AIDS and Behavior

, Volume 21, Issue 11, pp 3182–3193 | Cite as

Lessons Learned From the Implementation of Seek, Test, Treat, Retain Interventions Using Mobile Phones and Text Messaging to Improve Engagement in HIV Care for Vulnerable Populations in the United States

  • Katerina A. Christopoulos
  • William E. Cunningham
  • Curt G. Beckwith
  • Irene Kuo
  • Carol E. Golin
  • Kevin Knight
  • Patrick M. Flynn
  • Anne C. Spaulding
  • Lara S. Coffin
  • Bridget Kruszka
  • Ann Kurth
  • Jeremy D. Young
  • Sharon Mannheimer
  • Heidi M. Crane
  • Shoshana Y. Kahana
Original Paper


In the United States, little is known about interventions that rely on mobile phones and/or text messaging to improve engagement in HIV care for vulnerable populations. Domestic studies using these technologies as part of the National Institute on Drug Abuse “Seek, Test, Treat, Retain” research initiative were queried regarding intervention components, implementation issues, participant characteristics, and descriptive statistics of mobile phone service delivery. Across five studies with 1,135 predominantly male, minority participants, implementation challenges occurred in three categories: (1) service interruptions; (2) billing/overage issues, and; (3) the participant user experience. Response rules for automated text messages frequently frustrated participants. The inability to reload minutes/texting capacity remotely was a significant barrier to intervention delivery. No study encountered confidentiality breaches. Service interruption was common, even if studies provided mobile phones and plans. Future studies should attend to the type of mobile phone and service, the participant user experience, and human subjects concerns.


mHealth SMS Text messaging Retention in HIV care Engagement in HIV care 


Existe poca información acerca de las intervenciones que utilizan teléfonos móviles y/o mensajes de texto para mejorar el cuidado de VIH en poblaciones vulnerables. Estudios nacionales que utilizan estas tecnologías como parte de la iniciativa sobre la “búsqueda, prueba, tratamiento, retención” del Instituto Nacional sobre el Abuso de Drogas describieron los componentes de la intervención, los aspectos de la implementación, las características de los participantes, y las estadísticas descriptivas relacionadas con el uso de teléfonos móviles. Cinco estudios, con un total de 1.135 participantes predominantemente masculinos y minoritarios, expresaron desafíos de implementación en tres categorías: (1) interrupciones de servicio; (2) problemas de facturación/rebasamiento; y; (3) las experiencias de uso del participante. Las reglas automatizadas en las respuestas de mensajes frustraron a los participantes frecuentemente. La inhabilidad de recargar remotamente los minutos/mensajes de texto fueron una barrera significativa para suministrar la intervención de forma consistente. Es importante destacar que ningún estudio encontró violaciones de confidencialidad. La interrupción del servicio fue común, incluso para los estudios que proporcionaban teléfonos móviles y planes a sus participantes. Futuros estudios deben atender al tipo de teléfono móvil y servicio, las experiencias de uso del participante, y consideraciones sobre la protección de los participantes en la investigación.



The authors would like to acknowledge Terence Johnson for assistance in assembling the cost data.


Funded by National Institutes of Health R01 DA032057, R01 DA030781, R01 DA030747, R01 DA030793, R34 DA035728.

Compliance with Ethical Standards

Conflict of interest

Dr. Christopoulos has been a scientific advisory board member for Roche and a community advisory board member for Gilead. No other conflicts of interest reported.The opinions in this article are those of the authors and do not necessarily reflect official positions of the National Institute on Drug Abuse, the National Institutes of Health, or the Department of Health and Human Services.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Katerina A. Christopoulos
    • 1
  • William E. Cunningham
    • 2
  • Curt G. Beckwith
    • 3
  • Irene Kuo
    • 4
  • Carol E. Golin
    • 5
  • Kevin Knight
    • 6
  • Patrick M. Flynn
    • 6
  • Anne C. Spaulding
    • 7
  • Lara S. Coffin
    • 1
  • Bridget Kruszka
    • 8
  • Ann Kurth
    • 9
  • Jeremy D. Young
    • 10
  • Sharon Mannheimer
    • 11
  • Heidi M. Crane
    • 12
  • Shoshana Y. Kahana
    • 13
  1. 1.Division of HIV, ID and Global Medicine, Zuckerberg San Francisco General HospitalUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Departments of Medicine and Health Policy and ManagementUCLA Schools of Medicine and Public HealthLos AngelesUSA
  3. 3.Division of Infectious DiseasesWarren Alpert School of Medicine at Brown UniversityProvidenceUSA
  4. 4.Department of Epidemiology and Biostatistics, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonUSA
  5. 5.Department of Health BehaviorUNC Gillings School of Global Public HealthChapel HillUSA
  6. 6.Institute of Behavioral ResearchTexas Christian UniversityFort WorthUSA
  7. 7.Department of EpidemiologyRollins School of Public Health, Emory UniversityAtlantaUSA
  8. 8.Collaborative Health Studies Coordinating CenterUniversity of WashingtonSeattleUSA
  9. 9.School of NursingYale UniversityNew HavenUSA
  10. 10.Division of Infectious DiseaseUniversity of Illinois at ChicagoChicagoUSA
  11. 11.Departments of Medicine and EpidemiologyColumbia UniversityNew YorkUSA
  12. 12.Division of Allergy and Infectious DiseasesUniversity of WashingtonSeattleUSA
  13. 13.Services Research BranchNational Institute on Drug AbuseBethesdaUSA

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