Evaluating SMS to promote retention and adherence to ART programs

Objective: Lack of retention and adherence to antiretroviral treatment (ART) leads to increased mortality and suboptimal health outcomes of HIV patients. Mobile technologies are increasingly used to mitigate these challenges in resource-poor settings. We investigate whether a system of mobile text and image message reminders improves patients’ medical, physical and psychosocial outcomes in a nationally representative sample of HIV patients undergoing ART in Burkina Faso. We further evaluate whether reminders fatigue patients over time. The study contributes to the literature in terms of: (i) increased geographical coverage, (ii) the large population under study, (iii) the long duration of the intervention, and (iv) the country and linguistic context.

 

Description: The rapid uptake of mobile phones across the developing world in recent years has inspired a host of innovative concepts for how these devices can be harnessed to promote public health. In these contexts, the potential of mobile devices to promote healthy behaviors and facilitate health service delivery looms large. Yet, to date, few rigorous evaluations have been conducted demonstrating the impact of “mobile health” (mHealth) interventions.

In this study, we evaluate whether a short message service (SMS) reminder system can be harnessed to support HIV/AIDS patients in Burkina Faso. In the midst of the country’s push to escalate access to antiretroviral therapy (ART), high rates of attrition from treatment programs have been identified as a concern. Patients on antiretroviral treatment have been enrolled in the study and randomly assigned to an SMS intervention or control group. For those participants enrolled in the intervention, SMS are sent on a weekly basis, reminding them to take their antiretroviral medications. The evaluation determines whether this form of consistent follow-up serves as a helpful tool for patients initiating ART. Specifically, the evaluation identifies whether patients who receive SMS are more likely to remain in care, adhere to their antiretroviral regimens, and experience the health benefits associated with treatment. To this end, the impact of message type and frequency is considered. In this current era of antiretroviral scale-up, this evaluation provides a timely investigation of the fundamental behavioral components of effective treatment. By examining the various factors underlying decisions to discontinue treatment, it strives to identify the most significant barriers to long–term success with ART.

We implemented a nationwide five-arm randomized controlled trial over a period of two years in Burkina Faso. This represents the first nationally representative, long-term study in Africa. We use a 7:7:7:7:10 allocation ratio into four treated and one control group. Messages varied per type (text or ASCII image) and frequency (once or twice per week). Four rounds of data collection were implemented at baseline, six, 12 and 24 months into the intervention. The total sample included 3,838 patients and the intervention ran between 2015 and 2017.

Outcome: Primary outcomes were: (1) retention, (2) adherence, and (3) physical health. Secondary outcomes were: (1) subjective health, and (2) mental health.

Involved Researchers & Departments: Natascha Wagner & Arjun Bedi, International Institute of Social Studies

Contact Info: wagner@iss.nl

Countries Involved: Burkina Faso

Funding: International Initiative for Impact Evaluation