
Harsha
H
Thirumurthy
James P
JP
Habyarimana
Joshua G
JG
Zivin
Markus P
MP
Goldstein
Damien
D
de Walque
Leslie
L
MacKeen
Jessica
J
Haberer
Sylvester
S
Kimaiyo
John
J
Sidle
Duncan
D
Ngare
David R
DR
Bangsberg
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D040421:Cell Phone; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D007630:Kenya; D008297:Male; D010349:Patient Compliance; D017010:Reminder Systems / Q000295:instrumentation*; D012423:Rural Health / Q000592:standards*
D044966:Anti-Retroviral Agents
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