title: SMSaúde: Evaluating Mobile Phone Text Reminders to Improve Retention in HIV Care for Patients on Antiretroviral Therapy in Mozambique.
abstract: OBJECTIVE
  We evaluated whether regular mobile phone text reminders improved patients' retention in antiretroviral therapy (ART) care in Mozambique.
  
  
  METHODS
  SMSaúde was a randomized control trial of HIV-infected patients on ART who received regular text message reminder vs. standard of care at 3 public health facilities in Maputo Province, Mozambique. The primary outcome was retention in HIV care. Between November 2011 and March 2012, 830 eligible HIV-infected patients on ART were randomized 1:1 to the text reminder intervention or standard of care.
  
  
  METHODS
  We used Kaplan-Meier estimators and log-rank tests to compare proportions of patients who received SMS reminders who were retained in HIV care compared to the control group who received standard of care. Post hoc analyses were performed using Cox proportional hazards models stratified by urban/rural facility and when initiated ART (≤3 months vs. >3 months). Hazard ratios and confidence intervals (CIs) are reported. Analysis was with intention to treat.
  
  
  RESULTS
  Patients who received text messages had lower attrition from HIV care at 12 months, though the difference was nonsignificant (RR: 0.68, 95% CI: 0.41 to 1.13). Among urban patients, text messages improved retention in HIV care (RR: 0.54, 95% CI: 0.31 to 0.95). Intervention patients newly initiated on ART (<3 months) had lower attrition than control patients (HR: 0.54; 95% CI: 0.23 to 0.91), especially urban newly initiated patients (HR: 0.20, 95% CI: 0.06 to 0.64). Text messages had no effect on retention among rural patients.
  
  
  CONCLUSIONS
  Text messages did not improve retention in HIV care for all patients on ART but improved retention in care of urban patients and those who recently started ART and received text reminders compared with standard of care.
authors.affiliation: *Ark, Maputo, Mozambique;†Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA;‡Department of Mathematics and Informatics, Eduardo Mondlane University, Maputo, Mozambique;§School of Business, Örebro University, Örebro, Sweden; and‖Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Dvora
authors.initials: D
authors.lastname: Joseph Davey
authors.forename: José António
authors.initials: JA
authors.lastname: Nhavoto
authors.forename: Orvalho
authors.initials: O
authors.lastname: Augusto
authors.forename: Walter
authors.initials: W
authors.lastname: Ponce
authors.forename: Daila
authors.initials: D
authors.lastname: Traca
authors.forename: Alexandre
authors.initials: A
authors.lastname: Nguimfack
authors.forename: Cesar
authors.initials: C
authors.lastname: Palha de Sousa
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009073:Mozambique; D010349:Patient Compliance; D017010:Reminder Systems; D060145:Text Messaging
chemical_list: D019380:Anti-HIV Agents