Mobile text messaging intervention to improve antiretroviral treatment adherence among adolescents living with HIV in Ethiopia

Abstract: Adherence to antiretroviral therapy is a global problem among adolescents living with human immunodeficiency viruses (HIV), and it is associated with treatment failure and the development of viral resistance. One of the most significant barriers to treatment adherence among adolescents is forgetting to take drugs as prescribed. One of the key strategies recommended to improve this problem is the use of mobile phone text message. However, it is not yet shown how effective these interventions are and how new technologies will be integrated into the routine care system. Therefore, the aim of this thesis was to develop, test the feasibility, and evaluate the effectiveness of mobile phone text messaging interventions in improving adherence to, and retention in, care among adolescents living with HIV in Southern Ethiopia. This thesis includes a systematic review and meta-analysis (Paper I), one qualitative study (Paper II), one convergent mixed-method study (Paper III), and a randomized controlled trial (Paper IV). In Paper I, there was inconclusive evidence that mobile text message reminders improved antiretroviral therapy (ART) adherence in adolescents. In Paper II, treatment adherence and retention in HIV care experiences, and the needs of adolescents living with HIV, were explored among 18 adolescents living with HIV in Southern Ethiopia. Among the identified barriers to adherence were forgetting medication or medication time, a lack of privacy, perceived stigma, and lack of support. In Paper III, a process evaluation was conducted among 153 adolescents assigned to the intervention arm, and the result showed that 99.4% of the 30,700 reminder messages sent were successfully delivered. The problems of the 0.6% failed messages were identified. A five-dimensions evaluation approach was used. In Paper IV, 306 adolescents randomly assigned to intervention and control arms were followed for six months. The result revealed that the average effect of proportion of adherence increased in the intervention arm, while viral load decreased. Therefore, the findings of this thesis provide promising evidence that automated mobile text message reminders improve adherence among patients living with HIV in resource-constrained settings.