Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria

Abstract

Context: Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is one of the world’s most challenging pandemics. For treatment with Highly Active Anti‑Retroviral Therapy (HAART) to be effective, high rate of adherence is essential.
Aim: To demonstrate the effect of adherence counseling and text message reminders in improving patients’ adherence to HAART.
Settings and Design: A randomized control trial among non‑adherents was carried out in a tertiary hospital in Nigeria between March and July, 2011.
Materials and Methods: A total of 104 patients: 45 males (43.3%) and 59 females (56.7%) participated in the study. They were randomized into intervention and control groups. The intervention group received monthly adherence counseling and twice weekly short message reminders for four months, while the control group received only standard care. Self‑reported adherence and CD4+ cell counts were measured pre‑ and post‑intervention.
Statistical Analysis Used: Data was analysed using Statistical Package for Social Sciences (SPSS) version 18. Risk rates, Chi‑square, Mann‑Whitney U test and Cohen’s effect size were calculated. Level of significance was set at P = 0.05.
Results: At post‑intervention, 76.9% of the intervention group and 55.8% of the control group achieved adherence (χ2 = 5.211, P = 0.022, RR = 0.75 (0.55-0.96), Cohen’s w = 0.224). Also, median CD4+ cell count of the intervention group increased from 193 cells/ml to 575.0 cells/ml against 131.0 cells/ml to 361.5 cells/ml in the control group (P = 0.007).
Conclusion: Adherence counseling and text message reminders improved adherence among HIV patients. Its adoption for HIV patient management is advocated.

Key words: Adherence, antiretroviral treatment, counseling, human immunodeficiency virus/acquired immunodeficiency syndrome, people living with human immunodeficiency virus, text message reminders