S.C. Ibeneme1,2, S.C. Ndukwu1, H. Myezwa2, F.O. Irem1, F.E. Ezenwankwo1,3, T.A. Ajidahun2, A.D. Ezuma4, A. Nnamani5, O. Onodugo6, G. Ibeneme7, G. Fortwengel8
1University of Nigeria, Medical Rehabiliutation (Physiotherapy), Enugu, Nigeria, 2University of the Witwatersrand, Department of Physiotherapy, Johannesburg, South Africa, 3University of Cape Town, University of Cape Town/ Sports Science Institute of South Africa, Cape Town, South Africa, 4University of Nigeria Teaching Hospital, Physiotherapy, Ituku/Ozalla, Enugu, Nigeria, 5University of Nigeria Teaching Hospital, Radiation Medicine, Ituku/Ozalla, Enugu, Nigeria, 6University of Nigeria Teaching Hospital, Medicine, Ituku/Ozalla, Enugu, Nigeria, 7Ebonyi State University, Nursing Sciences, Abakiliki, Nigeria, 8Hochschule Hannover University of Applied Sciences and Arts, Fakultaat III, Hannover, Germany

Background: Mobile text reminder (SMS) is considered a viable strategy for targeting/facilitating healthy behavioural change such as improved adherence to prescribed physical exercises (PE) and medication (antiretroviral therapy-ART), which should translate to improved quality of life (Qol) in people living with HIV/AIDS (PLWHA). Thus, the literature was appraised to synthesise evidence of its effects by providing answers to the main review question: What is the effect of SMS on adherence to ART, physical exercise prescription and QoL in PLWHA, based on reports from the studies published in the databases from 1990 to July 2020?

Purpose: To determine the effect of SMS compared to usual care, on adherence to ART medication, physical exercise prescription and the QoL in PLWHA.

Methods: A systematic review of eight databases was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)  protocol. Only randomized control trials (RCTs) investigating the effect of SMS on either QoL, PE or ART adherence or a combination of these variables, in PLWHA, were included in the review. Inclusion was not restricted to a particular type, frequency, and duration of intervention or follow-up period after the intervention. The eligibility of the studies was determined by two independent reviewers. The primary outcome is adherence to the ART prescription. The two secondary outcomes are adherence to physical exercise prescription and QoL. Data were extracted and quality assessment was conducted with the Physiotherapy Evidence Database (PEDro) tool. 

Results: The observed heterogeneity of methods and outcome measures warranted a narrative synthesis of the nine included studies (n=1621 participants at study completion) comprising males/females aged ≥18years. SMS reminder significantly improved the adherence to ART prescription in six (66.67%) of the nine studies, unlike the other three underpowered studies. The effective SMS prescriptions include I.Personalised SMS reminder:3-5times/week x 6months, 30mins before medication time; ii.SMS: weekly x30days, iii.SMS: either short or long x daily or weekly x 48weeks, iv.Customized dynamic SMS: via a personalized cellular phone reminder system(ARemind) with several daily reminder events matching patients ART dosing x 6 weeks, v.Four educative SMS/week x 4weeks; and vi.Real-time SMS reminder triggered by a-30 mins delay in medication, with/without usual care. However, no study provided the effect size of the intervention. Also, the only study on  QoL was underpowered and reported no significant change while there were no RCTs on the effects of SMS on adherence to physical exercises.

Conclusion(s): Application of SMS reminders shows promising evidence of significant improvement in the adherence to ART in PLWHA. However, there is paucity/lack of RCTs, and thus little or no evidence to form a scientific opinion on the effects of SMS reminders on adherence to physical exercise prescriptions and QoL, respectively, in PLWHA.    

Implications: SMS reminders could be explored in improving adherence to ART in PLWHA, but the clinical significance of the findings is uncertain because the effect size is unknown. The observed heterogeneity in the methods/outcome measures for studies on ART and the paucity of literature on the effects of SMS on adherence to physical exercise prescriptions and QoL highlight priorities for future research. 

Funding, acknowledgements: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors

Keywords: Mobile text reminder, Medication and physical exercise adherence, Quality of life

Topic: Oncology, HIV & palliative care

Did this work require ethics approval? No
Institution: University of Nigeria
Committee: Health Research Ethics Committee on Certificate Number - NHREC/05/01/2008B
Reason: This is not applicable as human subjects are not involved.

All authors, affiliations and abstracts have been published as submitted.

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