RCT from Kenya showing that weekly SMS improves adherence to ART
I am pleased to share with you that a randomized controlled trial by Christian Pop-Eleches, Harsha Thirmurthy, James Habyarimana and others has just been published in the journal AIDS. It finds that weekly SMS reminders improve MEMS cap ART adherence in Kenya compared to standard care. We were surprised to find that weekly messages were more effective than daily messages and short messages were more effective than long messages. This study confirms recent findings by Lester in Lancet with more a more detailed measure of adherence, although viral load measurements were not available. I'd be interested in any feedback you have.
Abstract (from PubMed):
Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders.
Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, de Walque D, Mackeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR.
AIDS. 2011 Jan 19. [Epub ahead of print]
OBJECTIVE: There is limited evidence on whether growing mobile phone availability in sub-Saharan Africa can be used to promote high adherence to antiretroviral therapy (ART). This study tested the efficacy of short message service (SMS) reminders on adherence to ART among patients attending a rural clinic in Kenya.
DESIGN: A randomized controlled trial of four SMS reminder interventions with 48 weeks of follow-up.
METHODS: Four hundred and thirty-one adult patients who had initiated ART within 3 months were enrolled and randomly assigned to a control group or one of the four intervention groups. Participants in the intervention groups received SMS reminders that were either short or long and sent at a daily or weekly frequency. Adherence was measured using the medication event monitoring system. The primary outcome was whether adherence exceeded 90% during each 12-week period of analysis and the 48-week study period. The secondary outcome was whether there were treatment interruptions lasting at least 48 h.
RESULTS: In intention-to-treat analysis, 53% of participants receiving weekly SMS reminders achieved adherence of at least 90% during the 48 weeks of the study, compared with 40% of participants in the control group (P = 0.03). Participants in groups receiving weekly reminders were also significantly less likely to experience treatment interruptions exceeding 48 h during the 48-week follow-up period than participants in the control group (81 vs. 90%, P = 0.03).
CONCLUSION: These results suggest that SMS reminders may be an important tool to achieve optimal treatment response in resource-limited settings.