title: Mobile phone text messages for improving adherence to antiretroviral therapy (ART): an individual patient data meta-analysis of randomised trials.
abstract: OBJECTIVE
  Our objectives were to analyse the effects of text messaging versus usual care in improving adherence to antiretroviral therapy (ART) in people living with HIV using individual patient data meta-analysis. Adjusted, sensitivity and subgroup analyses were conducted.
  
  
  METHODS
  3 randomised controlled trials conducted between 2010 and 2012 in rural and urban centres in Cameroon and Kenya (two studies) were used.
  
  
  METHODS
  A total of 1166 participants were included in this analysis (Cameroon=200; Kenya=428 and 538).
  
  
  METHODS
  The primary outcome was adherence to ART >95%. The secondary outcomes were mortality, losses to follow-up, transfers and withdrawals.
  
  
  RESULTS
  Text messaging improved adherence to ART (OR 1.38; 95% CIs 1.08 to 1.78; p=0.012), even after adjustment for baseline covariates (OR 1.46; 95% CI 1.13 to 1.88; p=0.004). Primary education (compared with no formal education) was associated with a greater intervention effect on adherence (OR 1.65; 95% CI 1.10 to 2.48; p=0.016) and also showed a significant subgroup effect (p=0.039). In sensitivity analysis, our findings were robust to a modified threshold of adherence, multiple imputation for missing data and aggregate level data pooling, but not to fixed-effects meta-analyses using generalised estimation equations. There was a significant subgroup effect for long weekly (p=0.037), short weekly text messages (p=0.014) and interactive messaging (p=0.010). Text messaging did not significantly affect any of the secondary outcomes.
  
  
  CONCLUSIONS
  Text messaging has a significant effect on adherence to ART, and this effect is influenced by level of education, gender, timing (weekly vs daily) and interactivity. We recommend the use of interactive weekly text messaging to improve adherence to ART, which is most effective in those with at least a primary level of education.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mbuagbaw
authors.forename: Mia L
authors.initials: ML
authors.lastname: van der Kop
authors.forename: Richard T
authors.initials: RT
authors.lastname: Lester
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.forename: Cristian
authors.initials: C
authors.lastname: Pop-Eleches
authors.forename: Chenglin
authors.initials: C
authors.lastname: Ye
authors.forename: Marek
authors.initials: M
authors.lastname: Smieja
authors.forename: Lisa
authors.initials: L
authors.lastname: Dolovich
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane