Pilot RCT of Bidirectional Text Messaging for ART Adherence among Nonurban Substance Users with HIV
OBJECTIVE:
This
pilot study tested the preliminary efficacy of a theory-based bidirectional
text messaging intervention (TEXT) on antiretroviral (ART) adherence, missed
care visits, and substance use among people with HIV.
METHOD:
Participants
with recent substance use and ART nonadherence from 2 nonurban HIV clinics were randomized to TEXT or to usual
care (UC). The TEXT intervention included daily queries of ART adherence, mood,
and substance use. The system sent contingent intervention messages created by
participants for reports of adherence/nonadherence, good mood/poor mood, and no
substance use/use. Assessments were at preintervention, postintervention, and
3-month postintervention follow-up. Objective primary outcomes were adherence,
measured by past 3-month pharmacy refill rate, and proportion of missed visits
(PMV), measured by medical records. The rate of substance-using days from the
timeline follow-back was a secondary outcome.
RESULTS:
Sixty-three
patients participated, with 33 randomized to TEXT and 30 to UC. At
preintervention, adherence was 64.0%, PMV was 26.9%, and proportion of days
using substances was 53.0%. At post intervention, adherence in the TEXT
condition improved from 66% to 85%, compared with 62% to 71% in UC participants
(p = .04). PMV improved from 23% to 9% for TEXT participants and 31% to 28% in
UC participants (p = .12). There were no significant differences between
conditions in substance-using days at postintervention. At 3-month follow-up,
differences were not significant.
CONCLUSIONS:
Personalized
bidirectional text messaging improved adherence and shows promise to improve
visit attendance, but did not reduce substance using days. This intervention
merits further testing and may be cost-efficient given its automation.
Below: Raw rate of adherence, missed visits, and substance-using days by condition over time
- 1Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine.
- 2Department of Medicine, University of Virginia School of Medicine.
- 3Department of Public Health Sciences, University of Virginia School of Medicine.
- 4Health Decision Technologies.
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