Table 2. Characteristics of interventions and outcome measurements.
| Author (year) | Mobile technology | Nature of message delivered | Duration (months) | Delivery frequency | Outcome measured | Outcome |
|---|---|---|---|---|---|---|
| Randomized control trials | ||||||
| Lester et al. (2010b) | SMS check-ins |
Intervention: SMS check-ins Control: Usual care |
12 | Weekly | ART adherence measured by self-report HIV-1 Viral suppression, Total attrition |
Adherence outcome Adherence to ART was reported in 168 of 273 patients receiving the SMS intervention compared with 132 of 265 in the control group (relative risk[RR] for non-adherence 0.81, 95% CI 0.69–0.94). Viral load Suppressed viral loads were reported in 156 of 273 patients in the SMS group and 128 of 265 in the control group, (RR for virologic failure 0.84, 95% CI 0.71–0.99) |
| Kalichman et al. (2011) | Voice |
Intervention: Behavioral self-regulation counselling phone call. Control: Usual care. |
4 | 4-biweekly calls | ART adherence Self–efficacy Adherence measured by Pill count and response to a challenge situation |
Adherence outcome Adherence improved from 87% of pill taken at baseline to 94% adherence 4 months after baseline in the intervention group compared with Self-efficacy Behavioural self-management counselling condition demonstrated greater self-efficacy for medication adherence. |
| Pop-Eleches et al. (2011) | SMS |
Intervention: Short and long simple messages developed in conjunction with clinic staff. Participants specified their preferred languages. Control: Usual care |
12 | Daily or weekly interval | Adherence and treatment interruptions measured by MEMS |
Adherence outcome 53% of participants receiving weekly SMS reminders achieved adherence of at least 90% during the 48wks of study, compared with 40% of participants in the control group. Treatment Interruptions Participants in groups receiving weekly reminders were also significantly less likely to experience treatment interruptions exceeding 48h during the 48-wk. follow-up period than participants in the control group (81 vs 90%) |
| da Costa et al. (2012) | SMS | Intervention: The message ‘take good care of your Health’ was chosen by the multidisciplinary team involved in patient care and researchers. Control: Usual care |
12 | Weekends and alternate days during the week | Adherence >95% (1st to 4th month) measured by: Self-reported Pill counting MEMS |
Adherence outcomes Self-reported: 11 participants (84.62%) remained adherent in the control group vs.8 participants (100%) in the intervention group Pill counts: 5 participants (38.46%) for the control group and 4 (50.00%) in the intervention group remained compliant MEMS: 6 participants (46.15%)in the control group and 6 participants (75.00%) in the intervention group remained compliant |
| Shet et al. (2014) | Voice call |
Intervention: Customized motivational voice call reminders and a pictorial message. Patients chose the sex and language of the pre-recorded message Control: Usual care |
24 | Once a week and a weekly reminder after four days of call | Adherence measured by pill count |
Adherence outcome Comparison of suboptimal adherence was similar between both groups (unadjusted incidence rate ration 1.24, 95% CI 0.93 to 1.65, P = 0.14). Incidence proportion of patients with suboptimal adherence was 81/300 (27%) in the intervention arm and 65/299 (21.7% in the standard arm |
| Maduka and Tobin-West (2015) | SMS |
Intervention: Adherence counselling and short message reminders Control: Usual care |
4 | Twice a week | ART adherence measured by self-report CD4 count |
Adherence outcome At post-intervention, 76.9% of the intervention group and 55.8% of the control group achieved adherence (χ2 = 5.211, P = 0.022, RR = 0.75 (0.55–0.96). Median CD4+ cell count of the intervention group increased from 193 cells/ml to 575.0 cells/ml against 131.0cells/ml to 361.5 cells/ml in the control group (P = 0.007) |
| Belzer et al. (2015) | Voice call |
Intervention: Customized calls with a conversation that included medication review, problem-solving support and scheduling of relevant referrals. Control: usual care |
6 | Weekly | ART adherence measured by self-report Viral loads |
Adherence outcome Adherence higher in the intervention group compared to the control group (P = 0.007) Viral load Log 10 HIV VL was significantly lower at 24 weeks (2.82 vs 4.52, P = 0.002) and 48 weeks (3.23 vs 4.23, P = 0.043) |
| Sabin et al. (2015) | SMS |
Intervention: Adherence counselling and SMS phone reminder when Wisepill system fails to open 30minutes after scheduled dose time Control: usual care |
9 | 30 mins after wise pills fail to detect device opening | ART adherence Viral loads UDVL rates |
Adherence outcome Mean adherence of 96.2% vs 89.1% (p = 0.003) was recorded for the intervention and control respectively. Suboptimal adherers: Mean adherence of 93.3% vs 84.7% (p = 0.039) for the intervention and control groups respectively were recorded. Optimal adherers: Mean adherence of 97.8% vs 91.7% (p = 0.028) for the intervention and control groups respectively. |
| Huang et al. (2013) | Voice calls | Intervention: mobile phone conversations consisted of semi-structured dialogue eliciting the reasons and difficulties in making a hospital visit, symptoms and treatment, treatment adherence and difficulty in taking medications. Control: Usual care |
3 months | reminder calls made every two weeks | Adherence measured by self-report Viral load Quality of life measured by WHOQOL-HIV-BREF |
Adherence outcome Treatment-naïve: mean adherence of 99.7 (SD-1.6) and 96.5(SD-17.8) for the intervention and control groups respectively (p = 0.09). Treatment-experienced: mean adherence of 99.6 (SD-1.0) and 99.5 (SD-2.0) for the intervention and control groups respectively(p = 0.37). CD4 (cell count/mm3 ) Overall viral load significantly decreased, and CD4 count significantly increased from baseline to follow-up. Quality of life After 3 months, significant QOL improvements were observed in domains of physical health (p = 0.003), level of independence (p = 0.018), environment (p = 0.002), and spirituality/religion/personal beliefs (p = 0.021) among treatment-naïve patient |
| Mbuagaw et al. (2012) | SMS |
Intervention: motivational messages with reminder component and a phone number that patient could call back if they needed help. The content was varied and contemporary. There were 11 messages that were changed weekly Control: Usual care |
6 | Once every Wednesday at 9:00 am | Adherence to ART measured by Visual analogue scale (VAS) Quality of life (QOL) |
Adherence outcome No significant effect on adherence was found by: - VAS>95% (risk ratio [RR] 1.06, 95% [CI] 0.89, 1.29; - reported missed doses (RR 1.01, 95% CI 0.87, 1.16; -number of pharmacy refills (mean difference [MD] 0.1, 95% CI: 0.23, 0.43 |
| Haberer et al.(2016) | SMS reminder |
Intervention Scheduled SMS arm: Scheduled SMS + real-time adherence monitoring Triggered SMS arm: Triggered SMS + real-time adherence monitoring Control Real-time adherence monitoring only Study participants in this arm received no SMS reminders. |
9 | Scheduled: daily SMS for 1 month, weekly for 2 months Triggered: SMS received only if no signal is received in 2 hrs |
Adherence measured by Wise pill monitoring technology HIV RNA suppression |
Adherence outcome Compared to control, adherence was 11.1% higher (P = 0.04), and more than 48-h lapses were less frequent (IRR 0.6, P = 0.02) in the scheduled SMS arm. Adherence and more than 48-lapses were similar in the triggered SMS arm and control HIV RNA suppression No difference in HIV RNA was seen |
| Quasi–experimental time series/ prospective studies | ||||||
| Rodrigues et al. (2012) | Interactive voice response (IVR) Non- interactive neutral picture SMS |
Two reminders (interactive calls and non-interactive neutral short SMS) | 6 | Weekly | ART adherence measured by pill count |
Adherence outcome The proportion of participants with optimal adherence increased from 85% to 91% during the intervention period, an effect that was maintained 6 months after the intervention was discontinued |
| Dowshen et al. (2012) | SMS | Personalized SMS reminders | 6 | Daily | Adherence measured by Visual analogue scale CD4 cell count Viral load monitoring |
Adherence outcomes Participants increased from a baseline value of 74.7 on the VAS to 93.1 at the 24-week follow-ups. Viral load suppression No significant difference in CD4 cell count or viral load between baseline and 12- or 24-week follow-up |
SMS, short message service; ART, antiretroviral therapy
MEMS, Medication event monitoring system
UDVL, Undetected viral load levels
WHOQOL-HIV BREF, World Health Organization Quality of Life in HIV-infected Person instrument
VAS, Visual analogue scale