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Persuasive Texting in Mozambique

Inspired by trials that used text messages to change behaviors, a U.K. charity tested whether it could persuade HIV-positive people to attend their appointments.

Problem
About 1.6 million people in the southeast African country of Mozambique live with HIV. Antiretroviral therapy can prevent its spread, but only 74 percent of patients who start HIV treatment are still taking the medicines a year later.

Solution
In November 2011, the U.K.-based children’s organization ARK began a two-year test of sending text messages to HIV-positive people in urban and rural areas of Mozambique’s Maputo Province to remind them about treatments and appointments. About 15.5 million mobile phones are already connected in the country of 25.8 million people, and use of the technology is growing.

Study
ARK’s study followed 830 men and women undergoing antiretroviral therapy for an average of 16 months, and 522 HIV-positive expectant mothers until eight weeks after giving birth. Patients were randomly assigned to receive the text reminders or to continue regular treatment with no reminders.

Method
Using a database of electronic patient records, a computer program sent out automated text reminders at times including a week before an appointment, two days before the appointment, and two days after any missed appointments. HIV-positive pregnant women also received educational messages about testing and treatments.

Results
The SMS messages helped some patients improve their treatment regimen, but not all. The messages significantly helped urban and recently diagnosed HIV patients stick with treatment. Such patients who didn’t receive text messages were nearly twice as likely to fall off the program, failing to consistently pick up drugs or attend appointments. Results at the rural centers were disappointing, possibly because of transportation issues, limited cellular coverage, migration to other provinces, and a limited sample size.

The texts did help persuade mothers to test their newborns for HIV, but overall the program didn’t make them more likely to complete pre-birth treatment or to give birth in a health center.

Next
Now that texting has been shown to help some patients, several groups are launching a much bigger messaging program in another Mozambican province. This program could reach 58,000 patients by the time it concludes in 2016. Researchers will examine how cost-effective the trial is, how to improve technology in rural areas, and how best to support patients who are most at risk of not completing treatment.

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