Abstract
BackgroundStudies report serious adherence problems among youth (individuals age 15–24 years of age) in Uganda. Recent growth in mobile phone ownership has highlighted the potential of using text-based interventions to improve antiretroviral treatment (ART) adherence among Ugandan youth. We piloted a randomized controlled trial of a text-based intervention providing weekly real-time antiretroviral adherence feedback, based on information from a smart pill box, to HIV-positive Ugandan youth. In this paper, we report the acceptability, feasibility, and preliminary impact of the intervention.MethodsWe randomized participants to a control group, or to receive messages with information on either their own adherence levels (Treatment 1 - T1), or their own adherence and peer adherence levels (Treatment 2 – T2). We conducted six focus groups from December 2016 to March 2017 with providers and youth ages 15–24, double coded 130 excerpts, and achieved a pooled Cohen’s Kappa of 0.79 and 0.80 based on 34 randomly selected excerpts.ResultsThe quantitative and qualitative data show that the intervention was deemed acceptable and feasible. After controlling for baseline adherence, the T1 group had 3.8 percentage point lower adherence than the control group (95% CI -9.9, 2.3) and the T2 group had 2.4 percentage points higher adherence than the control group (95% CI -3.0, 7.9). However, there was an increasing treatment effect over time for the T2 group with the largest effect towards the end of the study; a 2.5 percentage point increase in the initial 9-weeks that grows steadily to 9.0 percentage points by the last 9-weeks of the study. We find negative treatment effects for T1 in 3 of the 4 9-week intervals. This pilot study was not designed to detect statistically significant differences.ConclusionsImproving youth’s adherence by supplementing information about their adherence with information about the adherence of peers is a promising new strategy that should be further evaluated in a fully-powered study. Providing one’s own adherence information alone appears to have less potential.Trial registrationNCT02514356 07/30/2015.
Highlights
Studies report serious adherence problems among youth in Uganda
There are over 1.3 million people in Uganda living with Human immunodeficiency virus (HIV), and those age 10–24 only make up 33% of the population, they represent 50% of the country’s HIV/AIDS cases [1, 2]
We focused on two well-documented Behavioral economics (BE) biases that may be relevant for youth
Summary
Studies report serious adherence problems among youth (individuals age 15–24 years of age) in Uganda. Recent growth in mobile phone ownership has highlighted the potential of using text-based interventions to improve antiretroviral treatment (ART) adherence among Ugandan youth. Studies in Uganda report serious adherence problems among youth 15–24 years of age [3,4,5,6,7], with barriers including HIV-related stigma, treatment disruptions, caretaker delay in disclosure of HIV status, lack of clinical support [8], and limited access to treatment in rural areas [9]. Recent growth in mobile phone ownership among youth in resource-poor settings [11] has highlighted the potential of using text-based interventions to improve antiretroviral treatment (ART) adherence [12, 13]. Behavioral economics (BE) offers novel insights into systematic decisionmaking errors (‘biases’) that might contribute to suboptimal adherence, potentially offering a way to enhance the effectiveness of text-based interventions
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