A Single-Blind, Parallel Design RCT to Assess the Effectiveness of SMS Reminders in Improving ART Adherence Among Adolescents Living with HIV (STARTA Trial)

Purpose: The study evaluated the feasibility, acceptability, and efficacy of interactive and tailored short message reminders on antiretroviral therapy adherence among adolescents (15-19 years) living with HIV in southwest Nigeria. Methods: The study was a single-blind, parallel-design (ratio 1:1), and multicenter RCT of 209 medication-non-adherent adolescents living with HIV at HIV clinics in two states in southwest Nigeria. The research assessed ART adherence using the visual analog scale, viral suppression, pill count, and ACTG scores; the feasibility of the intervention by the SMS delivery and response (overall and individual) rates; and acceptability using self-report, willingness to continue receiving the intervention, and desire for its scale-up. Results: A total of 17,690 text messages were sent while 10,119 (57.2%) got delivered to the participants. Out of 9,216 responses that were received from the study participants, 8,781 (95.3%) indicated acceptability of the intervention. The end-of-study log(10) of viral load values between control and intervention groups had a mean difference of 0.66 (95% CI 0.26-1.06) and p-value of .001. Also, the unadjusted odds ratio of undetected viral load (<= 20 copies/ml) was 1.356 (1.039-1.771) with a p-value of .002. However, the intervention had no effect on subjective measures of antiretroviral therapy adherence. Conclusions: The use of interactive and tailored short message reminders to enhance antiretroviral therapy adherence among adolescents has good potential. It seems feasible, highly acceptable, and possibly leads to improved viral load count. It is likely that the associated antiretroviral therapy adherence enhances viral suppression and, therefore, improves outcomes in adolescent HIV. (C) 2020 Society for Adolescent Health and Medicine. All rights reserved.