Text message intervention designs to promote adherence to antiretroviral therapy (ART): a meta-analysis of randomized controlled trials

• Published in: PloS one 2014-02, Vol.9 (2), p.e88166
• Main Authors: Finitsis, David J, Pellowski, Jennifer A, Johnson, Blair T
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adhesion; AIDS; Analysis; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Boolean algebra; Care and treatment; CD4 antigen; Clinical trials; Drugs; Health risks; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Intervention; Medicine; Meta-analysis; Patient Compliance; Randomization; Randomized Controlled Trials as Topic; Reminder Systems; Risk reduction; Searching; Sensitivity analysis; Short message service; Social and Behavioral Sciences; Systematic review; Text Messaging; Therapy; Treatment Outcome; Wireless telephones
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0088166

The efficacy of antiretroviral therapy depends on patient adherence to a daily medication regimen, yet many patients fail to adhere at high enough rates to maintain health and reduce the risk of transmitting HIV. Given the explosive global growth of cellular-mobile phone use, text-messaging interventions to promote adherence are especially appropriate. This meta-analysis synthesized available text messaging interventions to promote antiretroviral therapy adherence in people living with HIV. We performed Boolean searches of electronic databases, hand searches of recent year conference abstracts and reverse searches. Included studies (1) targeted antiretroviral therapy adherence in a sample of people living with HIV, (2) used a randomized-controlled trial design to examine a text messaging intervention, and (3) reported at least one adherence measurement or clinical outcome. Eight studies, including 9 interventions, met inclusion criteria. Text-messaging interventions yielded significantly higher adherence than control conditions (OR = 1.39; 95% CI = 1.18, 1.64). Sensitivity analyses of intervention characteristics suggested that studies had larger effects when interventions (1) were sent less frequently than daily, (2) supported bidirectional communication, (3) included personalized message content, and (4) were matched to participants' antiretroviral therapy dosing schedule. Interventions were also associated with improved viral load and/or CD4+ count (k = 3; OR = 1.56; 95% CI = 1.11, 2.20). Text-messaging can support antiretroviral therapy adherence. Researchers should consider the adoption of less frequent messaging interventions with content and timing that is individually tailored and designed to evoke a reply from the recipient. Future research is needed in order to determine how best to optimize efficacy.