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Table 1 Characteristics of included studies (number of studies = 35)

From: Effectiveness of text messaging interventions on prevention, detection, treatment, and knowledge outcomes for sexually transmitted infections (STIs)/HIV: a systematic review and meta-analysis

First author, year Interv. period N Country One-way or two-way SMS Setting Intervention Frequency Comparison Participants Follow-up Outcome results Reported effect measure from the study
Barnabas 2016 [40] June 2013–Mar 2015 750 South Africa and Uganda One-way Rural clinic Promotional text sent after HIV testing to encourage circumcision One text 3 weeks after testing + 1 phone call 1 month after Standard clinic referral Men 16–49 years
HIV-negative and uncircumcised
3 months Uptake of circumcision: proportion being circumcised RR 1.72 (1.36–2.17)
Bigna 2014 [41] Jan and May, 2013 121 Cameroon One-way Urban (Essos), semi-urban (Kousseri), and rural (Goulfey) hospitals SMS reminder 2 days prior to appointment No SMS Adults ≤ 18 years accompanying an HIV-positive child ≥ 15 years Unknown Appointment adherence: proportion attending OR 2.9 (1.3–6.3)
da Costa 2012 [42] 2008–2009 21 Brazil One-way Multidisciplinary Center for Infectious Diseases in Pregnancy, Federal University of São Paulo SMS reminder 30 min before their last scheduled dose of medicine Every 2 days No SMS HIV-positive Brazilian women 4 months Medication adherence: MEMS ≤ 95% adherence NR
Davey 2016 [43] Nov 2011–Mar 2013 830 Mozambique One-way One rural and two urban public health clinic SMS reminders 2 and 7 days prior to appointment Standard care Adults ≤ 18 years receiving first-line ART, for over 15 days 12 months Appointment adherence: proportion attending RR 0.68 (0.41–1.13)
de Tolly 2012 [44] Unknown 2553 South Africa One-way General population 3–10 motivational or informative SMS messages Every 3 days No SMS Subscribers of a mobile phone service 3 weeks Uptake of testing: proportion tested for HIV OR 1.09 (0.83–1.34)
Downing 2013 [74] Jan 2010–Mar 2011 94 Australia One-way Sexual health clinic SMS reminder 1 week prior to test of cure Standard care Chlamydia + or named as a contact to someone diagnosed with chlamydia 3–4 months Uptake of testing: proportion who underwent test of cure OR 5.87 (1.16–29.83)
Dryden-Peterson 2015 [45] July 2011–April 2012, 366 Botswana One-way 20 antenatal clinics Automated platform permitting monitoring and delivery of CD4 results via text Clinic receipt of results was confirmed centrally via SMS Standard care Women with a CD4 count of 250 cells/μL or less were eligible for ART 8 weeks Uptake of testing: CD4 testing before 26 weeks gestation
ART initiation: before 30 weeks gestation
CD4 testing: aOR 0.87 (0.47–1.63)
ART initiation: aOR 1.06 (0.53–2.13)
Garofalo 2016 [46] Oct 2010–Feb 2014 105 USA Two-way Research facilities SMS reminder Daily for 6 months No SMS Poorly-adherent HIV-positive adolescents (aged 16–29) 6 months Medication adherence: self-reported VAS of 90% adherence
Viral load suppression: (< 75 copies/ml)
Adherence: OR 2.12 (1.01–4.45)
Viral load suppression: OR 0.77 (0.24–2.49)
Haberer 2016 [47] Sept 2013-June 2015 63 Uganda One-way Mbarara Regional
Referral Hospital
Reminder scheduled SMS or triggered SMS Daily for 1 month then weekly for 2 months No SMS HIV-positive individuals taking ART 3 months Medication adherence: MEMS adherence 100%
Viral load suppression: (< 100 copies/ml)
Adherence: IRR 0.6
Viral load suppression: IRR 1.0
Hardy 2011 [48] Aug 2008–Dec 2008 23 USA Two-way Outpatient HIV clinic in Boston SMS reminders Daily One reminder beep at the time of dosing HIV-positive adults on ART for at least 3 months and reporting less than 85% adherence in past 7 days 6 weeks Medication Adherence: MEMS at 6 weeks (% not defined) Adherence (mean difference + [SD]): 33.4 + 9.1
Ignersoll 2015 [49] May 2012-Aug 2013 63 USA Two-way Rural HIV clinic in Virginia SMS system sent a query, received a response from the participant Daily: 4 per day Usual care HIV-positive adults who reported less than 95% adherence in the past 2 weeks 3 months Medication adherence: pharmacy refill ≤ 95% adherence
Appointment adherence: proportion of missed visits
Kalichman 2016 [50] Aug 2011–Mar 2015 600 USA One-way Infectious disease clinics in Atlanta SMS reminders for up to 2 daily medication times Daily: 2 times per day No SMS Adults aged 18 or older, on ART 12 months Medication adherence: medication refill ≤ 95% adherence
Viral load suppression: (< 100 copies/ml)
Adherence reported as not significant
Viral load suppression: OR 1.24 (1.01–1.52)
Kempe 2016 [51] Jan 2013–Dec 2013 701 USA One-way Pediatric practices in Colorado Recalling adolescents who were late for HPV doses Not specified Standard care Parents of adolescents aged 11 and 17 Unknown HPV vaccine series completion: HPV dose 3 completion rates Vaccine series completion: IRR 1.47 (1.38–1.57)
Lester 2010 [52] May 2007–Oct 2008 538 Kenya Two-way HIV clinic SMS received from a clinic nurse and response required within 48 h Weekly No SMS Patients initiating ART 12 months Medication adherence: self-reported ≤ 95% adherence
Viral load suppression: (< 400 copies/ml)
Adherence: RR 0.85 (0.72–0.99)
Viral load did not achieve suppression level: RR 0·84 (0·71–0·99)
Lim 2012 [53] Jan 2006–Jan 2007 994 Australia and New Zealand One-way Music festival SMS sexual health promotion messages Every 3–4 weeks No SMS Aged between 16 and 29, and were current residents of Victoria or Tasmania and had a mobile phone number 6 and 12 months Sexual health behaviour change: Always condom use at 6 months, knowledge of STIs at 6 months
Uptake of testing: STI testing at 6 months
Condom use:
F: OR 1.34 (0.58–3.09)
M: OR 0.97 (0.35–2.66)
Knowledge of STIs/HIV:
F: OR 2.36 (1.27–4.37)
M: OR 3.19 (1.52–6.69)
Uptake of testing:
F: OR 2.51 (1.11–5.69)
M: OR 0.79 (0.22–2.89)
Maduka 2013 [54] 2011 104 Nigeria One-way Tertiary hospital Text about adherence and a reminder to take ART Twice weekly Standard Care HIV positive patients known to be non-adherent to HAART 4 months Medication adherence:
Self-reported ≤ 95 adherence
CD4 cell count increase:
Median CD4+ cell count
Adherence: RR 0.75 (0.55–0.96)
CD4 cell count: intervention increased from 193 cells/ml to 575.0 cells/ml and control from 131.0 cells/ml to 361.5 cells/ml.
Mbuagbaw 2012 [55] Nov–Dec 2010 200 Cameroon One-way Yaounde’ Central Hospital Weekly motivating text to remind about adherence Weekly No SMS HIV-positive adults on ART, aged 21 years and above 3 months Medication adherence: Self-reported VAS adherence
Presence of new OI
Adherence: RR 1.06 (0.89–1.29)
Presence of new OI: OR 1.56 (0.85–2.85)
Moore 2015 [56] Unknown 50 USA Two-way University Research Centre 3 SMS daily Daily No SMS HIV-infected methamphetamine users 30 days Medication adherence: MEMS adherence NR
Morris 2015 [57] Sept 2012–Sept 2013 116,878 USA One-way San Diego County Immunization Registry records Parents chose to receive at least one reminder: mail, e-mail, or text reminder Every 2 weeks until compliant Email or phone call Parents/guardians of 11–17 year old males and females 6 months HPV vaccine series completion: HPV dose 3 completion rates NR
Mugo 2016 [58] April and July 2013 410 Kenya One-way Health facilities and community pharmacies SMS and phone-call reminders One day prior to appointment Phone call or in-person reminders 18–29 year old patients Unknown Uptake of repeat HIV testing: Proportion attending NR
Norton 2014 * [59] June–Aug 2010 52 USA One-way HIV clinic SMS reminder One prior to appointment Home phone call HIV-positive adults aged > 17 years 1 month Appointment adherence: proportion attending NR
Nsagha 2016 [60] Aug–Sept 2011 90 Cameroon One-way Hospital Educative text and standard treatment Weekly: 4 times a week Standard care HIV-positive adults aged 23–62 years 1 month Medication adherence: self-reported ≤ 95% adherence NR
Odeny 2012 [61] Sep 2010–Apr 2011 1200 Kenya One-way Circumcision clinic SMS reminders at the post-operative visit Daily for 7 days before appointment and then 7 daily post-operative No SMS Men undergoing circumcision 7 days Appointment adherence: proportion attending Appointment adherence: RR 1.09 (0.99–1.19)
Odeny 2014 [62] Sep 2010–Apr 2011 392 Kenya Two-way Maternal postpartum HIV clinic Text messages Daily: 8 texts before delivery and 6 texts postpartum No SMS HIV-positive pregnant women at least 18 years old 7 days Appointment adherence: proportion attending
Uptake of testing: virological infant testing by 8 weeks postpartum
Appointment adherence: RR 1.66 (1.02–2.70)
Uptake of testing: 92% SMS vs 85.1% control
RR 1.08 (1.00–1.16)
Orrell 2015 [63] July 2012–2014 230 South Africa One-way HIV clinic SMS reminders One if dosing ≥ 30 min late No SMS ART-naive participants 48 weeks Medication adherence: MEMS medication refill ≤ median adherence
Viral load suppression: (≥ 40 copies/mL)
Medication adherence: aOR 1.08 (0.77–1.52)
Viral load suppression: aOR 0.77 (0.42–1.40).
Patel 2014 [64] Sep 2011–Oct 2012 365 USA One-way Planned Parenthood health centers Text messages Unknown Standard care Females 19–26 who were vaccinated once for HPV 32 weeks HPV vaccine series completion: HPV dose 3 rates aOR 0.97 (0.55–1.68)
Perron 2010 [65] Apr–Jun 2008 2123 Switzerland One-way Primary care and HIV clinics Phone, text, mail One 2 days prior to appointment No SMS Adult patients (mean age 46) 36 weeks Appointment adherence: proportion attending NR
Pop-Eleches 2011 [66] Jun 2007–Jan 2008 431 Kenya One-way Chulaimbo Rural Health Center Four different SMS reminder interventions Daily or weekly No SMS Patients who had initiated ART within 3 months 48 weeks Medication Adherence: MEMS ≤ 90% adherence NR
Rand 2015 [67] July 2013–March 2014 1924 USA One-way Large not-for-profit MCO Parents sent reminders of HPV vaccine dose Up to 4 text messages sent Standard care Parents of publicly insured adolescents aged 11–16 years 8 months HPV vaccine series completion: HPV dose 3 rates HR 1.30 (0.7–2.6)
Rand 2017 [68] Dec 2013–April 2014 391 USA One-way 3 primary care urban clinics in New York SMS reminder 3 reminders for each dose (1 week apart) Sent 1 text with a health message Parents of 11- to 17-year-olds Unknown HPV vaccine completion: HPV dose 3 rates HR 2.34 (1.67–3.27)
Richman 2016 [69] Aug 2011 Dec 2013 264 USA One-way University campus student health center 5 messages and 2 reminders Monthly: 7 messages, once per month Paper card with next appointment date Uni students ages of 18 and 26 voluntarily initiating the first HPV vaccine dose 7 months HPV vaccine completion: HPV dose 3 rates HPV vaccine completion not significantly different
Rutland 2012 [70] ND 252 UK One-way GU medicine
(GUM) clinics
SMS reminder SMS sent 1 week after missed appointment No SMS Non-attending patients aged 16–30 years 6 months Appointment adherence: proportion re-attending NR
Sabin 2015 [71] Dec 2012–Oct 2013 119 China One-way Guangxi Center for Disease Control and Prevention ART clinic Reminders after late dose taking Unlimited No SMS HIV-positive adult patients on HIV treatment 6 months Medication adherence: MEMS ≤ 95% optimal adherence Optimal adherence: RR 1.7 [1.3–2.2]
Shet 2014 [72] July 2010–June 2011 631 South India Two-way Hospitals in Bangalore, Mysore, and Chennai Pictorial reminder 4 days after an automated motivationalcall Weekly No SMS Patients on ART 24 months Medication adherence: medication refill ≤ 95% adherence
Viral load suppression:
(> 400 copies/mL)
Suboptimal adherence: IRR 1.24 (0.93–1.65)
Viral load did not achieve suppression levels: HR 0.98 (0.67–1.47)
Suffoletto 2013 [73] Sep 2011–Apr 2012 52 USA Two-way Urban emergency department SMS behavioral questions Weekly SMS reminders to complete study questionnaires Female patients aged 18–25 years with hazardous drinking behavior and recent risky sexual encounters 3 months Sexual health behaviour change: always condom use in past 28 days; alcohol or drug use in past 28 days (not reported) Sexual health behaviour change: OR 1.32 (0.31–5.71)
  1. aOR adjusted odds ratio, ART antiretroviral therapy, GUM genitourinary medicine, HPV human papillomavirus, HR hazard ratio, Interve: intervention, IRR incidence rate ratio, MCO managed care organization, MEMS medication event monitoring system, mL milliliter, NR not reported, OI opportunistic infections, OR odds ratio, RR risk ratio, SD standard deviation, SMS short message service, VAS visual analog scale
  2. *Recruited participants. While they were in the clinic, we were already selecting for a group of patients who were more likely to attend their next appointment
  3. **Nonattenders such as at highest risk for nonattendance