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.
aSchool of International and Public Affairs, USA
bDepartment of Economics, Columbia University, New York, New York, USA
cDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
dThe World Bank, USA
ePublic Policy Institute, Georgetown University, Washington, District of Columbia, USA
fSchool of International Relations and Pacific Studies, University of California, San Diego, California, USA
gDevelopment Research Group, The World Bank, USA
hBureau for Global Health, United States Agency for International Development, Washington, District of Columbia, USA
iDepartment of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
jSchool of Medicine, Moi University, Eldoret, Kenya
kDivision of General Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
lDepartment of Medicine, Faculty of Health Sciences, Kenya
mSchool of Public Health, Moi University, Eldoret, Kenya
nRagon Institute of MGH, MIT and Harvard, Kenya
oMassachusetts General Hospital Center for Global Health, Boston, Massachusetts, USA
pMbarara University of Science and Technology, Mbarara, Uganda.
*C.P.-E., H.T. and J.P.H. contributed equally to the writing of this article.
Received 19 September, 2010
Revised 29 November, 2010
Accepted 2 December, 2010
Correspondence to Harsha Thirumurthy, PhD, The World Bank, 1818 H Street NW, Washington, DC 20433, USA. E-mail: firstname.lastname@example.org, email@example.com