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Beyond Reminders: Using Tailored Text-Messages to Promote Knowledge, Prevention, Social Support and Medication Adherence for

People Living with HIV

Project funded by the Agency for Healthcare Research and Quality, contractNumber HHSA290200600001I#7. Findings and conclusions are those of the authors and do not necessarily represent the views of AHRQ.

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What really works is…

A tailored, SMS-based

intervention to increase knowledge,

change beliefs, reduce risk behaviors,

enhance social support, and

improve medication adherence

among HIV+ MSM.

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Study Purpose

Develop, implement, and test a

tailored SMS-based intervention for HIV+

MSM to enhance outcomes

related to managing HIV

Messages addressed:– sexual risk reduction (tailored)– substance use risk reduction (tailored)– medication adherence (tailored)– social support (tailored/everyone)– general health and well-being (everyone)– patient involvement (everyone)

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Evaluation Design

RecruitmentEnrollment

(n=52)

Medical Record Review

Pre-intervention Survey

Assignment to Message

Cluster

Exposure to Intervention

(90 Days)

Patient Interviews

(n=9)and

Clinic Staff Interviews

(n=5)

Medical Record Review

Post-intervention Survey(n=46)

Parallel Data Collection:Input from Study Implementation Team - Text Messaging Archives - Feedback from Site Study Coordinator

Message Cluster:· Medication Adherence· Sexual Risk Reduction· Substance Use Risk Reduction· Social Support

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Positive Receptivity to Messages

0%

20%

40%

60%

80%

100%

120%

98%89% 87% 86% 82%

67%

(n=46)

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HIV Knowledge, Attitudes and Beliefs

All Participants Participants Receiving Sex Risk Reduction

Messages

n=52 n=46 n=21 n=17HIV knowledge(% items correct)

Believe HIV-positive partnersdo not need to use condom

0%10%20%30%40%50%60%70%80%90%

100%

36%

58%

90%

18%

Baseline Follow-up

% o

f P

artic

ipan

ts

Notes:All differences are statistically significant.Differences between baseline and follow-up participants are due to loss at follow-up or missing data.Smaller n's reflect SMS sent only to those with risk behavior at baseline.

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Reduction in Risk Behaviors

Had sex without condom in past 3 months

Rarely/never use alcohol/drugs before/during sex

0%10%20%30%40%50%60%70%80%90%

100%

73%

34%

48%55%

Baseline Follow-up

% o

f P

artic

ipan

ts

Notes:All differences are statistically significant.Differences between baseline and follow-up participants are due to loss at follow-up or missing data.Smaller n's reflect SMS sent only to those with risk behavior at baseline.

n=26 n=22 n=26 n=22

Participants Receiving Sexual Risk Reduction Messages

“I guess there are some things

subconsciously you internalize through

the messages. There has been some

benefit definitely.”

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Enhanced Social Support

Social support(score > 3)

0%10%20%30%40%50%60%70%80%90%

100%

60%

82%Baseline Follow-up

% o

f P

artic

ipan

ts

Notes:All differences are statistically significant.Differences between baseline and follow-up participants are due to loss at follow-up or missing data.

Participants Receiving Social Support Messages

n=50 n=45

“I was recently diagnosed as HIV positive, and it’s a

pretty isolating disease…it was nice to receive messages

that are positive about people who are

HIV positive.” 

“It wasn’t just information but more community support. You don’t get a lot of support…so it’s nice

to have that.” 

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Improved self-reported adherence

Missed dosein past7 days

Forgotto take

medication

Slept throughdose time

0%10%20%30%40%50%60%70%80%90%

100%100%

81%

62%53%

38%

23%

Baseline Follow-up

% o

f P

artic

ipan

ts

Notes:All differences are statistically significant.Differences between baseline and follow-up participants are due to loss at follow-up or missing data.Smaller n's reflect SMS sent only to those nonadherent at baseline.

n=21 n=17

Participants Receiving Medication Reminder Messages

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Improved clinical outcomes

Measure

Baseline(n=41)

Mean (SD)

Follow-up(n=40)

Mean (SD) p-value

Viral Load 62650.34 (220896.82) 3196.85 (9454.04) .049

CD4 539.34 (301.13) 584.26 (306.57) .101

“It [the study] really helped. My last viral load was 85, which is next to undetectable. I wish

that this would continue.”

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Summary of Findings

Among HIV+ MSM, intervention was associated with a statistically significant

increase in knowledge, change in beliefs, reduction in risk behaviors, increase in perceived social support, and improved medication adherence (self reported and

clinical data)

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Limitations

Proof-of-concept study– small sample size – no control group– short follow-up period

Study enrollment limited to individuals aged 25 or older so as not to compete with another ongoing study

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Directions for Future Research

Full scale study to confirm and expand upon findings– Larger sample size– Control group– Longer-term follow-up– Multiple sites– Younger participants

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Contact Information

Jen Uhrig, PhD

RTI International

e-mail: uhrig@rti.org

office: 919-316-3311