Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection

Abstract

Background

More than 34 million people are presently living with HIV infection. Antiretroviral therapy (ART) can help these people to live longer, healthier lives, but adherence to ART can be difficult. Mobile phone text‐messaging has the potential to help promote adherence in these patients.

Objectives

To determine whether mobile phone text‐messaging is efficacious in enhancing adherence to ART in patients with HIV infection.

Search methods

Using the Cochrane Collaboration's validated search strategies for identifying randomised controlled trials and reports of HIV interventions, along with appropriate keywords and MeSH terms, we searched a range of electronic databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Literatura Latino‐Americana e do Caribe em Ciências da Saúde (LILACS), MEDLINE (via PubMed), PsycINFO, Web of Science, and the World Health Organization (WHO) Global Index Medicus. The date range was from  01 January 1980 to 01 November 2011. There were no limits to language or publication status.

Selection criteria

Randomised controlled trials (RCTs) in which patients or their caregivers (in the case of infants and children) of any age, in any setting, and receiving ART were provided with mobile phone text messages as a means of promoting adherence to ART.

Data collection and analysis

Two authors independently examined the abstracts of all identified trials. We initially identified 243 references. Seventeen full‐text articles were closely reviewed. Both authors abstracted data independently, using a pre‐designed, standardised data collection form. When appropriate, data were combined in meta‐analysis.

Main results

Two RCTs from Kenya were included in the review. One trial compared short weekly text messages against standard care. The other trial compared short daily, long daily, short weekly and long weekly messages against standard care. Both trials were with adult patients.

In the trial comparing only short weekly messages to standard care, text messaging was associated with a lower risk of non‐adherence at 12 months (RR 0.77, 95% CI 0.63 to 0.93) and with the non‐occurrence of virologic failure at 12 months (RR 0.83, 95% CI 0.69 to 0.99).

In the trial that compared different intervals and lengths for text‐messaging to standard care, long weekly text‐messaging was not significantly associated with a lower risk of non‐adherence compared to standard care (RR 0.79, 95% CI 0.60 to 1.04). Patients receiving weekly text‐messages of any length were at lower risk of non‐adherence at 48 weeks than were patients receiving daily messages of any length (RR 0.79, 95% CI 0.64 to 0.99). There were no significant differences between weekly text‐messaging of any length (RR 1.01, 95% CI 0.75 to 1.37) and between short or long messaging at either interval (RR 0.99, 95% CI 0.78 to 1.27). Compared to standard care, any daily text‐messaging, whether short or long, did not reduce the risk for non‐adherence (RR 0.99, 95% CI 0.82 to 1.20).

In meta‐analysis of both trials, any weekly text‐messaging (i.e. whether short or long messages) was associated with a lower risk of non‐adherence at 48‐52 weeks (RR 0.78, 95% CI 0.68 to 0.89). The effect of short weekly text‐messaging was also significant (RR 0.77, 95% CI 0.67 to 0.89).

Authors' conclusions

There is high‐quality evidence from the two RCTs that mobile phone text‐messaging at weekly intervals is efficacious in enhancing adherence to ART, compared to standard care. There is high quality evidence from one trial that weekly mobile phone text‐messaging is efficacious in improving HIV viral load suppression. Policy‐makers should consider funding programs proposing to provide weekly mobile phone text‐messaging as a means for promoting adherence to antiretroviral therapy. Clinics and hospitals should consider implementing such programs. There is a need for large RCTs of this intervention in adolescent populations, as well as in high‐income countries.

Mobile phone text messaging to help patients with HIV infection take their antiretroviral medications every day

More than 34 million people are presently living with HIV infection. Antiretroviral therapy (ART) can help these people to live longer, healthier lives, but because of side‐effects, adherence (taking these medications every day) can be difficult. Mobile phone text‐messaging has the potential to help promote adherence in these patients.

Two randomised controlled trials from Kenya were included in the review. One trial compared short weekly text messages against standard care. The other trial compared short daily, long daily, short weekly and long weekly messages against standard care.

In the trial comparing only short weekly messages to standard care, text messaging was associated with lower risk of non‐adherence at 12 months, and with the non‐occurrence of virologic failure at 12 months.

Combining the data from both trials, weekly mobile phone text‐messaging was associated with greater ART adherence at 48‐52 weeks. The effect of short weekly text‐messaging was also significant.

In the trial that compared different intervals and lengths for text‐messaging to standard care, long weekly text‐messaging was not significantly associated with a lower risk of non‐adherence compared to standard care. Patients receiving weekly text‐messages of any length were at lower risk of non‐adherence at 48 weeks than were patients receiving daily messages of any length. There were no significant differences between weekly text‐messaging of any length and between short or long messaging at either interval. Compared to standard care, any daily text‐messaging, whether short or long, did not reduce the risk for non‐adherence.

Weekly mobile phone text messages to patients on ART can help them to take their medication every day. It can also help to reduce the amount of HIV in their bloodstream.

Because the two included trials were with adult patients only, there is a need for trials of this intervention with adolescents. Also, as the two trials were conducted in Kenya, a low‐income country, there is a need for trials of this intervention in high‐income countries.