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Mobile text messaging intervention to improve antiretroviral treatment adherence among adolescents living with HIV in Ethiopia

Tanga, Abayneh Tunje LU (2024) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Adherence to antiretroviral therapy is a global problem among adolescents living with human immunodeficiency viruses (HIV), and it is associated with treatment failure and the development of viral resistance. One of the most significant barriers to treatment adherence among adolescents is forgetting to take drugs as prescribed. One of the key strategies recommended to improve this problem is the use of mobile phone text message. However, it is not yet shown how effective these interventions are and how new technologies will be integrated into the routine care system. Therefore, the aim of this thesis was to develop, test the feasibility, and evaluate the effectiveness of mobile phone text messaging interventions in improving adherence to,... (More)
Adherence to antiretroviral therapy is a global problem among adolescents living with human immunodeficiency viruses (HIV), and it is associated with treatment failure and the development of viral resistance. One of the most significant barriers to treatment adherence among adolescents is forgetting to take drugs as prescribed. One of the key strategies recommended to improve this problem is the use of mobile phone text message. However, it is not yet shown how effective these interventions are and how new technologies will be integrated into the routine care system. Therefore, the aim of this thesis was to develop, test the feasibility, and evaluate the effectiveness of mobile phone text messaging interventions in improving adherence to, and retention in, care among adolescents living with HIV in Southern Ethiopia. This thesis includes a systematic review and meta-analysis (Paper I), one qualitative study (Paper II), one convergent mixed-method study (Paper III), and a randomized controlled trial (Paper IV). In Paper I, there was inconclusive evidence that mobile text message reminders improved antiretroviral therapy (ART) adherence in adolescents. In Paper II, treatment adherence and retention in HIV care experiences, and the needs of adolescents living with HIV, were explored among 18 adolescents living with HIV in Southern Ethiopia. Among the identified barriers to adherence were forgetting medication or medication time, a lack of privacy, perceived stigma, and lack of support. In Paper III, a process evaluation was conducted among 153 adolescents assigned to the intervention arm, and the result showed that 99.4% of the 30,700 reminder messages sent were successfully delivered. The problems of the 0.6% failed messages were identified. A five-dimensions evaluation approach was used. In Paper IV, 306 adolescents randomly assigned to intervention and control arms were followed for six months. The result revealed that the average effect of proportion of adherence increased in the intervention arm, while viral load decreased. Therefore, the findings of this thesis provide promising evidence that automated mobile text message reminders improve adherence among patients living with HIV in resource-constrained settings. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Moland, Karen Marie, University of Bergen
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Ethiopia, HIV, Retention in Care, Treatment Adherence and Compliance, Text Messaging, Adolescent
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2024:28
pages
75 pages
publisher
Lund University, Faculty of Medicine
defense location
Forum Medicum, plan 11, E11073, Sölvegatan 19 i Lund. Join by Zoom: https://lu-se.zoom.us/j/69432287927
defense date
2024-03-08 09:00:00
ISSN
1652-8220
ISBN
978-91-8021-521-3
project
eHealth as an aid for facilitating and supporting self-management in families with long-term childhood illness – development, evaluation and implementation in clinical practice
Improving adherence to antiretroviral therapy among adolescents living with HIV in Ethiopia
language
English
LU publication?
yes
id
052c7b1e-2ceb-41a2-b567-5c382c39fd46
date added to LUP
2024-02-16 09:52:19
date last changed
2024-02-20 07:42:53
@phdthesis{052c7b1e-2ceb-41a2-b567-5c382c39fd46,
  abstract     = {{Adherence to antiretroviral therapy is a global problem among adolescents living with human immunodeficiency viruses (HIV), and it is associated with treatment failure and the development of viral resistance. One of the most significant barriers to treatment adherence among adolescents is forgetting to take drugs as prescribed. One of the key strategies recommended to improve this problem is the use of mobile phone text message. However, it is not yet shown how effective these interventions are and how new technologies will be integrated into the routine care system. Therefore, the aim of this thesis was to develop, test the feasibility, and evaluate the effectiveness of mobile phone text messaging interventions in improving adherence to, and retention in, care among adolescents living with HIV in Southern Ethiopia. This thesis includes a systematic review and meta-analysis (Paper I), one qualitative study (Paper II), one convergent mixed-method study (Paper III), and a randomized controlled trial (Paper IV). In Paper I, there was inconclusive evidence that mobile text message reminders improved antiretroviral therapy (ART) adherence in adolescents. In Paper II, treatment adherence and retention in HIV care experiences, and the needs of adolescents living with HIV, were explored among 18 adolescents living with HIV in Southern Ethiopia. Among the identified barriers to adherence were forgetting medication or medication time, a lack of privacy, perceived stigma, and lack of support. In Paper III, a process evaluation was conducted among 153 adolescents assigned to the intervention arm, and the result showed that 99.4% of the 30,700 reminder messages sent were successfully delivered. The problems of the 0.6% failed messages were identified. A five-dimensions evaluation approach was used. In Paper IV, 306 adolescents randomly assigned to intervention and control arms were followed for six months. The result revealed that the average effect of proportion of adherence increased in the intervention arm, while viral load decreased. Therefore, the findings of this thesis provide promising evidence that automated mobile text message reminders improve adherence among patients living with HIV in resource-constrained settings.}},
  author       = {{Tanga, Abayneh Tunje}},
  isbn         = {{978-91-8021-521-3}},
  issn         = {{1652-8220}},
  keywords     = {{Ethiopia; HIV; Retention in Care; Treatment Adherence and Compliance; Text Messaging; Adolescent}},
  language     = {{eng}},
  number       = {{2024:28}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Mobile text messaging intervention to improve antiretroviral treatment adherence among adolescents living with HIV in Ethiopia}},
  url          = {{https://lup.lub.lu.se/search/files/171395987/2024_Tanga_Thesis_240124b.pdf}},
  year         = {{2024}},
}