Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders
Open accessAbstract
OBJECTIVE: There is limited evidence on whether growing mobile phone availability in sub-Saharan Africa can be used to promote high adherence to antiretroviral therapy (ART). This study tested the efficacy of short message service (SMS) reminders on adherence to ART among patients attending a rural clinic in Kenya. DESIGN: A randomized controlled trial of four SMS reminder interventions with 48 weeks of follow-up. METHODS: Four hundred and thirty-one adult patients who had initiated ART within 3 months were enrolled and randomly assigned to a control group or one of the four intervention groups. Participants in the intervention groups received SMS reminders that were either short or long and sent at a daily or weekly frequency. Adherence was measured using the medication event monitoring system. The primary outcome was whether adherence exceeded 90% during each 12-week period of analysis and the 48-week study period. The secondary outcome was whether there were treatment interruptions lasting at least 48 h. RESULTS: In intention-to-treat analysis, 53% of participants receiving weekly SMS reminders achieved adherence of at least 90% during the 48 weeks of the study, compared with 40% of participants in the control group (P = 0.03). Participants in groups receiving weekly reminders were also significantly less likely to experience treatment interruptions exceeding 48 h during the 48-week follow-up period than participants in the control group (81 vs. 90%, P = 0.03). CONCLUSION: These results suggest that SMS reminders may be an important tool to achieve optimal treatment response in resource-limited settings.
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Adding words of encouragement to an SMS did not prove more effective.
“Adding words of encouragement to an SMS did not prove more effective and confidentiality was a concern.”
In a Kenyan efficacy study of 428 HIV patients randomized to daily, weekly, or no SMS reminders, treatment adherence was improved for patients receiving weekly, but not daily, SMS.
“A Kenyan efficacy study provided 428 HIV patients with mobile phones and randomized patients to receive daily, weekly, or no SMS reminders. Treatment adherence was improved for patients receiving weekly, but not daily, SMS and treatment interruptions were less likely [29].”
In the Kenyan efficacy study, treatment interruptions were less likely.
“Treatment adherence was improved for patients receiving weekly, but not daily, SMS and treatment interruptions were less likely [29].”
Confidentiality was a concern in the Kenyan SMS reminder study.
“Adding words of encouragement to an SMS did not prove more effective and confidentiality was a concern.”
Based on the evidence from short-term trials, SMS reminders could be a cost-effective way to improve medication adherence in sub-Saharan Africa.
“Based on the evidence from these short-term trails, SMS reminders could be a cost-effective way to improve medication adherence in SSA.”
From mHealth in Sub-Saharan Africa (2013) · cites this paper as [13]
Another Kenya-based RCT by Lester et al. found that patients receiving weekly SMS reminder messages had significantly improved antiretroviral adherence and rates of viral suppression compared with the control individuals.
“another Kenya-based RCT by Lester et al. found that patients receiving weekly SMS reminder messages had significantly improved antiretroviral adherence and rates of viral suppression compared with the control individuals [21].”
From mHealth for HIV Treatment & Prevention: A Systematic Review of the Literature (2013) · cites this paper as [21]
RCTs such as those reported by Pop-Eleches, Lester, and their colleagues provide strong evidence of the utility of mHealth to address the HIV prevention and treatment cascade.
“RCTs, such as those reported by Pop-Eleches, Lester, and their colleagues [20,21], provide strong evidence of the utility of mHealth to address the HIV prevention and treatment cascade.”
From mHealth for HIV Treatment & Prevention: A Systematic Review of the Literature (2013) · cites this paper as [21]
The other includes pregnant women in its sample but presents no findings relevant to PMTCT.
“the other includes pregnant women in its sample but presents no findings relevant to PMTCT [21].”
From mHealth for HIV Treatment & Prevention: A Systematic Review of the Literature (2013) · cites this paper as [21]
Drug intake reminders have been found to improve treatment adherence of people with AIDS and Malaria.
“drug intake reminders have been found to improve treatment adherence of people with AIDS and Malaria [37–39]”
From A systematic review of randomized controlled trials of mHealth interventions against non-communicable diseases in developing countries (2016) · cites this paper as [38]
Seven randomized controlled trials testing effects of SMS communication on various health outcomes reported positive effects.
“For the seven randomised controlled trials testing effects of SMS communication on various health outcomes had reported positive effects [16, 20, 32, 33, 44–49], while the remaining trial showed no effect of mobile alarm devices on treatment adherence for HIV patients [15].”
From Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya (2017) · cites this paper as [33]
SMS communications had a positive effect on patient behaviour and health outcomes.
“These types of interventions have been proven to be effective as evidenced by the small sample of evaluated mHealth interventions [16, 20, 32, 33, 45], that showed that SMS communications had positive effect on patient behaviour and health outcomes and was also cost-effective and reliable [50].”
From Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya (2017) · cites this paper as [33]
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- Authors
- Pop-Eleches, C., Thirumurthy, H., Habyarimana, J. P., Zivin, J. G., Goldstein, M. P., de Walque, D., MacKeen, L., Haberer, J., Kimaiyo, S., Sidle, J., Ngare, D., & Bangsberg, D. R.
- Affiliations
- Columbia University (US)
- University of North Carolina at Chapel Hill (US)
- Georgetown University (US)
- University of California San Diego (US)
- World Bank (US)
- United States Agency for International Development (US)
- Massachusetts General Hospital (US)
- Moi University (KE)
- Indiana University Indianapolis (US)
- Mbarara University of Science and Technology (UG)
- Corresponding author
- Pop-Eleches, Cristian
- Thirumurthy, Harsha
- Habyarimana, James P
- ORCID
- Venue
- AIDS
- Published
- 2011-03-27
- Volume
- 25
- Issue
- 6
- Pages
- 825-834
- ISSN
- 0269-9370 (ISSN-L)
- PMC
- PMC3718389
- OpenAlex
- W2153360349
- Cited by
- 982
- References
- 40
- Citations by year
- 2026: 8 · 2025: 19 · 2024: 25 · 2023: 36 · 2022: 44 · 2021: 66 · 2020: 64 · 2019: 63 · 2018: 96 · 2017: 90 · 2016: 92 · 2015: 101 · 2014: 107 · 2013: 91 · 2012: 55
- FWCI
- 161.74
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- AIDS (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- United States Agency for International Development
- World Bank Group
- U.S. President’s Emergency Plan for AIDS Relief
- National Institutes of Health (2r24hd050924-06)
- National Institute of Mental Health (MH87228, K23MH087228, R01MH054907, K24MH087227, MH87227)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24 HD-050924)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- antiretroviral therapy adherence, SMS reminders, mobile phone technology, HIV, treatment interruption, medication event monitoring system, resource-limited settings, sub-Saharan Africa
- MeSH terms
- Adult, Female, Health Services Accessibility, Humans, Kenya, Male, Patient Compliance, Rural Health, HIV Infections, Reminder Systems, Cell Phone, Anti-Retroviral Agents
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