The impact of text message reminders on adherence to antimalarial treatment in northern Ghana: a randomized trial

Julia R G Raifman, Heather E Lanthorn, Slawa Rokicki, Günther Fink, Julia R G Raifman, Heather E Lanthorn, Slawa Rokicki, Günther Fink

Abstract

Background: Low rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens.

Methods: Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression.

Results: 1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028). Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252).

Conclusion: The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency.

Trial registration: ClinicalTrials.gov NCT01722734.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Study Flow.
Figure 1. Study Flow.
Notes: 1792 of 3317 screened individuals were eligible to participate in the study. The most common reasons for exclusion were living more than a 30-minute drive from the ACT vendor and not having a mobile phone, followed by purchasing drugs for somebody who was not a member of the same household. Of those eligible for study participation, 1140 enrolled with the same mobile phone number that they shared with data enumerators, of whom 554 were randomized to the control group, 277 to the reminder-only message group, and 309 to the reminder and additional information message group. A total of 1110 participants reported on their ACT adherence and were included in the main analysis.
Figure 2. Dose completion among adults in…
Figure 2. Dose completion among adults in the control group.
Notes: Figure 2 indicates the proportion of adults in the control group who reported taking each dose of treatment in the per-dose self-report. Among 239 adults who took AL and reported per-dose adherence, 200 (83.7%) reported taking the fourth dose, 174 (72.8%) reported taking the fifth dose, and 135 (56.5%) reported taking the sixth dose. Among 70 adults in the control group taking AS+AQ, 33 (47.9%) reported completing the full three-dose regimen.

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