Text Messages Can Help Improve Adherence to ART

Text Messages Can Help Improve Adherence to ART
Sending your patients short text reminders every week may help improve their adherence to antiretroviral therapy.
Mobile phones are already being used to deliver novel health interventions, but few data are available on their use for this purpose in resource-constrained settings, where cell phones are now ubiquitous. In this prospective randomized trial in Kenya, researchers provided 428 HIV-infected patients with mobile phones and then evaluated whether reminder text messages would improve their adherence to antiretroviral therapy (ART).

All the patients had initiated ART in the 3 months prior to study enrollment (mostly with AZT/3TC + nevirapine), and 97% resided within cell phone network range. One third of the patients served as a control group, while the others received either short or long text messages, delivered either daily or weekly. The short messages were simply reminders, whereas the long messages also included words of encouragement. Adherence was monitored using MEMS (Medication Event Monitoring System) bottle caps.

At 48 weeks, 16% of all study participants were lost to follow up; the proportion did not differ significantly among groups. In the control group, adherence was 76% overall and declined during follow-up, with only 46% of patients achieving high adherence levels (>90%) in weeks 37 through 48.

In a 48-week intent-to-treat analysis, weekly reminders had a positive effect on adherence, but daily reminders did not. Whether the messages were long or short did not seem to matter. The proportion of patients who achieved high adherence levels was 53% in the weekly-reminder groups, versus 41% in the daily-reminder groups and 40% in the control group. Similarly, the proportion of patients who interrupted treatment for at least 48 hours was 81%, 86%, and 90%, respectively.

Comment: This study demonstrates how much we still need to do to improve adherence to ART in developing countries. Only about 45% of patients in this study had high adherence levels, and although viral-load data were not presented, we can predict that rates of virologic suppression were not optimal. Reminder text messages may be an effective means of improving adherence to ART among patients in resource-limited settings who have cell phones, as long as the messages are kept short and sent only weekly.

— Carlos del Rio, MD <http://aids-clinical-care.jwatch.org/misc/board_about.dtl>
Published in Journal Watch HIV/AIDS Clinical Care <http://aids-clinical-care.jwatch.org> February 18, 2011
Citation(s):

Pop-Eleches C et al. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: A randomized controlled trial of text message reminders. AIDS 2011 Feb 10; [e-pub ahead of print]. (http://dx.doi.org/10.1097/QAD.0b013e32834380c1 <http://dx.doi.org/10.1097/QAD.0b013e32834380c1> )