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

Pop-Eleches, Cristiana,b,*; Thirumurthy, Harshac,d,*; Habyarimana, James Pe,*; Zivin, Joshua Gf; Goldstein, Markus Pg; de Walque, Damieng; MacKeen, Leslieh; Haberer, Jessicai,o; Kimaiyo, Sylvesterj; Sidle, Johnk,l; Ngare, Duncanm; Bangsberg, David Rn,p

doi: 10.1097/QAD.0b013e32834380c1
Epidemiology and Social

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:,

© 2011 Lippincott Williams & Wilkins, Inc.