title: Protocol for a Randomized Controlled Trial Evaluating Mobile Text Messaging to Promote Retention and Adherence to Antiretroviral Therapy for People Living With HIV in Burkina Faso.
abstract: BACKGROUND
  Retention in care and adherence to antiretroviral therapy (ART) among people living with human immunodeficiency virus (PLHIV) is a critical challenge in many African countries including Burkina Faso. Delivering text messaging (short message service, SMS) interventions through mobile phones may help facilitate health service delivery and improve patient health. Despite this potential, no evaluations have been delivered for national scale settings to demonstrate the impact of mobile health (mHealth) for PLHIV.
  
  
  OBJECTIVE
  This study aims to test the impact of SMS text messaging reminders for PLHIV in Burkina Faso, who are under ART. The evaluation identifies whether patients who receive SMS text messages are more likely to (1) retain in care (measured as a dichotomous variable), (2) adhere to antiretroviral regimens (measured as the number of doses missed in the past 7 days), and (3) experience slower disease progression (measured with T-lymphocytes cells). The second objective is to assess its effects on the frequency of health center visits, physical and psychosocial health, nutrition and whether the type of message (text vs image) and frequency (weekly vs semiweekly) have differential impacts including the possibility of message fatigue over time.
  
  
  METHODS
  This 24-month, wide-scale intervention implements a randomized controlled trial (RCT) to evaluate the impact of four variants of a mHealth intervention versus a control group. Our sample comprises adult patients (>15 years of age) undergoing antiretroviral therapy with access to mobile phone services. Multivariate regression analysis will be used to analyze the effect of the intervention on the study population. Data collection is done at baseline and three follow-up waves 6, 12, and 24 months after the intervention starts.
  
  
  RESULTS
  The targeted 3800 patients were recruited between February 2015 and May 2015. But political uncertainty delayed the launch of the intervention until October 2015. Data analysis has not yet started. The first follow-up data collection started in April 2016. To the best of our knowledge, this is the first research that explores the effects of mobile message reminders using a wide-spread sample across an entire nation over a 2-year horizon, especially in a Francophone African country.
  
  
  CONCLUSIONS
  We hypothesize that the interventions have a positive impact on retention in care and adherence to ART schemes and that a more sluggish disease progression will be observed in the short run. However, these benefits may fade out in the long run. The study expects to advance the research on how long mHealth interventions remain effective and when fatigue sets in the context of wide-scale interventions. This information will be useful in designing future wide-scale mHealth interventions in developing countries.
authors.affiliation: International Institute of Social Studies, Erasmus University Rotterdam, The Hage, Netherlands. wagner@iss.nl.
authors.forename: Natascha
authors.identifier: http://orcid.org/0000-0003-0830-6429
authors.initials: N
authors.lastname: Wagner
authors.forename: Denis
authors.identifier: http://orcid.org/0000-0002-1107-1993
authors.initials: D
authors.lastname: Ouedraogo
authors.forename: Luis
authors.identifier: http://orcid.org/0000-0002-7471-7974
authors.initials: L
authors.lastname: Artavia-Mora
authors.forename: Arjun
authors.identifier: http://orcid.org/0000-0001-5659-6569
authors.initials: A
authors.lastname: Bedi
authors.forename: Boundia Alexandre
authors.identifier: http://orcid.org/0000-0001-5781-9605
authors.initials: BA
authors.lastname: Thiombiano
keywords: HIV; PLHIV; RCT; SMS; developing countries; mHealth