Effect of Behaviourally Informed Text Messages to Promote Retention in HIV Care: A Randomized Trial in Ekurhuleni District, South Africa

  1. Caroline Govathson
  2. Sophie Pascoe
  3. Candice Chetty-Makkan
  4. Laura Schmucker
  5. Preethi Mistri
  6. Harsha Thirumurthy
  7. Tonderai Mabuto

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Abstract

Introduction

Sustained engagement in care among people living with HIV is vital for realising the individual and public health benefits of antiretroviral therapy (ART). We examined whether mobile phone-based text messages that leveraged behavioural science principles promoted timely clinic attendance among ART recipients.

Methods

We conducted a randomized controlled trial in three primary health clinics in Gauteng Province, South Africa between July 2021 and December 2021. ART recipients with an upcoming clinic appointment were randomised to standard of care appointment reminders or three enhanced reminders that leveraged behavioural science principles of loss aversion, social norms, and altruism. The primary outcome was a timely clinic visit, on or before the scheduled appointment day. Poisson regression with clinic fixed effects and controls for age, sex, and ART duration was used to examine the effect of the enhanced reminders on the primary outcome.

Results

Among 1539 participants, 690 (44.8%) were male and median time on ART was 11 months (IQR, 3.7-51.9). The primary outcome of timely clinic visit was 50.3% in the standard of care arm, and similar in the loss aversion arm (53.5%; adjusted risk ratio, ARR 1.1; 95% CI: 0.9-1.2), social norms arm (48.0%; ARR 1.1; 95% CI: 0.8-1.1), and altruism arm (50.9% ARR 1.0; 95% CI: 0.9-1.5). In subgroup analyses, messages framed with loss aversion increased the timely clinic visits among participants with ART duration <90 days (ARR=1.37; 95% CI: 1.08-1.74).

Conclusions

The use of behavioural science principles to frame reminder messages did not increase timely clinic visits among HIV care recipients. Among those who recently initiated ART, however, loss aversion framing increased timely clinic visits. Future research should explore alternative behavioural science principles to revise health communication with HIV care recipients.

Clinical Trials Number

NCT05010291

Article activity feed

  1. PREreview

    This Zenodo record is a permanently preserved version of a Structured PREreview. You can view the complete PREreview at https://prereview.org/reviews/10269706.

    Does the introduction explain the objective of the research presented in the preprint? Yes The introduction states "We examined whether mobile phone-based text messages that leveraged behavioural science principles promoted timely clinic attendance among ART recipients" which clearly explains what the objective is.
    Are the methods well-suited for this research? Somewhat appropriate They did not have a control who received no text messages to compare to for the randomized control trials.
    Are the conclusions supported by the data? Somewhat supported It was concluded that the reminder messages did not increase timely clinic visits but among those who recently started ART, loss aversion framing increased timely visits. I feel that this is somewhat supported as they don't have a control that received no text messages which makes it hard to really know if these results make an actual difference.
    Are the data presentations, including visualizations, well-suited to represent the data? Somewhat appropriate and clear The table at the end of the preprint nicely summarizes the results. However, the data analysis section could've been more detailed
    How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research? Very clearly They provided detailed explanations for their results.
    Is the preprint likely to advance academic knowledge? Moderately likely This preprint is a start as it does show how applying behavioral science principles can influence the way healthcare is delivered. However, the limitations make the results a bit weak which makes it not as reliable.
    Would it benefit from language editing? No
    Would you recommend this preprint to others? Yes, but it needs to be improved
    Is it ready for attention from an editor, publisher or broader audience? Yes, after minor changes

    Competing interests

    The author declares that they have no competing interests.

  2. Version published to 10.1101/2023.10.29.23297725v2 on medRxiv
  3. Version published to 10.1101/2023.10.29.23297725v1 on medRxiv