title: Text message intervention designs to promote adherence to antiretroviral therapy (ART): a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Eight 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).
  
  
  CONCLUSIONS
  Text-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.
authors: Department of Psychology, Center for Health, Intervention, & Prevention (CHIP), University of Connecticut, Storrs, Connecticut, United States of America.
authors: David J
authors: DJ
authors: Finitsis
authors: Department of Psychology, Center for Health, Intervention, & Prevention (CHIP), University of Connecticut, Storrs, Connecticut, United States of America.
authors: Jennifer A
authors: JA
authors: Pellowski
authors: Department of Psychology, Center for Health, Intervention, & Prevention (CHIP), University of Connecticut, Storrs, Connecticut, United States of America.
authors: Blair T
authors: BT
authors: Johnson
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic; D017010:Reminder Systems; D060145:Text Messaging; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents