Division of HIV, ID and Global Medicine, University of California San Francisco.
Department of Public Health Sciences, University of Miami, Florida.
Clin Infect Dis. 2018 Aug 16;67(5):751-759. doi: 10.1093/cid/ciy156.
Text messaging is a promising strategy to support human immunodeficiency virus (HIV) care engagement, but little is known about its efficacy in urban safety-net HIV clinics.
We conducted a randomized controlled trial of a supportive and motivational text messaging intervention, Connect4Care (C4C), among viremic patients who had a history of poor retention or were new to the clinic. Participants were randomized (stratified by new or established HIV diagnosis status) to receive either of the following for 12 months: (1) thrice-weekly intervention messages, plus texted primary care appointment reminders and a monthly text message requesting confirmation of study participation or (2) texted reminders and monthly messages alone. Viral load was assessed at 6 and 12 months. The primary outcome was virologic suppression (<200 copies/mL) at 12 months, estimated via repeated-measures log-binomial regression, adjusted for new-diagnosis status. The secondary outcome was retention in clinic care.
Between August 2013 and November 2015, a total of 230 participants were randomized. Virologic suppression at 12 months was similar in intervention and control participants (48.8% vs 45.8%, respectively), yielding a rate ratio of 1.07 (95% confidence interval, .82-1.39). Suppression was higher in those with newly diagnosed infection (78.3% vs 45.3%). There were no intervention effects on the secondary outcome. Exploratory analyses suggested that patients with more responses to study text messages had better outcomes, regardless of arm.
The C4C text messaging intervention did not significantly increase virologic suppression or retention in care. Response to text messages may be a useful way for providers to gauge risk for poor HIV outcomes.
NCT01917994.
短信在支持和促进人类免疫缺陷病毒 (HIV) 护理参与方面是一种很有前景的策略，但在城市公共卫生诊所中，其效果知之甚少。
我们对有既往留失或新入诊的病毒载量阳性的患者进行了一项支持性和激励性短信干预（Connect4Care，C4C）的随机对照试验。参与者按照新诊断或旧诊断的状态分层，随机分为以下两组，接受为期 12 个月的治疗：（1）每周接受三次干预信息，加上定期的初级保健预约提醒，每月发送一条短信，要求确认研究参与情况；（2）仅发送提醒和每月信息。在 6 个月和 12 个月时评估病毒载量。主要结局是在 12 个月时病毒学抑制（<200 拷贝/ml），采用重复测量对数二项式回归估计，根据新诊断状态进行调整。次要结局是诊所护理的保留。
2013 年 8 月至 2015 年 11 月，共有 230 名参与者被随机分组。12 个月时，干预组和对照组的病毒学抑制率相似（分别为 48.8%和 45.8%），产生的比值比为 1.07（95%置信区间，0.82-1.39）。新发感染者的抑制率更高（78.3%比 45.3%）。次要结局没有干预效果。探索性分析表明，无论分组如何，对研究短信回复较多的患者结局更好。
C4C 短信干预并未显著提高病毒学抑制率或护理保留率。对短信的回应可能是提供者衡量 HIV 不良结局风险的有用方法。
NCT01917994。
