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Table 1 Details of included studies

From: A systematic review and meta-analysis in the effectiveness of mobile phone interventions used to improve adherence to antiretroviral therapy in HIV infection

Trial Delivery mechanism Trial design, Country, Device, Media, Intervention length Participants Aims Intervention Behavioural Change Theory, interactivity, link to support Abraham and Michie Taxonomy Comparator
TEXT MESSAGE
Da Costa 2012 [31] Text message 5 times a week RCT, Brazil, mobile phone, SMS, 4 month 21 HIV infected adults. 100% female To assess whether a warning system based on mobile SMS increases the adherence (95%) of HIV-infected Brazilian women to ART regimens and their impression and satisfaction with respect to incoming messages. Participants received SMS messages 30 min before their last scheduled time for a dose of medicine during the day. Sent Saturday, Sunday, and alternate days during the working week   Social support 3.1, prompts 7.1 Monthly multidisciplinary attendance, no text messages
Pop-Eleches 2011 [32] Weekly, daily, short and long text message Parallel group RCT 5 arms, Kenya, mobile phone, SMS, 48 weeks 431 HIV infected adults, initiated ART less than 3 months ago. 66% female. To test the efficacy of SMS reminders on adherence (90%) to ART among patients attending a rural clinic in Kenya. Participants received SMS reminder that were either short or long and sent at a daily or weekly frequency.   Social support 3.1, prompts 7.1 No SMS messages
Mbuagbaw 2012 [33] Weekly text message Parallel RCT, Cameroon, mobile phone, text message, 6 months 200 HIV positive adults, 21 years and above, been on ART for 1 month. 73.5% female. To test the effectiveness of sending weekly motivational text messages via mobile phone to improve adherence. Weekly standardised motivational text message Health belief model of behaviour change.
Link to support - SMS contained a phone number they could call back if they needed help
Social support 3.1, prompts 7.1 Standard care and no text message
Hardy 2011 [30] Daily text message Parallel RCT, America (Boston), mobile phone, message, 6 weeks 23 HIV infected adults, on ART for at least 3 months but less than 85% adherence. 39% female. To compare the efficacy of a personalized cell phone reminder system (A remind) in enhancing adherence to ART versus a beeper. Personalised text messages daily to match ART dosing frequency, beep every 15 min till patient acknowledges message. Interactivity - participant instructed to respond with an SMS in order to confirm they were taking medication. It would bleep every 15 min prompts 7.1 Beeper, reminder beeper at the time of dosing, beeps once for 30 s then no repeats.
Sabin 2015 [34] SMS text reminder RCT, China, 9 month 119 participants. Age 18+, deemed at risk of poor adherence, 36.1% female Hypothesized that adherence information and education likely to be effective when delivered in real time and in direct response to lapses when they occur. To assess the effect of real-time feedback using triggered cell phone reminders coupled with Wisepill generated data enhanced counselling. Adherence counselling and SMS phone reminder when the Wisepill system failed to detect 30 mins post scheduled dose time.
Monthly clinic if adherence < 95% - received behaviourally targeted counselling session with a counsellor guided by performance report
  Feedback on behaviour 2.2 Prompt 7.1
Social support 3.1
Monthly clinic if adherence < 95% - received behaviourally targeted counselling session with a counsellor guided by performance report
Ingersoll 2015 [35] Automated SMS text message RCT, USA (Virginia), 12 weeks 63 participants. Age 18+, 39.7% female. Less than 95% adherence used illicit drugs and drank risky amounts of alcohol Test the preliminary efficacy of a theory based bi-directional text message intervention on ART adherence, missed care visits and substance use among people with HIV Daily queries of ART adherence, mood and substance use. The system sent contingent intervention messages by participants for reports of medication dosing, mood and substance use Interactivity – bidirectional texting
Behaviour change Theory – Information, motivation and behaviour skills model of adherence and social action theory. Individual change model
Social support 3.1,
Monitoring of emotional consequences 5.4, Prompt 7.1
HIV primary care, speciality service, medical case management, pharmacist adherence support, psychological care and substance abuse counselling
Haberer 2016 [36] SMS message RCT, Uganda, 9 months 62 people with HIV, 65% female and their social supporters. RCT of multiple types of interventions based on SMS and real time adherence monitoring to improve adherence among individuals initiating ART in Uganda 1) Scheduled SMS – SMS daily for 1 month, then weekly for 2 months, then for the next 6 months only if no signal within 2 h, and SMS to social supporter if no signal 48 h + real time adherence monitoring
2) Triggered SMS only if no signal within 2 h of dosing, last 6 months SMS sent to social supporter + real time adherence
3) real time adherence only
  Feedback on behaviour 2.2,
Social support 3.1, Prompt 7.1
Social supporter had a text message
Real time adherence no SMS reminders
Nsagha 2016 [28] SMS message RCT, Cameroon, 1 month 90 people living with HIV and AIDS who had been on ARV for 1 month. 61% female, aged 18 and above 95% adherence To assess the usefulness of cell phone text messages to improve the adherence (95%) of HIV and AIDS patients to their treatment and care in the NW region of Cameroon Educative SMS messages, four times a week for 4 weeks   Prompt 7.1 Usual care – no details
Orrell 2015 [37] Text message RCT South Africa, 48 weeks 230 ART naïve. 65.2% female. Adherence more than 80% Determine if text message triggered by missed doses would improve overall daily adherence execution in ART naïve South African adults Participants preferred daily dosing time recorded in the EMS and if device not opened within 30 min of scheduled dosing time – text message sent.   Feedback on behaviour 2.2 Prompt 7.1 3 group treatment preparedness sessions before or within the first month of commencing ART. Delivered by HIV positive peer counsellors.
VOICE CALL
Belzer 2014 [38] Daily phone call Longitudinal RCT, America, mobile phone, voice calls, 48 weeks 37 youth (age 15-24) with HIV, history of non-adherence. 37% were females. Half the youth were perinatally infected. To determine if daily cell-phone conversation with health-care providers around self-care and taking HIV management would lead to successful self-administration of ART in HIV infected adolescents with poor medication adherence (< 90%). Calls Monday to Friday either once or twice a day. Confirmed if medications were taken, provided problem-solving support and referred to services to address adherence barriers. Link to support - adherence facilitator did a mediation review, problem solving and scheduling relevant referrals. Goals and planning 1.2, 1.6, Feedback and monitoring 2.2, Social support 3.1, prompts 7.1 Usual care
Huang 2013 [39] Fortnightly phone call RCT, China, mobile phone, voice call, 3 months 196 HIV positive patients, both treatment naïve and treatment experienced. 52% female. To investigate the effects of a phone call intervention on adherence to ART and QOL of treatment-naïve and treatment-experienced patients. Reminder phones call every 2 weeks by registered nurse/ health personnel. Discuss medications, self-management and related difficulties. Link to support - patients were given a hospital phone number and a mobile phone number Feedback and monitoring 2.1, Social support 3.2 Usual care - educational on HIV/AIDS and treatment
Kebaya 2014 [29] Fortnightly mobile phone call RCT, Kenya, mobile phone, voice call, 6 weeks 150 mother- infant pairs, in HIV exposed infants. To compare self-reported adherence to infant NVP prophylaxis and retention in care in. Fortnightly mobile phone based reminder and on prevention of mother to child transmission.   prompts 7.1 Standard health care, no phone calls.
Uzma 2011 [40] Weekly phone call reminders RCT, Pakistan, mobile phone, voice call, 10 weeks 76 adult participants, 26.3% females, HIV positive on ART regime for at least 3 months To assess the efficacy of interventions for improving adherence to ART regimens in patients with HIV/AIDS in treatment centres. Weekly phone reminders and routine counselling   Goals and planning 1.4, Social support 3.1, prompts 7.1 Routine counselling
Kalichman 2011 [41] Bi-weekly phone call counselling session RCT, America (Atlanta), mobile phone, telephone counselling session, 4 months 40 HIV positive adults with less than 95% self-reported adherence. 35% female. To examine the effect of a brief cell phone-delivered adherence intervention designed to improve medication adherence in people living with HIV/AIDS 45 min counselling session with feedback and adherence counselling after pill count calls, which were bi-weekly. Behavioural self management model, self-regulation models of medication adherence
Link to support - counsellor initiated calls and check in on how participants were doing
Goals and planning 1.1, Feedback and monitoring 2.2, 2.3, Social support 3.1, 3.2, Natural consequence 5.1 Pill counts checked over the phone, no feedback on adherence or counselling.
MIXED
Maduka 2013 [45] Mixed- twice a week text message and monthly adherence counselling RCT, Nigeria, mobile phone, short message reminders, 4 months 104 participants, 56.7% female, HIV positive been on HAART for 3 months, history of non-adherence To demonstrate the effect of adherence counselling and text message reminders in improving patient’s adherence to HAART. Mixed - monthly adherence counselling that lasted 45 - 60 min, and twice weekly short message reminders Interactivity - trial participants were encouraged to call, “flash” or send an SMS to those numbers to acknowledge receipt of SMS and indicate need for further counselling or information
Link to support - researchers phone contact were added to the receiver category of every message
Social support 3.1, prompts 7.1 Standard care -included health education, occasional encouragement by doctors & quarterly assessment of CD4 count.
Lester 2010 [44] Weekly text message + counselling if required Parallel group RCT, Kenya, mobile phone, SMS, 12 months 538 HIV infected, ART naïve adults. 65.6% female. Assess whether mobile phone communication between health-care workers and patients initiating ART, in Kenya improved drug adherence and suppression of plasma HIV-1 RNA load. Weekly SMS messages that required a response within 48 h. Structured mobile phone communication between health care workers and patients. Interactivity - instructed to respond after 48 h if they were doing well or if they had a problem. Those that had a problem the clinician called them back or those who failed to respond.
Link to support - SMS reminded them of phone based support
Social support 3.1 One counselling sessions in Kajido and two in Nairobi. Additional brief counselling at each site provided during dispensation of the drugs in the clinic or pharmacy.
Shet 2014 [43] Automated weekly voice message + weekly pictorial message Parallel group RCT, India, mobile phone, automated voice call and pictorial message 96 weeks 631 HIV infected, ART naïve adults. 43.3% women. To assess whether customised mobile phone reminders would improve adherence to therapy and thus decrease virological failure among HIV infected patients started ART Customised, interactive automated voice reminder and a pictorial message sent weekly to the patient’s mobile phones. Social cognitive theory of planned behaviour
Interactivity - required patient to respond about previous days dosing. If there was no response to the call then three more attempts were made until a response was obtained.
Feedback and monitoring 2.1, Social support 3.1 Standard care included 3 counselling sessions prior to the initiation of ART, routine clinical and lab testing at baseline, follow up and assessments every 6 months
Abdulrahman 2017 [46] SMS and telephone call reminder Single blinded RCT, Malaysia, SMS and telephone call reminder + adherence counselling, 24 weeks 242 Adult HIV positive new to ART. 12% female. Excluded pregnant/HIV patients already on/restarted ART and foreigners. Evaluate the effectiveness of mobile phone reminders and peer counselling in improving adherence and treatment outcome among HIV positive patients on ART in Malaysia Weekly medication reminder SMS 3 days prior to app, telephone call reminders (90 s during lunch hours) for scheduled clinic appointments and peer counselling during clinical visits (minimum of 3 visits) Link to support - not mandatory to respond but could text back for additional support Prompt 7.1 Standard care – routine adherence counselling and paper based appointment scheduling by two training research assistants
IMAGING
Perera 2014 [42] Daily imaging RCT, New Zealand, smartphone application, imagery, 3 months 28 adults on ART for at least 6 months, 7% female. To examine the efficacy of a smartphone application incorporating personalized health related visual imagery with real-time information about medication level and immune-protection to enhance adherence to ART. Augmented version contained components that illustrated participant’s current estimated plasma concentration of ART and the immune protection.   Feedback and monitoring 2.2, prompts 7.1 Standard version of smartphone application, which comprised a 24-h medication clock, displaying the participants daily ART dosing schedule. Patients could record when they had taken their medication each day.