HIV/AIDS
Conditions
Keywords
Behavioral sciences, Retention in care
Brief summary
The proportion of South Africans aware of their HIV status and on treatment remains lower than optimal. The goal of this study is to rapidly determine whether text messages framed according to behavioural economics principles increase clinic attendance among recipients of care on antiretroviral therapy in South Africa. We hypothesize that messages incorporating behavioural economics principles will increase the likelihood of recipients of care attending clinic appointments and returning within 28 days of a missed appointment.
Detailed description
The objective of this study is to rapidly determine whether text messages framed according to behavioural economics principles increase the likelihood that recipients of care attend their clinic appointment and return to clinic within 28 days of a missed appointment. The study will be nested in a routine HIV program, in approximately 5 selected Aurum Institute clinics based in Ekurhuleni district, Gauteng province, South Africa. Intervention arms will include voice call attempts and one-way text messages sent by clinic staff to recipients of care in two scenarios: 1) Approximately 3-7 days in advance of a clinic appointment for collecting antiretroviral medication supplies or collection of a specimen for viral load testing and 2) Approximately 24 hours after a missed clinic appointment. This individually randomised trial will have four arms. Each time there is an upcoming or missed clinic visit clinic staff will randomly assign recipients of care to one of the following study arms: 1) Standard of Care 2) Loss aversion framed messaging 3) Social norms framed messaging or 4) Altruism framed messaging.
Interventions
BEHAVIORALStandard of Care (SOC) text message reminder to attend clinic appointment
SOC one-way text message reminding recipient of care to either 1) attend a scheduled clinic appointment or 2) visit the clinic after a missed appointment.
BEHAVIORALLoss aversion framed text message reminder to attend clinic appointment
Loss aversion framed one-way text message reminding recipient of care to either 1) attend a scheduled clinic appointment or 2) visit the clinic after a missed appointment.
BEHAVIORALSocial norms framed text message reminder to attend clinic appointment
Social norms framed one-way text message reminding recipient of care to either 1) attend a scheduled clinic appointment or 2) visit the clinic after a missed appointment.
BEHAVIORALAltruism framed text message reminder to attend clinic appointment
Altruism framed one-way text message reminding recipient of care to either 1) attend a scheduled clinic appointment or 2) visit the clinic after a missed appointment.
Sponsors
University of Witwatersrand, South Africa
Aurum Institute
University of Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SCREENING
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Registered to receive ART (this includes patients receiving ART through multi-month scripting) at selected study sites. * Aged ≥18 years. * Have a documented cell phone number in their clinic records * Are eligible to receive appointment reminders as part of routine care OR eligible to receive follow-up text messages as part of routine care for missed clinic appointments.
Exclusion criteria
* Do not have contact details in their clinic records. * Have contact details on record that are established to belong to someone else upon follow-up (i.e., wrong number). * Have contact details that are deactivated/non-functional (i.e., voice notification that the number does not exist). * Are documented to have self-transferred out of the clinic. * Are known to have been deceased.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Appointment reminders | Approximately 3-5 months | Proportion of clients with schedule clinic visit attendance, defined as the number of patients with a verified clinic on the scheduled appointment day/the total number of clients that were sent appointment reminders (stratified by study arm). |
| Missed clinic appointments | Approximately 3-5 months | Proportion of patients with a verified clinic visit within 28 days of missing a scheduled clinic appointment defined as the number of patients with a verified clinic within 28 days of missing a scheduled clinic appointment/the total number of clients that Tracers sent text messages following a missed clinic appointment. |
Countries
South Africa
Outcome results
None listed