Cover: Text Messaging for Improving Antiretroviral Therapy Adherence

Text Messaging for Improving Antiretroviral Therapy Adherence

No Effects After 1 Year in a Randomized Controlled Trial Among Adolescents and Young Adults

Published in: American Journal of Public Health [Epub October 2017]. doi: 10.2105/AJPH.2017.304089

Posted on Nov 2, 2017

by Sebastian Linnemayr, Haijing Crystal Huang, Jill E. Luoto, Andrew Kambugu, Harsha Thirumurthy, Jessica Haberer, Glenn Wagner, Barbara Mukasa

Research Questions

  1. Do short text SMS reminder messages improve medication adherence?
  2. Would two-way SMS messages be more effective than SMS reminders without a response option?


To assess the effectiveness of Short Message Service (SMS) reminder messages on antiretroviral and cotrimoxazole prophylaxis adherence among HIV-positive youths as well as the relative effectiveness of SMS with and without a response option.


Eligible HIV-positive patients aged 15 to 22 years at 2 HIV clinics in Kampala, Uganda, participated in a year-long parallel individual-randomized controlled trial and were assigned in a 1-to-1-to-1 ratio to a weekly SMS message group, weekly SMS message with response option group, or a usual-care control group.


We enrolled 332 participants. Electronically measured mean adherence was 67% in the control group, 64% in the 1-way SMS group (95% confidence interval [CI] = 0.77, 1.14), and 61% in the 2-way SMS group (95% CI = 0.75, 1.12) in an intent-to-treat analysis. Results for secondary outcomes and complete-case analysis were similarly statistically insignificant across groups.


Despite previous evidence that interventions using SMS reminders can promote antiretroviral therapy adherence, this study shows that they are not always effective in achieving behavior change. More research is needed to find out for whom, and under what conditions, they can be beneficial.

Key Findings

  • SMS reminder messages sent to young HIV-positive patients at two clinics in Uganda did not improve medication adherence.
  • Adding a response option to the messages, thus creating a two-way form of communication, did not have a differential effect on behavior.
  • The finding that messages did not improve adherence stands in contrast to other previously published studies.
  • Messages may not have had an effect on adherence in this study because of the ubiquity of mobile phones and text messages, in comparison to their relative novelty in previous years.
  • Another reason for lack of effect could be that patients targeted for this study were mostly well-established clients, and may not have been forming medication-taking habits.
  • Expectations about the role of SMS messages in capturing the attention of recipients and changing behavior may need to be re-evaluated as technologies change.

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