Abstract
ABSTRACTObjective: Several studies have demonstrated that cellular phone short message service (SMS) improve antiretroviral adherence for people living with HIV in Africa, although less data are available to support using SMS reminders to improve timeliness of antiretroviral therapy (ART) pharmacy pick up. This study tested the efficacy of SMS reminders on timeliness of ART pharmacy pickups at an urban clinic in Gaborone, Botswana.Design: A randomized-controlled trial evaluating the effect of SMS reminders on ART collection for patients with HIV on treatment.Methods: One hundred and eight treatment-experienced adult patients were enrolled and randomly assigned to a control group or an intervention group. Participants in the intervention group received SMS reminders that were sent in advance of monthly ART refills that needed to be collected. The primary outcome was 100% timeliness of pharmacy ART pickups. Secondary outcomes included frequency of physician visits, CD4 cell counts and viral loads.Results: Baseline characteristics in the intervention (n = 54) and control arms (n = 54) were similar. After six months, 85% of those receiving SMS reminders were 100% on time picking up monthly ART refills compared to 70% in the control group (p = 0.064). In secondary analysis, there were no significant changes in the CD4 counts and viral loads over the course of the study.Conclusions: Timeliness of ART pickup was not significantly improved by SMS reminders. Additionally, the intervention had no impact on immunologic or virologic outcomes in treatment-experienced patients.
Highlights
Antiretroviral therapy (ART) has significantly reduced morbidity and mortality for people living with HIV/AIDS in Sub-Saharan Africa (SSA) (Palella et al, 1998)
While initial concerns about poor adherence and widespread drug resistance have not been realized, evidence suggests that medication adherence among individuals in Sub-Saharan Africa does decline over time (Byakika-Tusiime et al, 2009; Mannheimer et al, 2005)
More than 70% in both arms had been on ART for at least 4 years at the time of enrollment
Summary
Antiretroviral therapy (ART) has significantly reduced morbidity and mortality for people living with HIV/AIDS in Sub-Saharan Africa (SSA) (Palella et al, 1998). Mobile phone text messages using the short message service (SMS) have been demonstrated to be a feasible and affordable means of improving ART adherence (Finitsis, Pellowski, & Johnson, 2014; Kelly & Giordano, 2011; Mills et al, 2014; Pop-Eleches et al, 2011; Riaz, Riaz, Hussain, & Kherani, 2012; Vodopivec-Jamsek, de Jongh, GurolUrganci, Atun, & Car, 2012). We undertook a randomized-controlled trial at a single site in Gaborone, Botswana, to assess whether SMS reminders improved timeliness of pharmacy pickup of antiretroviral medications for HIV-infected adults
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