Introduction: In randomized controlled trials, short message service (SMS) programs have improved adherence to HIV antiretroviral therapy (ART). In response, the World Health Organization recommended use of SMS programs to support ART. However, there is limited data on real-world implementations of SMS programs.
Methods: We conducted two studies to assess the acceptability and impact of an SMS program implementation into clinical care at an HIV clinic in KwaZulu-Natal, South Africa. Study 1 included structured interviews with a cross-sectional convenience sample of 100 adult patients who were invited to join the program, 88 of whom had received a program SMS.
Study 2 was a retrospective cohort study. We analyzed data from all adult patients who 1) enrolled at the clinic before the observation period (July 2013 through June 2014), 2) had ≥1 ART prescriptions in the observation period, and 3) had data on phone number availability (N = 2,255). Our primary exposure was whether or not the patient had been sent SMS, which was based on availability of phone numbers recorded at the patients’ initial clinic enrollments. Our main outcome measure was prescription coverage, defined as the presence of a valid ART prescription for each day observed. Using an intention-to-treat approach, we fit generalized linear mixed models adjusted for pre- program prescription coverage, demographics, and ART duration, dosing, and regimen.
Results: In study 1, 81 (92%) of respondents who had received an SMS would recommend the program to a friend. Sixty-eight (77%) felt the program helped them remember clinic appointments, a response associated with male gender [adjusted odds ratio (AOR) 5.88, 95% confidence interval (CI) 1.52 – 23.26, P=0.011] and HIV disclosure outside the home [AOR 3.40, 95%CI 1.00 – 11.60, P=0.050].
In study 2, exposure to the SMS program was independently associated with greater prescription coverage (AOR = 1.23, 95%CI 1.13 – 1.34, P<0.001) compared with non-exposure, although the absolute increase in prescription coverage was small (4.7 days of ART prescription coverage per average patient per year). Among a subset of patients (n=725) whose pre-program prescription coverage was <100%, the corresponding mean expected absolute increase in prescription coverage was 8.2 days per year.
Conclusions: This clinical SMS adherence program was found to have high patient- perceived usefulness and a positive impact on prescription coverage of uncertain clinical significance
