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More than just Reminders: Using text Messaging to Improve HIV care Outcomes Among Youth and Young Adults Living with HIV


This study evaluated engagement, satisfaction, and efficacy of an automated and live two-way text messaging intervention that linked youth and young adults at high risk for poor HIV outcomes to their medical case managers, with the aims of increasing viral load suppression rates and improving medical visit attendance. Participants (N = 100) were an average age of 22–23 years old. Most were Black (93%) and men who have sex with men (82%). A total of 89,681 automated text messages were sent to participants; and 62% of participants engaged in monthly text-message exchanges with medical case managers. McNemar’s test results indicated that a significantly greater proportion of intervention participants were virally suppressed at 6 and 12 month follow-up than at enrollment. Adjusted odds ratio results showed a significant association between likelihood of achieving viral suppression at 6 and 12 months, and a greater number of participant responses to automated text messages. Future research should prospectively compare outcomes between usual care case management and usual care plus text-messaging to test for significant differences between groups.


La presente investigación evaluó el compromiso, la satisfacción y la eficacia de una intervención de mensajes de texto bidireccional automatizada y en vivo que vinculó a jóvenes y adultos jóvenes con altos riesgos de resultados deficientes del VIH con sus administradores de casos médicos, con el objetivo de aumentar las tasas de supresión de la carga viral y mejorar la asistencia a las visitas médicas. Los participantes (n = 100) tenían una edad promedio de 22 a 23 años. La mayoría eran negros (93,0%) y hombres que tienen sexo con hombres (82,0%). Un total de 89.681 mensajes de texto automatizados fueron enviados a los participantes; y 62,0% de los participantes participaron en intercambios de mensajes de texto mensuales con los administradores de casos médicos. Los resultados de la prueba de McNemar indicaron que una proporción significativamente mayor de participantes de la intervención fueron suprimidos viralmente a los 6 y 12 meses de seguimiento que al momento de la inscripción. Los resultados del índice de probabilidad ajustado mostraron una asociación significativa entre la probabilidad de lograr la supresión viral a los 6 y 12 meses, así como un mayor número de respuestas de los participantes a los mensajes de texto automatizados. Las investigaciones futuras deben comparar prospectivamente los resultados entre la gestión de casos de atención habitual y la atención habitual más mensajes de texto para evaluar las diferencias significativas entre los grupos.

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This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant H79HA28897-Use of Social Media to Improve Engagement, Retention, and Health Outcomes along the HIV Care Continuum ($300,000; 3% financed non-governmental). This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, not should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

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Authors and Affiliations



Donald Gerke led the evaluation of the intervention and the writing of the manuscript. Jeff Glotfelty and Stacey Slovacek coordinated the intervention and assisted with writing the manuscript. Maria Freshman and Julia Schlueter managed evaluation data and edited the manuscript. Katie Plax was the PI on the study and assisted with writing of the manuscript.

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Correspondence to Donald R. Gerke.

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Ethics Approval

This study was approved by the Human Research Protections Office at Washington University in St. Louis.

Consent to Participate

All participants provided informed consent to participate in this study. Since the intervention was delivered via text message, special care was taken during the consent procedure to ensure participants had access to a private mobile phone before they were enrolled in the study.

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Gerke, D.R., Glotfelty, J., Slovacek, S. et al. More than just Reminders: Using text Messaging to Improve HIV care Outcomes Among Youth and Young Adults Living with HIV. AIDS Behav 27, 2988–2996 (2023).

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