Mobile phone text messages for improving adherence to antiretroviral therapy (ART): an individual patient data meta-analysis of randomised trials

Mbuagbaw, Lawrence; van der Kop, Mia L; Lester, Richard T; Thirumurthy, Harsha; Pop-Eleches, Cristian; Ye, Chenglin; Smieja, Marek; Dolovich, Lisa; Mills, Edward J; Thabane, Lehana

doi:10.1136/bmjopen-2013-003950

Cited by 147Mobile Health and mHealth ApplicationsHIV/AIDS Research and InterventionsMedication Adherence and Compliance

Mobile phone text messages for improving adherence to antiretroviral therapy (ART): an individual patient data meta-analysis of randomised trials

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Mbuagbaw, Lawrence, van der Kop, Mia L, Lester, Richard T, Thirumurthy, Harsha, Pop-Eleches, Cristian, Ye, Chenglin, Smieja, Marek, Dolovich, Lisa +2 more·2013·BMJ Open

DOI 10.1136/bmjopen-2013-003950PMC PMC3884740

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Abstract

Objectives: Our objectives were to analyse the effects of text messaging versus usual care in improving adherence to antiretroviral therapy (ART) in people living with HIV using individual patient data meta-analysis. Adjusted, sensitivity and subgroup analyses were conducted. Setting: 3 randomised controlled trials conducted between 2010 and 2012 in rural and urban centres in Cameroon and Kenya (two studies) were used. Participants: A total of 1166 participants were included in this analysis (Cameroon=200; Kenya=428 and 538). Primary and secondary outcomes: The primary outcome was adherence to ART >95%. The secondary outcomes were mortality, losses to follow-up, transfers and withdrawals. Results: Text messaging improved adherence to ART (OR 1.38; 95% CIs 1.08 to 1.78; p=0.012), even after adjustment for baseline covariates (OR 1.46; 95% CI 1.13 to 1.88; p=0.004). Primary education (compared with no formal education) was associated with a greater intervention effect on adherence (OR 1.65; 95% CI 1.10 to 2.48; p=0.016) and also showed a significant subgroup effect (p=0.039). In sensitivity analysis, our findings were robust to a modified threshold of adherence, multiple imputation for missing data and aggregate level data pooling, but not to fixed-effects meta-analyses using generalised estimation equations. There was a significant subgroup effect for long weekly (p=0.037), short weekly text messages (p=0.014) and interactive messaging (p=0.010). Text messaging did not significantly affect any of the secondary outcomes. Conclusions: Text messaging has a significant effect on adherence to ART, and this effect is influenced by level of education, gender, timing (weekly vs daily) and interactivity. We recommend the use of interactive weekly text messaging to improve adherence to ART, which is most effective in those with at least a primary level of education.

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Reviews have found variation in effect depending on how mechanisms were operationalised.
“Reviews have found variation in effect depending on how mechanisms were operationalised.”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [49]
Text messaging used to improve adherence to antiretroviral therapy had more effect for those with at least primary education.
“Similarly, text messaging used to improve adherence to antiretroviral therapy had more effect for those with at least primary education.49”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [49]
Messages had more impact when they were linked with patient-health worker interaction.
“and messages had more impact when they were linked with patient–health worker interaction.17 27 49 51–53”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [49]
Weekly reminders worked better than daily reminders.
“For example, weekly reminders worked better than daily reminders”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [49]

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Authors: Mbuagbaw, L., van der Kop, M. L., Lester, R. T., Thirumurthy, H., Pop-Eleches, C., Ye, C., Smieja, M., Dolovich, L., Mills, E. J., & Thabane, L.
Affiliations: Central Hospital of Yaoundé (CM)
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
University of Nairobi (KE)
University of North Carolina at Chapel Hill (US)
Columbia University (US)
St. Joseph’s Healthcare Hamilton (CA)
University of Ottawa (CA)
Population Health Research Institute (CA)
Corresponding author: Mbuagbaw, Lawrence
ORCID: Mbuagbaw, Lawrence
Lester, Richard T
Thirumurthy, Harsha
Pop-Eleches, Cristian
Smieja, Marek
Dolovich, Lisa
Mills, Edward J
Thabane, Lehana
Venue: BMJ Open
Publisher: BMJ
Published: 2013-12
Volume: 3
Issue: 12
Pages: e003950
ISSN: 2044-6055 (ISSN-L)
DOI: 10.1136/bmjopen-2013-003950
PMC: PMC3884740
OpenAlex: W2105519498
Cited by: 147
References: 38
Citations by year: 2026: 1 · 2025: 3 · 2024: 2 · 2023: 10 · 2022: 5 · 2021: 13 · 2020: 10 · 2019: 8 · 2018: 21 · 2017: 15 · 2016: 24 · 2015: 25 · 2014: 9 · 2013: 1
FWCI: 2.36
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by-nc
Locations: BMJ Open (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion, other-oa)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
Funders: Grand Challenges Canada
National Institutes of Health (2r24hd050924-06)
Canadian Institutes of Health Research
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: text messaging, antiretroviral therapy adherence, HIV, mobile health, primary education, treatment retention, Cameroon, Kenya

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Mobile phone text messages for improving adherence to antiretroviral therapy (ART): an individual patient data meta-analysis of randomised trials

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