A pilot study of the acceptability, feasibility, and preliminary impact of SITA (SMS as an Incentive To Adhere): A mobile technology-based intervention informed by behavioral economics to improve ART adherence among youth in Uganda

Abstract

Background Studies report serious adherence problems among youth (individuals age 15 to 24 years of age) in Uganda. Recent growth in mobile phone ownership among Ugandan youth has highlighted the potential of using text-based interventions to improve ART adherence. We therefore developed and conducted a randomized controlled trial and examined the acceptability, feasibility, and preliminary impact of a pilot intervention providing weekly real-time antiretroviral adherence feedback, based on information from a smart pill box, to HIV-positive Ugandan youth. Methods We randomized participants to a control group, or to receive messages with information on either their own adherence levels (Treatment 1 - T1), or their own adherence and peer adherence levels (Treatment 2 – T2). We conducted six focus groups with providers and youth ages 15-24, double coded interviews, and achieved a Cohen’s Kappa of 0.79. Result The quantitative and qualitative data show that the intervention was deemed acceptable and feasible. The direction and magnitude of the treatment effects for T2 are promising. Adherence in the control group decreased from 80% to 70% by the end of the study. In the T2 group, adherence increased initially and remained between 80% and 85% for the duration of the study. Regression models estimate a 3 percentage point increase in adherence in the initial 9 weeks of the study in the T2 group relative to the control, which grows to a 9 percentage point increase by the last 9 weeks of the study. The T1 intervention shows no signs of impact; adherence in the T1 group decreased from 84% to 74%. This pilot study was not powered to detect statistical differences. Conclusions Improving youth’s adherence by supplementing information about their adherence with information about adherence of peers is a promising new strategy that should be further evaluated in a fully-powered study. Providing one’s own adherence information alone appears to have less potential.