title: Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria.
abstract: BACKGROUND
  Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is one of the world's most challenging pandemics. For treatment with Highly Active Anti-Retroviral Therapy (HAART) to be effective, high rate of adherence is essential.
  
  
  OBJECTIVE
  To demonstrate the effect of adherence counseling and text message reminders in improving patients' adherence to HAART.
  
  
  METHODS
  A randomized control trial among non-adherents was carried out in a tertiary hospital in Nigeria between March and July, 2011.
  
  
  METHODS
  A total of 104 patients: 45 males (43.3%) and 59 females (56.7%) participated in the study. They were randomized into intervention and control groups. The intervention group received monthly adherence counseling and twice weekly short message reminders for four months, while the control group received only standard care. Self-reported adherence and CD4+ cell counts were measured pre- and post-intervention.
  
  
  METHODS
  Data was analysed using Statistical Package for Social Sciences (SPSS) version 18. Risk rates, Chi-square, Mann-Whitney U test and Cohen's effect size were calculated. Level of significance was set at P = 0.05.
  
  
  RESULTS
  At post-intervention, 76.9% of the intervention group and 55.8% of the control group achieved adherence (χ2 = 5.211, P = 0.022, RR = 0.75 (0.55-0.96), Cohen's w = 0.224). Also, median CD4+ cell count of the intervention group increased from 193 cells/ml to 575.0 cells/ml against 131.0 cells/ml to 361.5 cells/ml in the control group (P = 0.007).
  
  
  CONCLUSIONS
  Adherence counseling and text message reminders improved adherence among HIV patients. Its adoption for HIV patient management is advocated.
authors.affiliation: Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
authors.forename: O
authors.initials: O
authors.lastname: Maduka
authors.forename: C I
authors.initials: CI
authors.lastname: Tobin-West
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D010349:Patient Compliance; D018709:Statistics, Nonparametric; D060145:Text Messaging