Abstract
Objective:To understand how a pilot intervention combining SMS reminders with real-time adherence monitoring improved adherence to HIV antiretroviral therapy (ART) for adults initiating treatment in rural Uganda.Design:Qualitative study, conducted with a pilot randomized controlled trial.Methods:Sixty-two pilot intervention study participants took part in qualitative interviews on: preferences for content; frequency and timing of SMS adherence reminders; understandings and experiences of SMS reminders; and understandings and experiences of real-time adherence monitoring. Analysis of interview data was inductive and derived categories describing how participants experienced the intervention, and what it meant to them.Results:SMS reminders prompted taking individual doses of antiretroviral therapy, and helped to develop a ‘habit’ of adherence. Real-time adherence monitoring was experienced as ‘being seen’; participants interpreted ‘being seen’ as an opportunity to demonstrate seriousness of commitment to treatment and ‘taking responsibility’ for adherence. Both SMS reminders and real-time monitoring were interpreted as signs of ‘caring’ by the healthcare system. Feeling ‘cared about’ offset depressed mood and invigorated adherence.Conclusion:Although serving as reminders, SMS messages and real-time adherence monitoring also had larger emotional and moral meanings for participants that they felt improved their adherence. Understanding the larger ‘meanings in the messages,’ as well as their more literal content and function, will be central in delineating how SMS reminders and other adherence interventions using cellular technology work or do not work in varying contexts.
Highlights
Cellular technology is widely used globally and offers promising opportunities for improving HIVantiretroviral therapy (ART) adherence and clinical outcomes
Mobile phones allow healthcare providers to communicate with patients remotely, reducing the need for costly and time-consuming travel to clinical sites
Categories resulting from analysis of qualitative data are presented in two sections, below, entitled ‘preferences for SMS reminders,’ and ‘meanings and experiences of intervention components’
Summary
Cellular technology is widely used globally and offers promising opportunities for improving HIVantiretroviral therapy (ART) adherence and clinical outcomes. Mobile phones allow healthcare providers to communicate with patients remotely, reducing the need for costly and time-consuming travel to clinical sites. SMS text aDepartment of Global Health and Social Medicine, Harvard Medical School, bDivision of Global Health Equity, Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts, USA, cMbarara University of Science and Technology, Mbarara, Uganda, dCenter for Global Health, Massachusetts General Hospital, and eDepartment of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
