Kiruthu-Kamamia Christine, Klabbers Robin E, Tweya Hannock, Huwa Jacqueline, Thawani Agness, Bisani Pachawo, Chintedza Joseph, Chiwaya Geldert, Kudzala Aubrey G, Ndhlovu Dumisani, Seyani Johnnie, Groot Wim, Pavlova Milena, Feldacker Caryl
United Nations University-Maastricht Economic and Social Research Institute on Innovation and Technology, Maastricht, Netherlands.
Lighthouse Trust, Lilongwe, Malawi.
PLOS Glob Public Health. 2025 Sep 10;5(9):e0004598. doi: 10.1371/journal.pgph.0004598. eCollection 2025.
Retention on antiretroviral therapy (ART) is critical for achieving viral load suppression (VLS) among people living with HIV (PLHIV). Retention remains challenging in high-prevalence settings like Malawi. Short messaging service (SMS) interventions, particularly hybrid two-way texting (2wT), show promise in improving ART retention. We conducted a randomized control trial (RCT) at Lighthouse Trust in Lilongwe, Malawi, to evaluate the effectiveness of a hybrid 2wT system to improve compliance to ART refill appointments, early retention, and VLS among new ART initiates. After receiving routine ART initiation counseling, 442 clients with mobile phones on ART ≤ six months were randomized to 2wT or standard of care (SoC). The 2wT group received weekly motivational messages, appointment reminders, and access to an open-ended SMS communication channel with retention officers. The SoC group received peer support at clinic visits and reminder calls, pre-visit and for missed appointments. All participants were traced if they missed an appointment by >14 days. Study outcomes ascertained six months post ART initiation included: ART appointment compliance (attending within 2 days), retention in care (alive on ART), and VLS (< 200 copies). Data from electronic medical records were analyzed using Chi-square tests and multivariable logistic regression. Data on 2wT participation were extracted from the 2wT database and summarized using Microsoft Excel. At six months, the 2wT group demonstrated higher compliance to ART refill visits compared to SoC (59.6% vs. 46.8%, p = 0.008). Among 2wT participants, 86% responded to ≥ 1 message, suggesting strong engagement with 2wT. The platform sent 1,645 reminders: all participants received visit reminders with the majority receiving multiple pre-appointment and follow-up messages. However, 2wT did not significantly improve retention or VLS at 6 months. Over 91% of both 2wT and SoC were retained in care (p = 0.969), and higher VLS among 2wT (97.5%) vs. SoC (93.2%) was not significant (p = 0.07). Implementing a larger 2wT study over 12-24 months and among more clients could provide evidence of 2wT impact on retention and VLS. Overall, the enhanced ART visit compliance and high care engagement among 2wT participants suggests that the low-tech, highly-accepted, 2wT approach could provide a scalable, appropriate complement to existing retention interventions in low-resource settings.
坚持接受抗逆转录病毒治疗（ART）对于实现人类免疫缺陷病毒感染者（PLHIV）的病毒载量抑制（VLS）至关重要。在马拉维等高流行率地区，坚持治疗仍然具有挑战性。短消息服务（SMS）干预措施，特别是混合双向短信（2wT），在提高ART治疗的坚持率方面显示出前景。我们在马拉维利隆圭的灯塔信托基金进行了一项随机对照试验（RCT），以评估混合2wT系统在提高新开始接受ART治疗者的ART药物补充预约依从性、早期治疗坚持率和VLS方面的有效性。在接受常规的ART启动咨询后，442名接受ART治疗≤6个月且拥有手机的患者被随机分为2wT组或标准护理（SoC）组。2wT组每周收到激励信息、预约提醒，并可通过与留存官员的开放式短信沟通渠道进行交流。SoC组在诊所就诊时接受同伴支持以及预约前和错过预约时的提醒电话。如果参与者错过预约超过14天，会对其进行追踪。确定ART启动后6个月的研究结果包括：ART预约依从性（在2天内就诊）、持续接受治疗（接受ART治疗且存活）和VLS（<200拷贝）。使用卡方检验和多变量逻辑回归分析电子病历数据。从2wT数据库中提取2wT参与情况的数据，并使用Microsoft Excel进行汇总。在6个月时，与SoC组相比，2wT组对ART药物补充就诊的依从性更高（59.6%对46.8%，p = 0.008）。在2wT参与者中，86%回复了≥1条信息，表明对2wT的参与度很高。该平台发送了1645条提醒：所有参与者都收到了就诊提醒，大多数人还收到了多条预约前和随访信息。然而，2wT在6个月时并未显著提高治疗坚持率或VLS。2wT组和SoC组均有超过91%的人持续接受治疗（p = 0.969），2wT组较高的VLS率（97.5%）与SoC组（93.2%）相比无显著差异（p = 0.07）。在12 - 24个月内对更多患者进行更大规模的2wT研究，可能会提供2wT对治疗坚持率和VLS影响的证据。总体而言，2wT参与者中ART就诊依从性的提高和较高的治疗参与度表明，这种低技术、高接受度的2wT方法可以为资源匮乏地区现有的留存干预措施提供一种可扩展的、合适的补充。
