基于行为学的双向短信服务以改善南非的艾滋病护理回访：一项随机对照试验的证据
Behaviourally-informed two-way text messaging to improve return to HIV care in South Africa: evidence from a randomised controlled trial.
作者信息
Njuguna Christine, Mistri Preethi, Long Lawrence, Chetty-Makkan Candice, Maughan-Brown Brendan, Buttenheim Alison, Schmucker Laura, Pascoe Sophie, Thirumurthy Harsha, O'Connor Cara, Mutasa Barry, Rees Kate
出版信息
medRxiv. 2024 Aug 20:2024.08.19.24312207. doi: 10.1101/2024.08.19.24312207.
INTRODUCTION
One-way text messaging to re-engage people in HIV care has shown promise, but little is known about two-way messaging where the recipient is asked to respond. We evaluated a two-way text messaging intervention, informed by behavioural science, to increase re-engagement in care following missed antiretroviral therapy (ART) visits.
METHODS
We conducted an individual-level randomised controlled trial between February and March 2023 in Capricorn District, South Africa. Adults aged ≥18 years who had missed an ART visit by >28 days were randomised to (1) a standard one-way text message, or (2) behaviourally informed two-way text messages. Two-way messages asked recipients to reply by selecting from a list of reasons for their missed visit. Those who responded received another text message tailored to their response and designed using behavioural economics principles (affect heuristic, availability heuristic, loss aversion, social norms, providing slack, expanding choice). The primary outcome was return to care within 45 days, analysed as 1) intention to treat, and 2) restricted to successful message delivery.
RESULTS
3,695 participants were randomised: 1,845 to the one-way message group and 1,850 to the two-way message group. 27.9% (515/1845) of participants sent a one-way message and 27.2% (503/1850) sent a two-way message returned for an ART visit within 45 days (proportion difference:-0.7%, p-value: 0.622). In an analysis restricted to participants whose text message was delivered, 28.3% (310/1094) in the one-way message group compared to 28.3% (304/1076) in the two-way message group returned to care (proportion difference:-0.09%, p-value: 0.966). 19.5% (210/1076) responded to the two-way message. The two most commonly reported reasons for missed appointments were being out of town (41.0%) and still having medication (31.0%.). Among those who responded, 27.1% (95%CI: 21.3-33.7) returned for an ART visit. Clients ≥50 years were less likely to respond to the two-way text message, (AOR 0.4; 95%CI: 0.2-0.9).
CONCLUSIONS
Behaviourally informed two-way text messages did not improve return to care over one-way messages. However, they elicited reasons for disengagement, which could inform future outreach for missed visits. Additional research is needed on the mode, content and timing of two-way messages intended to increase return to care.
CLINICAL TRIAL NUMBER
PACTR202202748760768 & DOH-27-042022-6703.
引言
通过单向短信促使人们重新参与艾滋病病毒治疗已显示出前景，但对于要求接收者回复的双向短信了解甚少。我们评估了一项基于行为科学的双向短信干预措施，以提高在错过抗逆转录病毒治疗（ART）就诊后重新参与治疗的比例。
方法
2023年2月至3月，我们在南非摩羯座地区进行了一项个体水平的随机对照试验。年龄≥18岁且错过ART就诊超过28天的成年人被随机分为两组：（1）标准单向短信组，或（2）基于行为学的双向短信组。双向短信要求接收者从错过就诊的原因列表中进行选择并回复。回复者会收到另一条根据其回复量身定制并运用行为经济学原理（情感启发式、可得性启发式、损失厌恶、社会规范、提供宽松度、扩大选择）设计的短信。主要结局是在45天内恢复治疗，分析时分为：1）意向性分析，以及2）仅限于成功发送短信的情况。
结果
3695名参与者被随机分组：1845人进入单向短信组，1850人进入双向短信组。单向短信组中27.9%（515/1845）的参与者以及双向短信组中27.2%（503/1850）发送了短信的参与者在45天内返回接受ART治疗（比例差异：-0.7%，p值：0.622）。在仅限于短信已发送的参与者的分析中，单向短信组中有28.3%（310/1094）的参与者恢复治疗，双向短信组中这一比例为28.3%（304/1076）（比例差异：-0.09%，p值：0.966）。19.5%（210/1076）的人回复了双向短信。错过预约最常报告的两个原因是外出（41.0%）和仍有药物（31.0%）。在回复者中，27.1%（95%置信区间：21.3 - 33.7）返回接受ART治疗。年龄≥50岁的客户回复双向短信的可能性较小（调整后比值比0.4；95%置信区间：0.2 - 0.9）。
结论
基于行为学的双向短信在促使恢复治疗方面并不比单向短信更有效。然而，它们引出了脱离治疗的原因，这可为未来针对错过就诊的外展工作提供参考。需要对旨在提高恢复治疗比例的双向短信的模式、内容和时机进行更多研究。
临床试验编号
PACTR202202748760768 & DOH - 27 - 042022 - 6703
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