Adaptive Text Messaging and Non-Monetary Incentives to Sustain ART Adherence Among Adolescents Living With HIV in Ethiopia

January 22, 2026 updated by: Abayneh Tunje Tanga, Arba Minch University

Adaptive Text Messaging Reminders Combined With Non-monetary Incentives to Improve Adherence to Antiretroviral Treatment Among Adolescents Living With HIV in Ethiopia: a Hybrid Effectiveness-implementation Trial

Many adolescents living with HIV have difficulty taking their medicine on time, which can make it less effective and affect their health. This study will test whether sending reminder text messages, combined with small rewards like school supplies, hygiene kits, or sports items, can help adolescents take their HIV medicine regularly and stay in care. Each adolescent will choose a daily habit or routine to link to their medication. We will compare two groups receiving messages and rewards to a group receiving standard care to see which approach works best. We will also ask participants about their experience with the messages and rewards. The aim is to find a simple and effective way to help adolescents living with HIV stay healthy and in care.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

327

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Consenting adolescents aged 15 to 19 who have been on ART for at least a year and want to continue treatment at the selected facility during the trial period are eligible.

Exclusion Criteria:

  • Participants outside of the specified age range.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Control (standard care)
Experimental: Non-adaptive reminder text messaging combined with non-monetary incentives
Behavioral: Adaptive interventions
Participants will choose a lifestyle 'cue,' as in arm 1, and receive daily, personalized text message reminders tailored to their selected cues for the first three months. After three months, adherence will be evaluated, and a non-monetary reward will be provided to both adherent and non-adherent participants. Following this, the cue reminder text messages will be discontinued for participants who achieved 95% ART adherence over the next 12-month period. However, they will receive a non-monetary reward for achieving 95% ART adherence over six months of follow-up.
Behavioral: The control arm
In the control arm, all adolescents will receive the standard care as per the national guidelines (25). The standard care provided encompasses counseling, mental health support, nutritional assessment, and social and emotional support given by family, friends, and healthcare providers to adolescents diagnosed with HIV.
Experimental: Adaptive text messaging
Behavioral: The control arm
In the control arm, all adolescents will receive the standard care as per the national guidelines (25). The standard care provided encompasses counseling, mental health support, nutritional assessment, and social and emotional support given by family, friends, and healthcare providers to adolescents diagnosed with HIV.
Behavioral: Non-adaptive reminder text messaging
Non-adaptive reminder text messaging combined with non-monetary incentives versus the standard of care. Under this sub-aim, we will compare adherence levels between those who receive continuous text messaging combined with participant-preferences of daily cue and medication time.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Adaptive text messaging reminders combined with non-monetary incentives to improve sustained adherence to antiretroviral treatment among adolescents in Ethiopia: a hybrid effectiveness-implementation trial
Time Frame: 12 months
ART adherence will be measured using a multi-method composite adherence assessment tool based on previously validated measures, including self-reported adherence, pill count (PC), and retention in care (missed appointments). Self-reported adherence will be assessed through four validated yes/no questions addressing difficulties remembering medication, intentional discontinuation when feeling better or worse, and missed doses over the preceding four days. Participants will also rate their adherence over the past 30 days using a visual analogue scale (VAS) ranging from 0 (no adherence) to 10 (perfect adherence). Each adherence component will be dichotomized using established thresholds (≥95% adherence for self-report, pill count, and VAS; no missed appointments for retention in care) and assigned a score of 1 (adherent) or 0 (non-adherent). Component scores will be summed to generate a composite adherence index ranging from 0 to 3, which will be reported as a single adherence measure ca
12 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Implementation Outcomes of Adaptive SMS Reminders with Incentives for Adolescents Living with HIV
Time Frame: 3-12 months

Implementation Outcomes: The delivery, uptake, and integration of the adaptive SMS reminder and non-monetary incentive intervention will be evaluated by assessing six key implementation outcomes: acceptability, feasibility, fidelity, adoption/uptake, penetration/reach, and sustainability/maintenance.

Description of Outcome Measures:

Acceptability: Measured using the validated Acceptability of Intervention Measure (AIM) and supplemented with in-depth qualitative interviews with participants regarding the intervention's content, timing, and incentives. Assessment timepoints: 3, 6, 9, and 12 months.

Feasibility: Evaluated through digital logs of SMS delivery, records of incentive distribution, and semi-structured interviews with clinic staff to identify barriers, facilitators, and ease of implementation. Formally assessed at 6 and 12 months, with continuous process monitoring.

Fidelity: Assessed by comparing the planned intervention protocol
3-12 months
Effect of Adaptive SMS and Incentives on 12-Month Viral Suppression in Adolescents with HIV
Time Frame: 12 months
The proportion of adolescents living with HIV who maintain a viral load below 1,000 copies/mL at the 12-month study visit, assessed as the primary clinical effectiveness outcome of the adaptive SMS and incentive intervention
12 months
Cost-Effectiveness and Cost-Utility of Adaptive SMS Reminders with Non-Monetary Incentives for Improving ART Adherence Among Adolescents with HIV
Time Frame: 12 months
This study will perform a comprehensive economic evaluation from both healthcare system and societal perspectives. The analysis will compare the incremental costs and health outcomes of the combined adaptive SMS reminder and non-monetary incentive intervention against the standard of care. Cost-effectiveness will be assessed as the incremental cost per additional adolescent achieving sustained ART adherence. Cost-utility will be measured as the incremental cost per Quality-Adjusted Life Year (QALY) gained, with health utilities derived from the EQ-5D-Y/3L instrument administered at baseline, 6, and 12 months. We will calculate Incremental Cost-Effectiveness Ratios (ICERs) and conduct sensitivity analyses to assess uncertainty. A budget impact analysis will model the financial consequences of potential scale-up.
12 months

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Patient-Level Psychosocial and Behavioral Determinants of ART Adherence
Time Frame: Measurement Time Points: Baseline, 3, 6, 9, and 12 months post-enrollment.

This study will measure a comprehensive set of patient-level factors hypothesized to influence sustained adherence to antiretroviral therapy (ART) among adolescents living with HIV. Validated self-report scales will be used to assess habit strength, intrinsic motivation, HIV-related stigma, depressive symptoms, and perceived social support.

Rationale for Measurement Schedule:

Baseline: To establish initial levels, identify baseline predictors of subsequent adherence and viral load suppression/rebound, and allow for statistical adjustment of participant differences.

3-Month Follow-up: To detect initial changes in psychosocial factors and investigate early mediators of adherence behavior following intervention initiation.

6-Month Follow-up (Midline): To track short-term trends and identify adaptation or emerging challenges in adherence behavior.

9- and 12-Month Follow-ups: To assess the longer-term trajector
Measurement Time Points: Baseline, 3, 6, 9, and 12 months post-enrollment.
Patient-Level Determinants and Contextual Factors
Time Frame: From baseline to 12-months
Patient-level determinants, including habit strength, intrinsic motivation, HIV-related stigma, depressive symptoms, and social support, will be measured using validated self-report scales at baseline, 3, 6, 9, and 12 months. Baseline: Establish initial levels, identify predictors of adherence and viral suppression and its rebound, and allow adjustment for participant differences. Early follow-up (3 months): Detect initial changes and early mediators of adherence. Midline (6 months): Track short-term trends, adaptation, and challenges in adherence behavior. Later follow-ups (9 and 12 months): Assess longer-term changes and maintenance of psychosocial factors. These measures will be analyzed as potential mediators or moderators of sustained ART adherence and viral load suppression.
From baseline to 12-months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Arba Minch University

Investigators

  • Study Director: Degu J Dare, MD,PhD, KNCV

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

March 9, 2026

Primary Completion (Estimated)

March 12, 2027

Study Completion (Estimated)

March 15, 2027

Study Registration Dates

First Submitted

January 1, 2026

First Submitted That Met QC Criteria

January 22, 2026

First Posted (Actual)

January 30, 2026

Study Record Updates

Last Update Posted (Actual)

January 30, 2026

Last Update Submitted That Met QC Criteria

January 22, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • CIPHER Research Grant IAS_146

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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