title: Acceptability and efficacy of interactive short message service intervention in improving HIV medication adherence in Chinese antiretroviral treatment-naïve individuals.
abstract: OBJECTIVE
  The aim of this study was to examine the acceptability and efficacy of interactive short message service (SMS) in improving medication adherence in antiretroviral treatment (ART)-naïve individuals living with HIV/AIDS in Hengyang, Hunan, China.
  
  
  BACKGROUND
  SMS via mobile phone has emerged as a potential tool for improving ART adherence. However, most studies used SMS only as a medication reminder, with few studies exploring the effect of comprehensive, interactive SMS.
  
  
  METHODS
  In a randomized controlled trial, 100 HIV-positive patients on ART for <3 months were randomized into control or intervention arm. Participants in the control group received routine standard instruction for ART medication in the HIV clinics, while the intervention group received 6 months of an SMS intervention in addition to the standard care. A total of 124 text messages within 6 modules were edited, preinstalled, and sent to participants according to personalized schedules. Knowledge (of HIV and HIV medications), self-reported antiretroviral adherence (Visual Analog Scale [VAS] and Community Programs for Clinical Research on AIDS [CPCRA] Antiretroviral Medication Self-Report), and CD4 count were assessed at baseline and immediate post-intervention. Intervention participants were interviewed after completion of the study about their satisfaction with and acceptability of the SMS intervention.
  
  
  RESULTS
  Baseline assessments were comparable between arms. Repeated-measures analysis showed that both HIV-related and ART medication knowledge of the intervention group showed better improvement over time than those of the control group after the intervention (P<0.0001). For the adherence measures, compared with the control group, participants in the intervention group had significantly higher VAS mean score (Z=2.735,P=0.006) and lower suboptimal adherence rate (Z=2.208,P=0.027) at the end of the study. The intervention had no effect on CD4 cell count. Almost all (96%) intervention participants reported satisfaction or high satisfaction with the SMS intervention, with 74% desiring to continue to receive the SMS intervention. The preferred frequency of messages was 1-2 messages per week.
  
  
  CONCLUSIONS
  An interactive SMS intervention with comprehensive content shows promising efficacy in promoting medication adherence in ART-naïve individuals. Future work might further refine its ability to optimally tailor the intervention for individual preferences.
authors.affiliation: Nursing Department, Second Xiangya Hospital.
authors.forename: Ye
authors.initials: Y
authors.lastname: Ruan
authors.affiliation: Xiangya School of Nursing, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Xueling
authors.initials: X
authors.lastname: Xiao
authors.affiliation: Xiangya School of Nursing, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Jia
authors.initials: J
authors.lastname: Chen
authors.affiliation: Xiangya School of Nursing, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Xianhong
authors.initials: X
authors.lastname: Li
authors.affiliation: School of Nursing, Yale University, West Haven, CT, USA.
authors.forename: Ann Bartley
authors.initials: AB
authors.lastname: Williams
authors.affiliation: Xiangya School of Nursing, Central South University, Changsha, Hunan, People's Republic of China.
authors.forename: Honghong
authors.initials: H
authors.lastname: Wang
keywords: China; HIV; adherence; antiretroviral treatment; short message service