Evidences on the effectiveness of text messages in the adherence to antiretroviral therapy in adults

Soares, Yndiara Kássia da Cunha; Araújo, Telma Maria Evangelista de

doi:10.1590/1983-1447.2020.20190242

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Sumário

Integrative Review • Rev. Gaúcha Enferm. 41 • 2020 • https://doi.org/10.1590/1983-1447.2020.20190242 copy

Evidences on the effectiveness of text messages in the adherence to antiretroviral therapy in adults

Evidencias sobre la eficacia de los mensajes de texto en la adherencia a la terapia antretroviral en adultos

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the evidence available in the literature on the effectiveness of text messages in the adherence to antiretroviral therapy in adults.

Method:

Integrative review. The search for primary studies was carried out in MEDLINE/PubMed, Web of Science, CINAHL, LILACS, and SCOPUS and the sample consisted of 18 studies, in April 2019, with no time delimitation.

Results:

The synthesis of the evidences indicated that, of the 18 analyzed articles, 11 showed an increase in the adherence rates to antiretroviral therapy and an increase in CD4, after using text messages.

Conclusion:

Text messages are an important tool for health education and the synthesis of knowledge can help nurses to obtain increasingly substantive adherence rates in relation to antiretroviral therapy.

Keywords:
HIV; Text messaging; Antiretroviral therapy, highly active; Adult; Cell phone; Medication adherence

Database	Descriptors
Medline via PubMed	Controlled/MeSH: Adult; Text Messaging; Smartphone; Mobile Applications; Cell Phone; Computers, handheld; Telephone; HIV; Antiretroviral Therapy, Highly Active
	Not controlled: SMS; Mobile Phone; Phone; Device Application
	Search terms
	("adult"[MeSH Terms] AND ((((((((("Text Messaging"[MeSH Terms] OR "smartphone"[MeSH Terms]) OR "Mobile Applications"[MeSH Terms]) OR "Cell Phone"[MeSH Terms]) OR "Computers, handheld"[MeSH Terms]) OR "telephone"[MeSH Terms]) OR SMS[Text Word]) OR "Mobile Phone"[Text Word]) OR Phone[Text Word]) OR "Device Application"[Text Word])) AND ("hiv"[MeSH Terms] OR "Antiretroviral Therapy, Highly Active"[MeSH Terms])
Web of Science	Controlled/ MeSH: Adult; Text Messaging; Smartphone; Mobile Applications; Cell Phone; Reminder Systems; HIV; Antiretroviral Therapy, Highly Active
	Not controlled: Mobile Phone; SMS
	Search terms
	TOPIC: (Adult) AND TOPIC: (“Text Messaging”) OR TOPIC: (Smartphone) OR TOPIC: (“Mobile Applications”) OR TOPIC: (“Cell Phone”) OR TOPIC: (“Mobile Phone”) OR TOPIC: (SMS) OR TOPIC: ("Reminder Systems") AND TOPIC: (hiv) OR TOPIC: (“Antiretroviral Therapy, Highly Active“)
CINAHL	Controlled/Emtree: Adult; Text Messaging; Smartphone; Mobile Applications; Cellular Phone; Human Immunodeficiency Virus; AntiretroviralnTherapy, Highly Active
	Not controlled: SMS; Short Message Service; Mobile Phone; Reminder Systems
	Search terms
	(MH "Adult") AND ( (MH "Text Messaging") OR (MH "Smartphone") OR (MH "Mobile Applications") OR (MH "Cellular Phone") OR (MH "Reminder Systems") OR "Short Message Service" OR "SMS" OR ""Mobile Phone"" ) AND ( (MH "Human Immunodeficiency Virus") OR (MH "Antiretroviral Therapy, Highly Active") )
Scopus	Controlled/MeSH: Adult; Text Messaging; Cell Phone; Smartphone; Mobile Applications; HIV; Antiretrovital Therapy Highly Active; Treatment Adherence and Compliance
	Not controlled: Short Message Service
	Search terms
	( TITLE-ABS-KEY ( adult ) ) AND ( ( TITLE-ABS-KEY ( "Text Messaging" ) OR TITLE-ABS-KEY ( "Cell Phone" ) OR TITLE-ABS-KEY ( smartphone ) OR TITLE-ABS-KEY ( "Mobile Applications" ) OR TITLE-ABS-KEY ( "Short Message Service" ) ) ) AND ( ( TITLE-ABS-KEY ( hiv ) OR TITLE-ABS-KEY ( "Antiretroviral Therapy,Highly Active" ) OR TITLE-ABS-KEY ( "Treatment Adherence and Compliance" ) ) )
Lilacs, via the BVS	Controlled/DeCS: Adulto; Mensagem de texto; Smartphone; Aplicativos móveis; Telefone Celular; Telefone Móvel; HIV; Terapia Antirretroviral de Alta Atividade
	Not controlled: Telefone Móvel; SMS; Apps Móveis; Terapia Antirretroviral
	Search terms
	(mh:(Adulto)) AND (mh:("Mensagem de texto")) OR (mh:(Smartphone )) OR (mh:("Aplicativos Móveis" )) OR (mh:("Telefone Celular")) OR (tw:("Telefone Móvel")) OR (tw:(SMS)) OR (tw:(Apps Móveis )) AND (mh:(hiv)) OR (tw:("Terapia Antirretroviral")) OR (mh:("Terapia Antirretroviral de Alta Atividade"))

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
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[1] Corresponding author:
Yndiara Kássia da Cunha Soares E-mail: yndiarakassia@hotmail.com

Main author Year	Title	Objective	Adherence assessment tool	Main results
Maduka O1515. Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract. 2013;16(3):302-8. doi: https://doi.org/10.4103/1119-3077.113451 https://doi.org/10.4103/1119-3077.113451... 2013	Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria.	To demonstrate the effect of adherence counseling and text message reminders to improve adherence to ART.	Self-report and CD4+ cell count.	Increased adherence (statistically significant) and increased number of CD4+ cells.
Lester RT1616. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet. 2010;376(9755):1838-45. doi: https://doi.org/10.1016/S0140-6736(10)61997-6 https://doi.org/10.1016/S0140-6736(10)61... 2010	Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial.	To assess whether cell phone communication between health care professionals and patients initiating antiretroviral therapy in Kenya improves drug adherence and suppression of viral load.	HIV self-report and viral load.	Increased adherence (statistically significant) and a greater number of suppressed viral loads.
Georgette N1717. Georgette N, Siedner MJ, Petty CR, Zanoni BC, Carpenter S, Haberer JE. Impact of a clinical program using weekly short message service (SMS) on antiretroviral therapy adherence support in South Africa: a retrospective cohort study. BMC Med Inform Decis Mak. 2017;17:18. doi: https://doi.org/10.1186/s12911-017-0413-9 https://doi.org/10.1186/s12911-017-0413-... 2017	Impact of a clinical program using weekly Short Message Service (SMS) on antiretroviral therapy adherence support in South Africa: a retrospective cohort study.	To evaluate a weekly SMS reminder clinical program at an HIV clinic to determine prescription coverage.	Prescription coverage.	Greater prescription coverage (statistically significant) .
Abdulrahman SA1818. Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Kadir Shahar H, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: a randomized clinical trial. PLoS One. 2017;12(5):e0177698. doi: https://doi.org/10.1371/journal.pone.0177698 https://doi.org/10.1371/journal.pone.017... 2017	Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial.	To determine the effectiveness of cell phone reminders and peer counseling to improve adherence and treatment outcomes among HIV positive patients on ART in Malaysia.	Modified membership questionnaires from the Adult Clinical Trial Group (ACTG).	The mean adherence was higher in the intervention group (statistically significant). Other benefits observed: lower frequency of missed appointments, lower viral load and increased CD4+ cell count (all statistically significant).
Da Costa TM1919. Costa TM, Barbosa BJP, Gomes e Costa DA, Sigulem D, Marin HF, Castelo Filho A, et al. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform. 2012;81(4):257-69. doi: https://doi.org/10.1016/j.ijmedinf.2011.10.002 https://doi.org/10.1016/j.ijmedinf.2011.... 2012	Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages.	To assess whether an alert system based on mobile SMS messages increases the adherence of HIV-infected Brazilian women.	Self-report, pill count, microelectronic monitors (MEMS) and interview.	It was observed that all the participants in the intervention group remained in compliance.
Mao LM2020. Mao L, Buchanan A, Wong HTH, Persson A. Beyond mere pill taking: SMS reminders for HIV treatment adherence delivered to mobile phones of clients in a community support network in Australia. Health Soc Care Community. 2018;26(4):486-94. doi: https://doi.org/10.1111/hsc.12544 https://doi.org/10.1111/hsc.12544... 2018	Beyond mere pill taking: SMS reminders for HIV treatment adherence delivered to mobile phones of clients in a community support network in Australia.	To evaluate the usefulness of ART adherence reminders offered by SMS messages in real life.	Not described.	Although without statistically significant differences, there was an improvement in the participants' adherence.
Reid M2121. Reid M, Steenhoff A, Thompson J, Gabaitiri L, Cary M, Steele K, et al. Evaluation of the effect of cellular SMS reminders on consistency of antiretroviral therapy pharmacy pickups in HIV-infected adults in Botswana: a randomized controlled trial. Health Psychol Behav Med. 2017;5(1):101-9. doi: https://doi.org/10.1080/21642850.2016.1271333 https://doi.org/10.1080/21642850.2016.12... 2017	Evaluation of the effect of cellular SMS reminders on consistency of antiretroviral therapy pharmacy pickups in HIV-infected adults in Botswana: a randomized controlled trial.	To assess the effect of SMS reminders on receiving ARVs for HIV patients undergoing treatment.	Number of visits to the pharmacy, HIV viral load, CD4 counts and number of consultations.	Better adherence rates in the intervention group. There were no significant changes in CD4 counts and viral loads.
Pop-Eleches C2222. Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, De Walque D, et al. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS. 2011;25(6):825-34. doi: https://doi.org/10.1097/QAD.0b013e32834380c1 https://doi.org/10.1097/QAD.0b013e328343... 2011	Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders.	To test the effectiveness of the Short Message Service (SMS) reminders about adherence to ART among patients seen at a rural clinic in Kenya.	Monitoring system for medication events.	Increased adherence rate (statistically significant). Other benefits: the participants were significantly less likely to interrupt treatment for more than 48 hours.
Hardy H2323. Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, et al. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. Aids Patient Care and STDs. 2011;25(3):153-61. doi: https://doi.org/10.1089/apc.2010.0006 https://doi.org/10.1089/apc.2010.0006... 2011	Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy.	To compare the effectiveness of a cell phone reminder system in increasing adherence to ART versus a whistle.	Self-report, pill count and MEMS.	The adherence increased and remained significantly higher in the discussion group using multiple measures of adherence.
Mbuagbaw L2424. Mbuagbaw L, Thabane L, Ongolo-Zogo P, Lester RT, Mills EJ, Smieja M, et al. The Cameroon Mobile Phone SMS (CAMPS) trial: a randomized trial of text messaging versus usual care for adherence to antiretroviral therapy. PLoS One. 2012;7(12):e46909. doi: https://doi.org/10.1371/journal.pone.0046909 https://doi.org/10.1371/journal.pone.004... 2012	The Cameroon Mobile Phone SMS (CAMPS) Trial: A Randomized Trial of Text Messaging versus Usual Care for Adherence to Antiretroviral Therapy.	To investigate the use of motivational SMS as a way to improve adherence to ART.	Visual Analog Scale (VAS), number of missed doses and pharmacy refill data.	No significant increase was found on the adherence to ART among the participants.
Ware NC2525. Ware NC, Pisarski EE, Tam M, Wyatt MA, Atukunda E, Musiimenta A, et al. The Meanings in the messages: how SMS reminders and real‐time adherence monitoring improve antiretroviral therapy adherence in rural Uganda. AIDS. 2016;30(8):1287-94. doi: https://doi.org/10.1097/QAD.0000000000001035 https://doi.org/10.1097/QAD.000000000000... 2016	The Meanings in the messages: how SMS reminders and real-time adherence monitoring improve antiretroviral therapy adherence in rural Uganda.	To investigate the effects of various types of SMS reminders combined with real-time adherence monitoring on adherence to ART.	Not described.	There was an effect on the mood and motivation of the participants.
Cook PF2626. Cook P, Carrington J, Schmiege S, Starr W, Reeder B. A counselor in your pocket: feasibility of mobile health tailored messages to support HIV medication adherence. Patient Prefer Adher. 2015;9:1353-66. doi: https://doi.org/10.2147/PPA.S88222 https://doi.org/10.2147/PPA.S88222... 2015	A counselor in your pocket: feasibility of mobile health tailored messages to support HIV medication adherence.	To test the viability of messages as a way to improve adherence to ART.	MEMS and electronic devices that record the actual bottle openings in real time.	Acceptance was high based on 76% enrollment and 85% satisfaction. Adherence improved from 10% to 15%.
Nsagha DS2727. Nsagha DS, Lange I, Fon PN, Nguedia Assob JC, Tanue EA. A randomized controlled trial on the usefulness of mobile text phone messages to improve the quality of care of HIV and AIDS patients in Cameroon. Open AIDS J. 2016;10:93-103. doi: https://doi.org/10.2174/1874613601610010093 https://doi.org/10.2174/1874613601610010... 2016	A randomized controlled trial on the usefulness of mobile text phone messages to improve the quality of care of HIV and AIDS patients in Cameroon.	To assess the effectiveness of SMS in the adherence of people living with HIV and AIDS to its treatment and care in Cameroon.	Not described.	Adherence to ART was statistically significantly higher in the intervention group.
Ruan Y2828. Ruan Y, Xiao X, Chen J, Li X, Williams AB, Wang H. Acceptability and efficacy of interactive short message service intervention in improving HIV medication adherence in Chinese antiretroviral treatment-naïve individuals. Patient Prefer Adherence. 2017;11:221-8. doi: https://doi.org/10.2147/PPA.S120003 https://doi.org/10.2147/PPA.S120003... 2017	Acceptability and efficacy of interactive short message service intervention in improving HIV medication adherence in Chinese antiretroviral treatment-naïve individuals.	To examine the acceptability and effectiveness of SMS in adhering to ART.	Knowledge about HIV and drugs, self-report, VAS, community AIDS Clinical Research programs and CD4 count.	It was verified that the participants significantly improved knowledge about HIV and medications. The intervention group had better adherence rates (statistically significant). There was no effect on CD4 cell count.
Sabin LL2929. Sabin LL, Bachman DeSilva M, Gill CJ, Zhong L, Vian T, Xie W, et al. Improving adherence to antiretroviral therapy with triggered real time text message reminders: the China through technology study (CATS). J Acquir Immune Defic Syndr. 2015;69(5):551-9. doi: https://doi.org/10.1097/QAI.0000000000000651 https://doi.org/10.1097/QAI.000000000000... 2015	Improving Adherence to Antiretroviral Therapy with Triggered Real-time Text Message Reminders: The China Adherence Through Technology Study.	To assess the effect of triggered cell phone reminders and advice on adherence to ART.	Electronic monitoring in real time.	Greater adherence was observed in the intervention group, corresponding to 87.3% vs. 51.8% of the control group.
Kalichman SC3030. Kalichman SC, Kalichman MO, Cherry C, Eaton LA, Cruess D, Schinazi RF. Randomized factorial trial of phone-delivered support counseling and daily text message reminders for HIV treatment adherence. J Acquir Immune Defic Syndrs. 2016;73(1):47-54. doi: https://doi.org/10.1097/QAI.0000000000001020 https://doi.org/10.1097/QAI.000000000000... 2016	Randomized Factorial Trial of Phone-Delivered Support Counseling and Daily Text Message Reminders for HIV Treatment Adherence.	To test the independent and interactive effects of SMS medication counseling and reminders on adherence to ART.	Monthly pill counts and HIV viral load.	There were verified significant improvements in obtaining 90% of adherence to ART in relation to the control group in the first 6 monitoring months.
Joseph Davey D3131. Joseph Davey D, Nhavoto JA, Augusto O, Ponce W, Traca D, Nguimfack A, et al. SMSaúde: evaluating mobile phone text reminders to improve retention in hiv care for patients on antiretroviral therapy in Mozambique. J Acquir Immune Defic Syndr. 2016;73(2):e23-30. doi: https://doi.org/10.1097/QAI.0000000000001115 https://doi.org/10.1097/QAI.000000000000... 2016	SMSaúde: Evaluating mobile phone text reminders to improve retention in HIV care for patients on antiretroviral therapy in Mozambique.	To assess whether regular cell phone text reminders improve retention of patients on ART.	Not described.	The text messages improve retention in attention to HIV in urban patients.
Lewis MA3232. Lewis MA, Uhrig JD, Bann CM, Harris JL, Furberg RD, Coomes C. Tailored text messaging intervention for HIV adherence: a proof-of-concept study. Health Psychol. 2013;32(3):248-53. doi: https://doi.org/10.1037/a0028109 https://doi.org/10.1037/a0028109... 2013	Tailored text messaging intervention for HIV adherence: A proof-of-concept study.	To determine the acceptability and effect of medication messages on ART adherence.	Self-report, CD4 count and viral load.	Significant increase in adherence among participants who started the study as non-adherents. There was still a significant decrease in viral load and increase in CD4+ cells.