SMS as an Incentive To Adhere (SITA) - An Intervention Communicating Social Norms by SMS to Improve ARV Adherence
Condition: Human Immunodeficiency Virus
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections
Study type: Interventional

Summary: 
      The purpose of this study 'SMS as an Incentive To Adhere' (SITA) is to test two novel
      approaches of using SMS messages (provision of information about electronically measured own
      adherence, as well as in combination with group adherence level) to improve adherence to
      anitretroviral (ART) and pre-ART prophylaxis among youth age 15-24 at an HIV clinic in
      Uganda.
    

Detailed description: 
      SITA addresses two behavioral biases observed in people living with HIV/AIDS (PLWHA). The
      growing field of behavioral economics (BE) suggests that people display behavioral biases
      (i.e. systematic decision making errors) that among patients can contribute to suboptimal
      adherence. Investigators observed two important such biases in our own work in Uganda: first,
      investigators found that patients to a large degree overestimate their own adherence, i.e.
      think that they adhere better than they actually do. Second, a patient's social environment
      matters: PLWHA clearly care about their peers and their peers' attitudes and behavior.

      SITA is based on Social Cognitive Theory (SCT) and adapts two traditional interventions to
      mHealth. The first intervention is that of self-monitoring, i.e. providing participants with
      feedback about their adherence performance. Traditionally this involves clinic visits that
      take up provider and patient time and resources; SITA instead suggests providing objective,
      real-time information measured by electronic monitoring (Wisepill) devices sent to patients
      by weekly SMS. Such feedback builds self-efficacy, a key SCT concept and thereby may improve
      adherence. The second intervention is based on the SCT concept of social learning. Perceived
      group norms, and interventions that affect those perceptions, are a key influence on health
      behavior among youths, providing a substitute for direct learning. Investigators adapt this
      approach to a mHealth environment by providing PLWHA not only with their own adherence
      information but also that of a reference (peer) group.

      SITA will use mixed methods research techniques and focus on knowledge transfer within a
      multidisciplinary team. In formative Phase 1 investigators will conduct qualitative focus
      groups with key stakeholders to elicit information about the use of wisepill devices, and
      acceptance, feasibility and locally appropriate adaptation of SITA. In Phase 2, investigators
      will implement a nine-months, three-arm (with 50-60 participants each) randomized controlled
      trial: youths in intervention group 1 will receive information about their wisepill-measured
      adherence level by weekly SMS. Intervention group 2 will in addition be sent the adherence
      level of a reference group that investigators hypothesize to exert normative influence. The
      control group will receive the usual standard of care. Throughout the study investigators
      will focus on capacity building and knowledge transfer to the Ugandan collaborators through
      workshops and mentoring.
    

Intervention name(s): Own adherence; Own and group level adherence
Intervention type(s): Behavioral; Behavioral
Intervention description(s): In this intervention group, participants receive weekly SMS messages informing them of their adherence that week as measured by the wise pill device used by the participant.; In this intervention group, participants receive weekly SMS messages informing them of their adherence that week as measured by the wise pill device used by the participant. In addition, in the same message they are informed of the adherence demonstrated by the other participants
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: behavioral economics; antiretroviral adherence; SMS; mobile health (mHealth); Adolescents; Uganda; HIV