Evaluating the use of SMS to support people living with HIV
- How can technology (such as mobile phones) be used to facilitate health service delivery and improve patient health?
- How can it be used to ensure retention in healthcare, such as for continuous treatment of antiretroviral therapy (ART)?
In this project funded by the International Initiative for Impact Evaluation (3ie), researchers evaluated whether an SMS reminder system can be harnessed to support HIV/AIDS patients in Burkina Faso who are receiving ART therapy to promote healthy behaviours.
The study involved more than 3800 randomly selected people living with HIV across Burkina Faso. It identified whether patients who receive the SMS text messages are:
a) more likely to remain in care
b) more likely to stick to their antiretroviral regimens
c) experience health benefits associated with the treatment
The project also examined the impact of different types of SMS messaging. For example in terms of language and framing (health risks versus health gains) and form (text versus picture), as well as frequency (once a week versus twice a week). It also looked at whether message fatigue could be observed in the medium to long-term.
The SMS reminders were intended is to serve as an immediate and consistent means of patient follow-up. The SMS texts encouraged patients to take their pills, reminded them of the importance of ART for their health and reminded them for prescription refills. In regions where contact with health personnel is limited and distances to health centres may be considerable, this type of follow-up has high impact potential.
Why is this research relevant?
The HIV epidemic remains a major challenge for many African countries. Tremendous effort has been invested into scaling-up access to ART. However, in the years before the project started it was observed that many patients who begin ART do not continue beyond the first two years, while ART is a lifelong treatment and discontinuation or breaks will likely lead to rapid health deterioration.
In Sub-Saharan Africa, drop-out rates from ART programmes are particularly high. One systematic review found that 40% of patients discontinue after two years of treatment of which 21% in the first six months (Rosen and Fox, 2007). Drop-out and poor adherence pose serious challenges to antiretroviral scale-up, and this study can provide an entry point in exploring factors underlying these patient behaviors.
In addition, given the rapid uptake of mobile phones across the world, their potential to promote healthy behaviours and facilitate health service delivery looms large. This study aimed to contribute to the evidence on the impact of 'mobile health' (mHealth) interventions to support HIV care delivery in resource-poor settings.
This research is in line with Sustainable Development Goal 3 on healthy lives and well-being for all. In particular it is relevant for SDG 3 target 3 on ending the AIDS epidemic.
For this project, ISS collaborated with colleagues from Université Polytechnique de Bobo-Diioulasso.
Findings of the evaluation are discussed in a number of journal articles:
- "When I receive the message, it is a sign of love”: symbolic connotations of SMS messages for people living with HIV in Burkina Faso
- Adaptation and biomedical transition of people living with HIV to antiretroviral treatment in Burkina Faso
- Data and supplementary material: Adaptation and Biomedical Transition of People Living with HIV to Antiretroviral Treatment in Burkina Faso
- A Systematic Review of Mobile Phone Interventions (SMS/IVR/Calls) to Improve Adherence and Retention to Antiretroviral Treatments in Low- and Middle-Income Countries
- Protocol for a randomized controlled trial evaluating mobile text messaging to promote retention and adherence to antiretroviral therapy for people living with HIV in Burkina Faso
Views expressed in the study are not necessarily those of 3ie or its members, or of GDN.