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                          enGender Impact: The World Bank’s Gender Impact Evaluation Database



 Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a
                        randomized controlled trial of text message reminders
              Christian Pop-Eleches, Harsha Thirumurthy, James Habyarimana, Joshua Zivin, Markus Goldstein, Damien de Walque,
 Author(s)
              Leslie Mackeen, Jessica Haberer, Sylvester Kimaiyo, John Sidle, Duncan Ngare, David Bangsberg
  Contact     hthirumurthy@worldbank.org

  Country     Kenya
Organizing
              Health
 Theme
   Status     Completed
Intervention
             Reproductive Health
  Category
  Sector      Health, Nutrition & Population
              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
 Abstract
              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 (P¼0.03). 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%, P¼0.03).
              Conclusion: These results suggest that SMS reminders may be an important tool to achieve optimal treatment response
              in resource-limited settings.

 Gender
              Gender Focused Intervention
Connection
 Gender
              Use of healthcare services
Outcomes
 IE Design    Randomized Control Trial
             Participants were provided a Nokia mobile phone that they could use as desired. Participants were referred to a
             pharmacy where their antiretroviral medications were held in a bottle with medication event monitoring system (MEMS).
Intervention
             The participants were randomly assigned to one of four intervention groups or one control group which received no text
             message. The interventions included short messages or long messages, and weekly or daily reminders.
Intervention
             June 2007- August 2008; messages were sent either daily or weekly
   Period
  Sample     The sample was comprised of 431 adult patients who had initiated Anti-Retroviral Treatment within 3 months of the
 population intervention.


             Last updated: 14 August 2013                                                                     1
                           enGender Impact: The World Bank’s Gender Impact Evaluation Database


Comparison     There were four treatment arms and one control group. Each treatment arm received either short or long messages at a
 conditions    frequency of either daily or weekly. The control group received no text messages.
  Unit of
               Individual Level
  analysis
Evaluation
               Participants were required to return to the clinic once per month; there was a 48 week follow up period
   Period
             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, the difference is significant.
   Results
             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.
             69 participants lost their phones and 51 changed their number during the course of the study. The study cannot
   Primary
             differentiate between increased usage of pills or increased usage of electronic medication monitor. The study also cannot
     study
             measure the impact on viral suppression. Also, the study only measured adherence to one tablet and assumed that it
 limitations
             reflects adherence to the entire regimen.
   Funding   The World Bank Research Group, Bank-Netherlands Partnership Program, USAID AMPATH Partnership, National
    Source   Institute of Mental Health
             Pop-Eleches, C., Thirumurthy, H., Habyarimana, J., Graff Zivin, J., Goldstein, M., de Walque, D., ... & Bangsberg, D.
Reference(s) (2011). Mobile Phone Technologies Improve Adherence to Antiretroviral Treatment in Resource-Limited Settings: A
             Randomized Controlled Trial of Text Message Reminders. Aids, 25, 825-834.
   Link to
   Studies   http://journals.lww.com/aidsonline/Citation/2011/05150/Mobile_phone_technologies_improve_adherence_to.18.aspx
 Microdata




              Last updated: 14 August 2013                                                                    2