title: Short message service (SMS) reminders and real-time adherence monitoring improve antiretroviral therapy adherence in rural Uganda.
abstract: To explore the effects of four types of short message service (SMS) plus real-time adherence monitoring on antiretroviral therapy (ART) adherence: daily reminders, weekly reminders, reminders triggered after a late or missed dose (delivered to patients), and notifications triggered by sustained adherence lapses (delivered to patient-nominated social supporters).
  
  
  
  Pilot randomized controlled trial.
  
  
  
  Sixty-three individuals initiating ART received a real-time adherence monitor and were randomized (1 : 1 : 1): (1) Scheduled SMS reminders (daily for 1 month, weekly for 2 months), then SMS reminders triggered by a late or missed dose (no monitoring signal within 2 h of expected dosing); SMS notifications to social supporters for sustained adherence lapses (no monitoring signal for >48 h) added after 3 months. (2) Triggered SMS reminders starting at enrolment; SMS notifications to social supporters added after 3 months. (3) CONTROL: No SMS. HIV RNA was determined at 9 months. Percentage adherence and adherence lapses were compared by linear generalized estimating equations and Poisson regression, respectively.
  
  
  
  Median age was 31 years, 65% were women, and median enrolment CD4 cell count was 322 cells/μl 97% took once daily tenofovir/emtricitabine/efavirenz. Compared to control, adherence was 11.1% higher (P = 0.04) and more than 48-h lapses were less frequent (IRR 0.6, P = 0.02) in the scheduled SMS arm. Adherence and more than 48-h lapses were similar in the triggered SMS arm and control. No differences in HIV RNA were seen.
  
  
  
  Scheduled SMS reminders improved ART in the context of real-time monitoring. Larger studies are needed to determine the impact of triggered reminders and role of social supporters in improving adherence.
authors.affiliation: aMassachusetts General Hospital, Boston bHarvard Medical School, Boston, Massachusetts, USA cMbarara University of Science and Technology, Mbarara, Uganda dHarvard TH Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Haberer
authors.forename: Angella
authors.initials: A
authors.lastname: Musiimenta
authors.forename: Esther C
authors.initials: EC
authors.lastname: Atukunda
authors.forename: Nicholas
authors.initials: N
authors.lastname: Musinguzi
authors.forename: Monique A
authors.initials: MA
authors.lastname: Wyatt
authors.forename: Norma C
authors.initials: NC
authors.lastname: Ware
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010865:Pilot Projects; D017010:Reminder Systems; D012424:Rural Population; D060145:Text Messaging; D014454:Uganda
chemical_list: D044966:Anti-Retroviral Agents