Cell-Life, CPUT BARC Building, Cape Town, South Africa.
Telemed J E Health. 2012 Jan-Feb;18(1):18-23. doi: 10.1089/tmj.2011.0058. Epub 2011 Dec 8.
South Africa has one of the highest human immunodeficiency virus (HIV) prevalence rates in the world, but despite the well-established benefits of HIV counseling and testing (HCT), there is low uptake of HCT. The study aimed to investigate the effectiveness of using short message services (SMSs) to encourage HCT while interrogating the impact of altering SMS content and dosage (the number of SMSs).
About 2,533 participants were recruited via an SMS sent to 24,000 mobiles randomly sampled from a pre-existing database. Recruits were randomly allocated to four intervention groups that received 3 or 10 informational (INFO) or motivational (MOTI) SMSs, and a control group. After the intervention, participants were prompted to go for HCT, and postintervention assessment was done after 3 weeks.
In comparison with the control, receipt of 10 MOTI messages had the most impact on uptake of HCT with a 1.7-fold increased odds of testing (confidence interval 95%; p=0.0036). The lack of efficacy of three SMSs indicates a threshold effect, that is, a minimum number of MOTI SMSs is required. INFO SMSs, whether 3 or 10 were sent, did not have a statistically significant effect. The cost can be calculated for the marginal effect of the SMSs, that is, the cost to get people to test over and above those who were likely to test without the intervention. Use of 10 MOTI SMSs yielded a cost-per-tester of $2.41.
While there are methodological issues apparent in our study, the results demonstrate the potential of SMSs to influence the uptake of HCT, the importance of appropriate content, and the need to determine a threshold for SMS-based interventions. These results indicate a potential for SMSs to be used more generally for interventions encouraging people to take health-related actions, and the need for further research in this field. The reasonable cost-per-tester is promising for the scale-up of such an intervention.
南非是世界上人类免疫缺陷病毒（HIV）感染率最高的国家之一，但尽管 HIV 咨询和检测（HCT）的益处已得到充分证实，但 HCT 的普及率仍然很低。本研究旨在探讨使用短信息服务（SMS）来鼓励 HCT 的效果，同时调查改变 SMS 内容和剂量（SMS 数量）的影响。
通过向从现有数据库中随机抽取的 24,000 个手机号码发送 SMS，招募了约 2533 名参与者。招募的参与者被随机分配到四个干预组，分别收到 3 条或 10 条信息（INFO）或激励（MOTI）SMS，以及一个对照组。干预结束后，提示参与者进行 HCT，在 3 周后进行干预后评估。
与对照组相比，收到 10 条 MOTI 消息对 HCT 的接受率影响最大，检测的可能性增加了 1.7 倍（95%置信区间；p=0.0036）。三条 SMS 均无效表明存在阈值效应，即需要发送一定数量的 MOTI SMS。发送 3 条或 10 条 INFO SMS 均无统计学意义。可以计算出 SMS 的边际效应的成本，即干预措施使人们接受检测的费用超过没有干预措施时可能接受检测的人数。使用 10 条 MOTI SMS 的测试者人均成本为 2.41 美元。
尽管我们的研究存在方法学问题，但结果表明 SMS 具有影响 HCT 接受率的潜力，需要适当的内容，并需要确定基于 SMS 的干预措施的阈值。这些结果表明，SMS 可能更广泛地用于鼓励人们采取健康相关行动的干预措施，并且需要在这一领域进行进一步的研究。合理的测试者人均成本为此类干预措施的推广提供了希望。
