title: Designing text-messaging (SMS) in HIV programs: ethics-framed recommendations from the field.
abstract: Text messages (SMS) are being increasingly integrated into HIV programs across Southern Africa to improve patient adherence, linkage to care and provide psycho-social support. Careful attention needs to be paid to the design of SMS-based interventions for clients of HIV-care services to ensure that any potential harm, such as unwanted disclosure of HIV status, is minimized. In this article we propose a set of best practice recommendations to ensure that any SMS-based intervention considers ethical principles to safeguard safety, autonomy and confidentiality of its targeted HIV-positive beneficiaries. This analysis draws from our operational experience in Southern Africa in the design and conduct of mHealth interventions in the frame of HIV projects. The recommendations, framed in the context of the Belmont Report's three ethical pillars, may contribute to more safely operationalize any SMS service integrated into an HIV program if adopted by mHealth planners and implementers. We encourage actors to report on the ethical and methodological pathways followed when conducting SMS-based innovations to improve the wellbeing and quality provision of HIV-care for their targeted clients.
authors.affiliation: Médicos Sin Fronteras/Doctors Without Borders Spain, Barcelona, Spain.
authors.forename: Guillermo Martínez
authors.initials: GM
authors.lastname: Pérez
authors.affiliation: Doctors Without Borders South Africa, Johannesburg, South Africa.
authors.forename: Bella
authors.initials: B
authors.lastname: Hwang
authors.affiliation: Southern Africa Medical Unit, Doctors Without Borders South Africa, Cape Town, South Africa.
authors.forename: Helen
authors.initials: H
authors.lastname: Bygrave
authors.affiliation: Medical Department, Médecins Sans Frontières, Operational Centre, Brussels, Belgium.
authors.forename: Emilie
authors.initials: E
authors.lastname: Venables
mesh_terms: D000353:Africa, Southern; D001675:Bioethics; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D010349:Patient Compliance; D011787:Quality of Health Care; D012944:Social Support; D017216:Telemedicine / Q000941:ethics / Q000379:methods*; D060145:Text Messaging / Q000941:ethics
keywords: Ethics; HIV; Southern Africa; mHealth; medical; text messaging