META-ANALYSIS: THE EFFECT OF TEXT MESSAGE REMINDERS ON RETENTION TO CARE for HIV/STI
Rationale/Conceptual Basis/Background: Use of mobile technologies is an innovative and affordable approach to HIV prevention and care, particularly in resource limited settings. Approximately two thirds of people who are initially diagnosed with HIV are lost to follow-up before starting HIV treatment in low and middle-income countries, posing serious global health concerns. While text message reminders for HIV medication adherence have shown positive health outcomes, it is not well understood whether the reminders can also improve patients’ retention to care.
Methods: The author, assisted by two librarians, conducted a meta-analysis of literature in the following databases: PubMed, CINAHL, Proquest, Web of Science and Embase. Search terms were ‘HIV AND mobile phone, cellular phone, text message OR SMS (short message service)’. Of the 469 peer-reviewed research articles reviewed, eight studies met the inclusion criteria and were included in the final analysis. Inclusion criteria for the final reviewed papers were 1) clinical research employing SMS reminders to improve retention to care and 2) Inclusion of HIV patients or individuals at high risk of acquisition of HIV. The author extracted data and scored the quality of the studies based on Agency for Healthcare Research and Quality (AHRQ) scores. SPSS version 20 was used to generate forest plots and calculated pooled effect sizes and confidence intervals.
Results: Eight studies (3 randomized controlled and 5 before and after controlled studies) from 6 countries included 6,853 participants. The most commonly represented participant profile in the sample was a 34 year-old man having sex with men (MSM). HIV and sexually transmitted infection (STI) clinics sent automated text message reminders to clients prior to follow-up appointments for routine STI screenings. People who received text message reminders were 18% more likely to return to the care compared to people who did not receive the messages (pooled RR=1.18, 95% CI: 1.05-1.33). However, sub-group analysis of people who had HIV revealed that the intervention had no effect on their return to care (pooled RR=1.01, 95% CI: 0.89-1.17).
Implications: This meta-analysis of text message reminders among HIV/STI clinic users found that there is a moderate effect of the reminders on retention to care, but the effect is attenuated when solely examining the population with HIV. Despites several limitations, this review found that SMS reminders are feasible and effective in most settings, including limited resource setting in Africa, and text message reminders may improve retention to care, although this was not consistent for patients with HIV alone. Future studies that use SMS reminders should allow for bidirectional conversations, and be tailored for individual needs to bridge to other resources, with the ultimate goal of improving retention to HIV care.