Texts can help HIV patients stay on therapy
Text messages sent by cell phone can help HIV patients stay on their medications, according to a Cochrane review.
High-quality evidence from two randomized controlled trials conducted in Kenya suggests text messaging reduced the risk of non-adherence by 22%, according to Tara Horvath, MA, of the University of California San Francisco, and colleagues.
And there is also good evidence that the text messaging was associated with lower viral load, Horvath and colleagues found in a Cochrane Systematic Review.
"Clinics and hospitals should consider using weekly text messaging as a way to ensure HIV patients stick to their antiretroviral therapy regimens," Horvath said in a statement.
"With the expansion of mobile phone networks worldwide, particularly in regions that are new to these technologies, text messaging interventions for HIV are rapidly becoming more feasible," Horvath said.
The researchers said the studies, conducted in adults, found a clear benefit, and urged that studies be conducted in other populations, especially adolescents.
Her group also argued that, contrary to the usual progression of randomized trials, studies should be conducted in the developed world, where adherence is also a problem.
Horvath and colleagues noted that some 34 million people are living with HIV/AIDS, and many of them on highly active anti-retroviral therapy. But the therapy can fail, they noted, if the drugs are not taken as prescribed, leading to the need to switch regimens and also potentially to drug resistance.
"Mobile phone text-messaging has the potential to help promote adherence," they argued.
To find out if it does, they conducted a systematic review of the HIV/AIDS literature, finding two randomized controlled trials that compared mobile text messaging with a control condition.
One year-long trial in adults compared brief weekly text messages against standard care. Those in the intervention arm received a message of "Mambo?," which means "How are you?" in Kiswahili, and were asked to reply within 48 hours.
A negative response was met with a direct phone call to obtains details and arrange for care.
The primary outcomes were self-reported adherence to medication - defined as taking more than 95% of prescribed doses in the previous 30 days, assessed at six months and again at 12 months - and suppression of HIV viral load at 12 months, defined as fewer than 400 copies of HIV RNA per microliter of plasma.
The other trial compared standard care with short daily, long daily, short weekly and long weekly messages, again among adult patients. The short message said simply: "This is your reminder." The long message said: "This is your reminder. Be strong and courageous. We care about you."
The primary endpoint was risk of non-adherence, defined as fewer than 90% of doses during each of four 12-week analysis periods.
Horvath and colleagues found that in the first trial, comparing only short weekly messages to standard care, those getting the text messages were 23% less likely to be non-adherent at 12 months.
The relative risk was 0.77 (95% CI 0.63 to 0.93). They were also less likely to have virologic failure (RR 0.83 at 12 months, 95% CI from 0.69 to 0.99).
In the second trial, the length of the messages did not affect adherence. Patients who got weekly messages were 21% less likely to be non-adherent (RR 0.79, 95% CI 0.64 to 0.99).
On the other hand, compared with standard care, any daily messaging did not reduce the risk for non-adherence. But in a meta-analysis of both trials, any weekly text-messaging was associated with a lower risk of non-adherence (RR 0.78, 95% CI 0.68 to 0.89).
As well, the effect of short weekly messaging remained significant (RR 0.77, 95% CI 0.67 to 0.89), Horvath and colleagues reported.