A randomised trial of “Fresh Start” text messaging to improve return to care in people living with HIV who missed appointments in South Africa

By Christine Njuguna  Dr. Lawrence Long  Preethi Mistri  Dr. Candice Chetty-Makkan  Dr. Alana Brennan  Dr. Alison Buttenheim  Laura Schmucker  Dr Sophie Pascoe  Dr. Harsha Thirumurthy  |  | 


Objective: Treatment interruptions are a barrier to successful antiretroviral therapy (ART). “Fresh start messages”, which leverage significant days on the calendar (e.g., new year, public holiday) in order to prompt action, have the potential to encourage people living with HIV to return to care. We evaluated a “fresh start” intervention (text messages) to increase return to care in PLHIV who had missed their last appointment.

Design: A three arm 1:1:1 individual randomised controlled trial.

Methods: We randomized adults in Capricorn District who had missed ART appointments by more than 28 days to: a) no text message; b) unframed messages (fresh start not mentioned); or c) framed messages (fresh start mentioned). Randomisation was stratified by treatment interruption duration and across two holidays (Youth Day, Mandela Day). The primary outcome was an ART-related clinic visit at ≤45 days of the first message.

Results: 9143 participants were randomised. For Youth Day, 1474 and 1468 were sent unframed and framed messages respectively, with 13.4% sent these messages having an ART visit vs 11.9% not sent a message (aOR 1.2; 95% CI:1.0-1.4, p-value = 0.075). For Mandela Day, 1336 and 1334 were sent unframed and framed messages respectively, with 6.7% sent these messages having an ART-related clinic visit vs 5.4% not sent a message (aOR 1.2; 95% CI: 1.0-1.6; p-value = 0.100).

Conclusions: Low-cost text messages sent around a “fresh start” date may increase the likelihood that patients who miss appointments return to care. This study suggests the potential of text messaging for motivating return to care.

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