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Text Messaging Improves Medication Use by HIV-Positive Youth

A randomized clinical trial published in AIDS and Behavior showed that personalized two-way daily text messaging improved adherence to antiretroviral therapy in HIV-positive youth ages 16­–29. The HIV/AIDS Prevention Research Synthesis (PRS) project at the U.S. Centers for Disease Control and Prevention (CDC) has identified this intervention as meeting criteria for good evidence of efficacy.

The intervention consisted of an initial text message reminder timed to coincide with the individual's dosing schedule, followed by a second message 15 minutes later asking whether participants had taken their medication. These messages were personalized by the participants themselves to ensure that they are meaningful and address the need for privacy and confidentiality. Examples include: "Mission accomplished?" or "Will you choose life?" Depending on the text response from participants, a motivational or encouraging follow-up message was sent, with statements such as "Well done," or "You can do it!" The daily text reminders were delivered by Remedy Health Media, which provided a user-friendly platform and interface for programming messages.

"Forgetting to take medication is a huge barrier to optimal treatment for youth living with HIV," says Robert Garofalo, MD, MPH, lead author on the study, division head of adolescent medicine at Ann & Robert H. Lurie Children's Hospital of Chicago, director of the Center for Gender, Sexuality and HIV Prevention for Stanley Manne Children's Research Institute at Lurie Children's, and a professor of pediatrics at Northwestern University Feinberg School of Medicine. "Text message reminders help them feel more in control over their ability to take medications as prescribed, which is critical to their skills building, motivation, and ultimately health."

High levels of adherence (more than 90%) are often needed to achieve and maintain viral suppression and avoid antiretroviral resistance. While achieving high rates of adherence is challenging due to complex dosing schedules and side effects, simply forgetting is the most commonly cited reason for missed doses.

The study found a significantly greater proportion of intervention participants with medication adherence at or more than 90% than the comparison group when evaluated at three months and six months after the start of the trial. The standard of care comparison group received a 20-minute animated tutorial on the importance of medication adherence in HIV disease management. Prior to the start of the study, all 105 participants had poor medication adherence.

"The text messaging intervention is a practical and inexpensive tool that can be implemented in primary care and HIV clinics across the country," Garofalo says. "It is well suited for supporting the treatment of conditions managed over extended periods of time."

The study was funded by the National Institute on Drug Abuse (grant number R34DA031053).

Complete information about the PRS efficacy review process, methods, and criteria can be found on the CDC Compendium of Evidence-based HIV Behavioral Interventions website: http://www.cdc.gov/hiv/dhap/prb/prs/index.html.
Research at Ann & Robert H. Lurie Children's Hospital of Chicago is conducted through the Stanley Manne Children's Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine, and ensuring healthier futures through the relentless pursuit of knowledge.

Lurie Children's is ranked as one of the nation's top children's hospitals in the U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 173,000 children from 50 states and 48 countries.

Source: Ann & Robert H. Lurie Children's Hospital of Chicago