January, 2017 - SUPPORT Summary of a systematic review | print this article |

Does mobile phone text messaging promote adherence to antiretroviral therapy in people with HIV infection?

Antiretroviral therapy (ART) can help people with HIV infection live a longer and healthier life. However, adherence to ART can be difficult because it requires taking medication every day. Text messages sent through mobile phones could improve adherence to ART in people with HIV infection.

 Key messages

 

  • Mobile phone text messages compared to standard care improve adherence to ART for up to 12 months.

  • Mobile phone text messages compared to standard care may lead to little or no difference in mortality or loss to fol-low-up after up to 12 months.

  • Weekly text messages probably improve adherence com-pared to daily text messages, and interactive text messages probably improve adherence compared to non interactive text messages.

  • All studies were conducted in low income countries in Africa.

 

 

Background

HIV affects more than 34 million people worldwide, with a disproportionate share of infections in low-income countries. Antiretroviral therapy (ART) has been available for more than two decades and has contributed to improved longevity and quality of life in people living with HIV infection. However, it can be difficult for people who are on ART to take their daily medication for several reasons. Low-adherence to ART could be associated with drug resistance.

 

Mobile phones have become increasingly present in recent years and their penetration in low-income countries is very high. The possibility to send text messages through mobile phones at very low cost makes it a promising tool for the promotion of healthy behaviours, including adherence to ART in people with HIV infection.

 



About the systematic review underlying this summary

Review objectives: To determine whether mobile phone text-messaging is efficacious in enhancing adherence to ART in people with HIV infection.
Type of What the review authors searched for What the review authors found
Study designs & interventions Randomised trials in which patients receiving ART or their caregivers (for children) were provided with mobile phone text messages to promote adherence to ART Three randomised trials comparing text messaging to a control condition. In two studies, weekly text messages reminders were compared to standard care. In the other study, short or long text messages, either daily or weekly, were compared to the provision of a cell phone, but without study-related communication.
Participants Adults or children receiving ART The studies included adults only
Settings Any setting Kenya (2 studies) and Cameroon (1 study)
Outcomes The primary outcomes were adherence to ART and viral load suppression. The secondary outcomes were quality of life, mortality, losses to follow-up, transfers and withdrawals All studies reported adherence to ART at 48 or 52 weeks and viral load suppression at 52 weeks. One study reported mortality, losses to follow-up, transfers and withdrawals. One study reported quality of life.
Date of most recent search: This review included three studies, which were the only published studies of which the authors were aware that met their selection criteria up until September 2013.
Limitations: This is a well-conducted review that analysed individual patient data from three randomised trials. However, a systematic search for other relevant studies was not undertaken.
Mbuagbaw L, van der Kop ML, Lester RT, et al. Mobile phone text messages for improving adherence to antiretroviral therapy (ART): an individual patient data meta-analysis of randomised trials. BMJ Open 2013; 3:e003950.

Mbuagbaw L, van der Kop ML, Lester RT, et al. Mobile phone text messages for improving adherence to antiretroviral therapy (ART): an individual patient data meta-analysis of randomised trials. BMJ Open 2013; 3:e003950.

Summary of findings

Two studies conducted in Kenya and one in Cameroon, including 1169 participants overall, evaluated mobile phone text messaging against standard care. One study compared short weekly messages to standard care. The other study compared one of four conditions (short or long messages, sent daily or weekly), and a control condition (provision of a mobile phone without any communication related to the study).

  • Mobile phone text messages compared to standard care improves adherence to ART for up to 12 months. The certainty of this evidence is high.

  • Mobile phone text messages compared to standard care may lead to little or no difference in mortality or loss to follow up after up to 12 months. The certainty of this evidence is low.

  • Weekly text messages probably improve adherence compared to daily text messages and interactive text messages probably improve adherence compared to non-interactive text messages. The certainty of this evidence is moderate.

  • Motivational content and the length of the text messages may lead to little or no difference in adherence. The certainty of this evidence is moderate.

Mobile phone text messages compared to standard care 

People:  Patients with HIV infection taking ART
Settings
:  Kenya and Cameroon
Intervention
: Mobile phone text messages (overall)
Comparison
: Standard care
Outcomes Illustrative comparative risks Relative effect
(95% CI)
Certainty of the evidence
(GRADE)
Without text message With text messaje

ART adherence

12 months follow up

50 per 100

 


 

Difference: 8 more per 100

(Margin of error: from 2 to 14 more)

58 per 100

OR 1.38
(1.08 to 1.78)

High

Mortality 12 months follow up 11 per 100

Difference : 1 less per 100

(Margin of error:from 5 less to 4 more)

10 per 100

OR 0.87

(0.52 to 1.43)

Low

Loss to follow up

12 months follow up

10 per 100

Difference : 1 less per 100

(Margin of error: from 3 less to 2 more)

9 per 100

OR 0.87

(0.63 to 1.19)

Low

Margin of error = Confidence interval (95% CI) 0R: Odds ratio GRADE: GRADE Working Group grades of evidence (see above and last page)

* The risk WITHOUT the intervention is based on the baseline risk in one of the included studies.† The corresponding risk WITH the intervention (and the 95% confidence interval for the difference) is based on the overall relative effect (the OR and its 95% confidence interval).

† Lester RT, Ritva P, Mills EJ, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet 2010; 376: 1838–45

 

 

 

 

 

 

 

 

Relevance of the review for low-income countries

Findings Interpretation*
APPLICABILITY
Three studies, all conducted in low-income countries (Cameroon and Kenya), were included.  

The findings of this intervention are likely to be applicable in low-income countries with comparable health system structures and prevalence of HIV infection.

 

 

  • Factors such as ownership of mobile phones and quality of the telecommunication network need to be considered when assessing the applicability of this intervention.

 


EQUITY
Included studies did not directly address equity.
This intervention could increase health inequities, disfavouring people without mobile phone or those living in remote areas (i.e. without mobile phone signal).
ECONOMIC CONSIDERATIONS
Included studies did not provide information regarding economic considerations.
The costs of acquisition and maintenance of mobile phones, as well as the costs of training people in the use of mobile phones should be considered.
MONITORING & EVALUATION
The review identifies four ongoing trials, three of which are conducted in resource-limited settings.

There is a need to conduct more studies on mobile phone text-messaging for improving adherence to ART in adolescent populations, and in persons who care for children and infants with HIV.


*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low-income countries. For additional details about how these judgements were made see: http://www.support-collaboration.org/summaries/methods.htm

 

Additional information

Related literature

Finitsis DJ, Pellowski JA, Johnson BT. Text message intervention designs to promote adherence to antiretroviral therapy (ART): a meta-analysis of randomized controlled trials. PloS One. 2014; 9(2):e88166.

Cochrane Review Group on HIV/AIDS. Electronic reminders for promoting adherence to ART among people living with HIV. Geneva: World Health Organization, 2013. http://apps.who.int/iris/handle/10665/94419

Horvath T, Azman H, Kennedy GE, Rutherford GW. Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. Cochrane Database Syst Rev 2012; 3: CD009756.

van Velthoven MH, Brusamento S, Majeed A, Car J. Scope and effectiveness of mobile phone messaging for HIV/AIDS care: A systematic review. Psychology, Health & Medicine 2013; 18:182-202.

Anglada-Martinez H, Riu-Viladoms G, Martin-Conde M, et al. Does mHealth increase adherence to medication? Results of a systematic review. International Journal of Clinical Practice. 2014; 69:9-32.

Bärnighausen T, Chaiyachati K, Chimbindi N, et al. Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies. The Lancet Infectious Diseases 2011; 11:942-51.

Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, et al. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev 2013; 12: CD007458.

de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, et al. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev 2012; Issue 12: CD007459.

Vodopivec-Jamsek V, de Jongh T, Gurol-Urganci I, et al. Mobile phone messaging for preventive health care. Cochrane Database Syst Rev 2012; 12: CD007457.

Wei, J., Hollin, I., & Kachnowski, S. A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions. J Telemedicine and Telecare 2011; 17:41-8.

 

This summary was prepared by

Marie-Pierre Gagnon, Université Laval, Canada.

 

Conflict of interest

None declared. For details, see: www.supportsummaries.org/coi

 

Acknowledgements

This summary has been peer reviewed by: Lawrence Mbuagbaw and Krisda Chaiyachati.

 

This review should be cited as

Mbuagbaw L, van der Kop ML, Lester RT, et al. Mobile phone text messages for improving adherence to antiretroviral therapy (ART): an individual patient data meta-analysis of randomised trials. BMJ open 2013; 3:e003950.

 

The summary should be cited as

Gagnon MP. Does mobile phone text messaging promote adherence to antiretroviral therapy in people with HIV infection? A SUPPORT Summary of a systematic review. January 2017. www.supportsummaries.org

 

Keywords

evidence-informed health policy, evidence-based, systematic review, health systems research, health care, low and middle-income countries, developing countries, primary health care antiretroviral therapy, adherence, mobile phone text messaging

 



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