Effectiveness of Short Message Service Reminders on Timely Pick-up of Antiretroviral Therapy Among Consenting Persons with HIV in Zambézia Province, Mozambique.

Abstract

A short message service (SMS) intervention was implemented in July 2016 at eight health facilities (HFs) within Zambézia Province, Mozambique. We assessed effectiveness by comparing antiretroviral therapy (ART) pick-up rates among persons with HIV (PWH) eligible for SMS reminders. All adult (≥15 years of age) PWH enrolled in ART services reporting cell phone access were offered SMS. PWH were sent messages 15, 7, and 2 days before scheduled ART pick-up appointments. Using routine data (July 2016-May 2018), mixed-effect logistic regression was used to determine adjusted odds ratios (aORs) of ART pick-up within 2, 6, and 59 days of scheduled appointments, adjusting for age, sex, adherence support group status, partner status, pregnancy, education, occupation, years on ART, HF, pick-up day, and year-week. Data were available for 18,941 scheduled ART pick-up clinic visits for 3,222 PWH (52% female) reporting cell phone access. Overall, 47% of men and 46% of women consented to receive SMS. PWH sent reminders had higher pick-up rates within 2 days of scheduled appointments compared with those not sent reminders (54% vs. 51%). Men sent reminders were more likely to pick-up within 2 days of scheduled appointments than men not sent reminders [aOR = 1.22 (1.09-1.37)]. No association was seen within 6 or 59 days of scheduled appointments [aOR = 1.09 (0.95-1.25), 0.90 (0.74-1.10)]. Women sent reminders had similar pick-up rates compared with women not sent reminders [aOR = 0.94 (0.85-1.05), 0.90 (0.79-1.03), 0.89 (0.72-1.10)]. In Zambézia Province, SMS reminders were associated with timely short-term ART pick-up rates among men, although this association attenuated with increased time from scheduled appointment. Study limitations included its observational (nonrandomized) nature and restricting analyses to individuals reporting phone access. SMS reminders may be an important approach for addressing the well-documented need for medication adherence support for males. Additional context-specific strategies are needed to ensure timely ART pick-up and improve retention.