Improving Long-term HIV Medication Adherence Using Text Messages and Incentives A Study at Mildmay Clinic in Uganda

What this Trial Is About

Researchers are investigating ways to improve long-term medication adherence among people starting antiretroviral treatment ART for HIV in Uganda. The study aims to evaluate a combined approach using behavioral economics techniques to support daily pill-taking routines. This approach is tested through a Stage III Sequential, Multiple Assignment, Randomized Trial SMART design to find the most cost-effective adaptive intervention that could be applied to other settings and chronic diseases. Participants will be randomly assigned to either usual care or receive daily text message reminders to help establish medication routines. After three months, those with less than 80% adherence will be re-randomized to receive either monthly prize draws or escalating monthly prizes based on their adherence levels. The study includes an 18-month follow-up period to monitor long-term adherence and recovery after interruptions, with a focus on the cost-effectiveness of different intervention sequences. Throughout the study, participants medication adherence is electronically monitored using the WisePill device. Researchers will assess adherence, retention in care, viral suppression, and routinization of ART adherence over a total of 24 months. Participants will receive counseling and support to develop pill-taking routines, and adherence will be tracked with daily messaging and prize incentives. The study includes ongoing evaluations to understand the behavioral mechanisms influencing adherence and to support future program scale-up.

INcentives and ReMINDers to Improve Long-term Medication Adherence (INMIND)