Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders

Abstract

Mobile phone technologies and their networks blanket the world. As they reach more outlying and impoverished communities, studies investigate to what extent technology could replace paying community health workers to help optimize antiretroviral therapy (ART). Although Pop-Eleches et al.[1] demonstrated that weekly text message reminders improved adherence, they were unable to replicate other adherence benefits associated with community health workers such as social support. Several studies endorse the lack of social support as a barrier to HIV treatment adherence [2,3]. Pop-Eleches et al.[1] designed long and short text message reminders to test the effect of electronic social support mechanisms on adherence. Longer messages added, ‘be strong and courageous, we care about you’, to the short message, ‘this is your reminder’. The study revealed that the length of text message reminders had no significant impact on adherence and suggests that text messages are not a replacement for social support generated by personal interactions. A South African study illustrates the life-saving power of social support when it comes from a human [4]. Mills et al. compared partial directly observed therapy (DOT) and self-administered ART and found a significant difference on survival rates but not adherence (both were greater than 95%). The partial DOT had significantly greater survival rates than self-administered ART, and possible explanations include higher CD4 cell counts within 6 months of enrollment and the social support received during daily visits from patient-nominated community health workers. Something relating to the personal interaction of the community health worker improved survival outcomes. Pop-Eleches et al.[1] improved adherence without testing clinical, immunological, or virological outcomes. We need to study these outcomes in the setting of weekly text message reminders to determine a possible effect on survival, and maybe we need an intervention that mixes mobile phone and community health worker technologies. So far, we have learned, from prior work, that losing the human touch could be deadly.