The third 90—ensuring adherence to ART needs approaches tailored to the clinical and social context of individuals

Editor’s notes: The third 90, ensuring that people who are on antiretroviral therapy are supported to adhere well enough to suppress their viral load, is key to preventing drug resistance and to ensuring efficiency of resources as treatment is scaled up to all people living with HIV.  Previous studies have demonstrated how useful SMS reminders can be for many people taking ARV medicines, and this evidence is now incorporated into WHO guidance on ART.  However, a randomized trial by Linnemayr and colleagues among adolescents and young adults in Kampala, Uganda found no benefit after one year of either a weekly reminder or a weekly reminder with the option to respond.  There are no magic bullets to ensure adherence.  SMS reminders may well suit some individuals, whereas others will need different approaches.  The differentiated care approach to ART emphasizes the need to develop the best treatment and support service for each individual, according to their specific social context and clinical situation.

Text messaging for improving antiretroviral therapy adherence: no effects after 1 year in a randomized controlled trial among adolescents and young adults.

Linnemayr S, Huang H, Luoto J, Kambugu A, Thirumurthy H, Haberer JE, Wagner G, Mukasa B. Am J Public Health. 2017 Dec;107(12):1944-1950. doi:10.2105/AJPH.2017.304089. Epub 2017 Oct 19.

Objectives: To assess the effectiveness of Short Message Service (SMS) reminder messages on antiretroviral and cotrimoxazole prophylaxis adherence among HIV-positive youths as well as the relative effectiveness of SMS with and without a response option.

Methods: Eligible HIV-positive patients aged 15 to 22 years at 2 HIV clinics in Kampala, Uganda, participated in a year-long parallel individual-randomized controlled trial and were assigned in a 1-to-1-to-1 ratio to a weekly SMS message group, weekly SMS message with response option group, or a usual-care control group.

Results: We enrolled 332 participants. Electronically measured mean adherence was 67% in the control group, 64% in the 1-way SMS group (95% confidence interval [CI] = 0.77, 1.14), and 61% in the 2-way SMS group (95% CI = 0.75, 1.12) in an intent-to-treat analysis. Results for secondary outcomes and complete-case analysis were similarly statistically insignificant across groups.

Conclusions: Despite previous evidence that interventions using SMS reminders can promote antiretroviral therapy adherence, this study shows that they are not always effective in achieving behavior change. More research is needed to find out for whom, and under what conditions, they can be beneficial.

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HIV Treatment
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