Minority youth living in the Southern U.S. face higher HIV rates and faster disease progression than non-minority youth. According to the Pew Institute, over 75% of youth use cell phones and the mean number of texts sent and received per day is 60. This study examined the utility of a text message program as an HIV self-management tool.
A prospective, randomized two-group pilot study was conducted from Fall 2014 thru Summer 2015 to assess the promise of text messaging among minority youth to increase their retention in care and HIV medication adherence. Eligible participants included English-speaking HIV-positive youth aged 15 to 24, who had personal cell phones with text-messaging capability whom received their HIV medical care at one of three clinics located in Louisiana, Alabama, or North Carolina. A total of 341 unique, culturally appropriate text messages were delivered from domains such as treatment and appointment adherence, HIV basics, clinical visits, social support and risk reduction. Data were collected via medical record abstraction and pre/post-intervention assessment focus groups and behavioral assessment surveys.
A total of 164 youth were eligible and 146 voluntarily enrolled. The demographics of those enrolled were 86% male, 77% African American, 66% homosexual, and 85% were aged 21 thru 24. The intervention group received a mean number of 12 texts a week; the control received standard of care that did not include text messaging. T-tests, chi-squares, and McNemar statistical analysis were employed for data analysis. Post-intervention data showed that the viral load was significantly statistically lower for the intervention group compared to the control group at three (p=.039) and six months (0.003) post-baseline among youth who were non-adherent or new to ART at baseline. There was no statistically significant difference between retention in medical care for the intervention group versus control group. Six months post-baseline, the intervention youth demonstrated a statistically significant better understanding of the effects of substance use on their ability to remember to take their ART (p=.007) than among the controls.
Delivering culturally appropriate, timely, tailored text messages to HIV positive youth is a promising new intervention. Youth who were non-adherent or new to taking ART benefited most with lower viral loads and understanding of the effects of substance use on their health.