A Randomized Controlled Trial of Personalized Text Message Reminders to Promote Medication Adherence Among HIV-Positive Adolescents and Young Adults
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HIV-positive adolescents and young adults often experience suboptimal medication adherence, yet few interventions to improve adherence in this group have shown evidence of efficacy. We conducted a randomized trial of a two-way, personalized daily text messaging intervention to improve adherence to antiretroviral therapy (ART) among N = 105 poorly adherent HIV-positive adolescents and young adults, ages 16–29. Adherence to ART was assessed via self-reported visual analogue scale (VAS; 0–100 %) at 3 and 6-months for mean adherence level and proportion ≥90 % adherent. The average effect estimate over the 6-month intervention period was significant for ≥90 % adherence (OR = 2.12, 95 % CI 1.01–4.45, p < .05) and maintained at 12-months (6 months post-intervention). Satisfaction scores for the intervention were very high. These results suggest both feasibility and initial efficacy of this approach. Given study limitations, additional testing of this intervention as part of a larger clinical trial with objective and/or clinical outcome measures of adherence is warranted.
KeywordsHIV infection Medication adherence Youth Text messaging
We thank the participants of the “TXTXT” study for their time and effort. Special thanks to Camdin Gray and Jennifer Leininger for their contributions to sample recruitment and retention. Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R34DA031053. Additional support was received from the Stanley Manne Children’s Research Institute at Ann & Robert H. Lurie Children’s Hospital of Chicago (Lurie Children’s). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Approval to conduct this study was received from the Institutional Review Board (IRB) at Lurie Children’s under protocol #2011-14398. Drs. Garofalo and Kuhns jointly developed the study rationale, aims, and design. Dr. Garofalo supervised the implementation of the study and drafted and revised the final manuscript. Dr. Kuhns drafted the methods section, assisted with interpretation of findings, and critically reviewed the manuscript. Dr. Hotton conducted all data analyses, created all tables, drafted the statistical methods and results sections, and critically reviewed the manuscript. Ms. Johnson and Ms. Muldoon oversaw data entry and data quality and critically reviewed the manuscript; additionally Ms. Muldoon drafted Fig. 1. Mr. Rice assisted with the background literature review and critically reviewed the final manuscript. All authors approved the final manuscript as submitted.
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- 1.Centers for Disease Control and Prevention. HIV surveillance report, 2013. Atlanta: GA; 2013.Google Scholar
- 2.Centers for Disease Control and Prevention. HIV surveillance report, 2011. Atlanta: GA; 2013.Google Scholar
- 25.Pew Research Center. Mobile technology fact sheet. Washington, DC: Pew Internet and American Life Project; 2014.Google Scholar
- 26.Pew Research Center. Teens and technology. Washington, DC: Pew Research Center; 2013.Google Scholar
- 34.BioCreations. HIV drug resistance and the importance of adherence. Johns Hopkins School of Medicine Division of Infectious Diseases; 2008.Google Scholar
- 40.Derogatis L. Brief symptom inventory: administration, scoring, and procedures manual. Minneapolis, MN: National Computer Systems, Inc.; 1993.Google Scholar
- 41.Humeniuk R. Validation of the alcohol, smoking and substance involvement screening test (ASSIST) and pilot brief intervention: a technical report of phase II findings of the WHO ASSIST project. Geneva: World Health Organization; 2006.Google Scholar
- 47.Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials. J Acquir Immune Defic Syndr. 2006;43(Suppl 1):S23–35.CrossRefPubMedPubMedCentralGoogle Scholar
- 48.Bain-Brickley D, Butler LM, Kennedy GE, Rutherford GW. Interventions to improve adherence to antiretroviral therapy in children with HIV infection. Cochrane Database of System Rev. 2011;12:CD009513.Google Scholar