A Randomized Controlled Trial of a Text Messaging Intervention to Promote Virologic Suppression and Retention in Care in an Urban Safety-Net Human Immunodeficiency Virus Clinic: The Connect4Care Trial

Katerina A. Christopoulos, Elise D. Riley, Adam Carrico, Jacqueline Tulsky, Judith T. Moskowitz, Samantha Dilworth, Lara S. Coffin, Leslie Wilson, Jason Johnson Peretz, Joan F. Hilton

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Text messaging is a promising strategy to support human immunodeficiency virus (HIV) care engagement, but little is known about its efficacy in urban safety-net HIV clinics. Methods. We conducted a randomized controlled trial of a supportive and motivational text messaging intervention, Connect4Care (C4C), among viremic patients who had a history of poor retention or were new to the clinic. Participants were randomized (stratified by new or established HIV diagnosis status) to receive either of the following for 12 months: (1) thrice-weekly intervention messages, plus texted primary care appointment reminders and a monthly text message requesting confirmation of study participation or (2) texted reminders and monthly messages alone. Viral load was assessed at 6 and 12 months. The primary outcome was virologic suppression (<200 copies/mL) at 12 months, estimated via repeated-measures log-binomial regression, adjusted for new-diagnosis status. The secondary outcome was retention in clinic care. Results. Between August 2013 and November 2015, a total of 230 participants were randomized. Virologic suppression at 12 months was similar in intervention and control participants (48.8% vs 45.8%, respectively), yielding a rate ratio of 1.07 (95% confidence interval, .82-1.39). Suppression was higher in those with newly diagnosed infection (78.3% vs 45.3%). There were no intervention effects on the secondary outcome. Exploratory analyses suggested that patients with more responses to study text messages had better outcomes, regardless of arm. Conclusions. The C4C text messaging intervention did not significantly increase virologic suppression or retention in care. Response to text messages may be a useful way for providers to gauge risk for poor HIV outcomes.

Original languageEnglish (US)
Pages (from-to)751-759
Number of pages9
JournalClinical Infectious Diseases
Volume67
Issue number5
DOIs
StatePublished - Aug 16 2018

Fingerprint

Text Messaging
Randomized Controlled Trials
HIV
Safety
Viral Load
Primary Health Care
Appointments and Schedules
Confidence Intervals
Infection

Keywords

  • HIV/AIDS
  • mobile health
  • retention in care
  • text messaging (SMS)
  • vulnerable populations.

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

A Randomized Controlled Trial of a Text Messaging Intervention to Promote Virologic Suppression and Retention in Care in an Urban Safety-Net Human Immunodeficiency Virus Clinic : The Connect4Care Trial. / Christopoulos, Katerina A.; Riley, Elise D.; Carrico, Adam; Tulsky, Jacqueline; Moskowitz, Judith T.; Dilworth, Samantha; Coffin, Lara S.; Wilson, Leslie; Peretz, Jason Johnson; Hilton, Joan F.

In: Clinical Infectious Diseases, Vol. 67, No. 5, 16.08.2018, p. 751-759.

Research output: Contribution to journalArticle

Christopoulos, Katerina A. ; Riley, Elise D. ; Carrico, Adam ; Tulsky, Jacqueline ; Moskowitz, Judith T. ; Dilworth, Samantha ; Coffin, Lara S. ; Wilson, Leslie ; Peretz, Jason Johnson ; Hilton, Joan F. / A Randomized Controlled Trial of a Text Messaging Intervention to Promote Virologic Suppression and Retention in Care in an Urban Safety-Net Human Immunodeficiency Virus Clinic : The Connect4Care Trial. In: Clinical Infectious Diseases. 2018 ; Vol. 67, No. 5. pp. 751-759.
@article{ca82338a49004140b313ef05710f8ee9,
title = "A Randomized Controlled Trial of a Text Messaging Intervention to Promote Virologic Suppression and Retention in Care in an Urban Safety-Net Human Immunodeficiency Virus Clinic: The Connect4Care Trial",
abstract = "Text messaging is a promising strategy to support human immunodeficiency virus (HIV) care engagement, but little is known about its efficacy in urban safety-net HIV clinics. Methods. We conducted a randomized controlled trial of a supportive and motivational text messaging intervention, Connect4Care (C4C), among viremic patients who had a history of poor retention or were new to the clinic. Participants were randomized (stratified by new or established HIV diagnosis status) to receive either of the following for 12 months: (1) thrice-weekly intervention messages, plus texted primary care appointment reminders and a monthly text message requesting confirmation of study participation or (2) texted reminders and monthly messages alone. Viral load was assessed at 6 and 12 months. The primary outcome was virologic suppression (<200 copies/mL) at 12 months, estimated via repeated-measures log-binomial regression, adjusted for new-diagnosis status. The secondary outcome was retention in clinic care. Results. Between August 2013 and November 2015, a total of 230 participants were randomized. Virologic suppression at 12 months was similar in intervention and control participants (48.8{\%} vs 45.8{\%}, respectively), yielding a rate ratio of 1.07 (95{\%} confidence interval, .82-1.39). Suppression was higher in those with newly diagnosed infection (78.3{\%} vs 45.3{\%}). There were no intervention effects on the secondary outcome. Exploratory analyses suggested that patients with more responses to study text messages had better outcomes, regardless of arm. Conclusions. The C4C text messaging intervention did not significantly increase virologic suppression or retention in care. Response to text messages may be a useful way for providers to gauge risk for poor HIV outcomes.",
keywords = "HIV/AIDS, mobile health, retention in care, text messaging (SMS), vulnerable populations.",
author = "Christopoulos, {Katerina A.} and Riley, {Elise D.} and Adam Carrico and Jacqueline Tulsky and Moskowitz, {Judith T.} and Samantha Dilworth and Coffin, {Lara S.} and Leslie Wilson and Peretz, {Jason Johnson} and Hilton, {Joan F.}",
year = "2018",
month = "8",
day = "16",
doi = "10.1093/cid/ciy156",
language = "English (US)",
volume = "67",
pages = "751--759",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "5",

}

TY - JOUR

T1 - A Randomized Controlled Trial of a Text Messaging Intervention to Promote Virologic Suppression and Retention in Care in an Urban Safety-Net Human Immunodeficiency Virus Clinic

T2 - The Connect4Care Trial

AU - Christopoulos, Katerina A.

AU - Riley, Elise D.

AU - Carrico, Adam

AU - Tulsky, Jacqueline

AU - Moskowitz, Judith T.

AU - Dilworth, Samantha

AU - Coffin, Lara S.

AU - Wilson, Leslie

AU - Peretz, Jason Johnson

AU - Hilton, Joan F.

PY - 2018/8/16

Y1 - 2018/8/16

N2 - Text messaging is a promising strategy to support human immunodeficiency virus (HIV) care engagement, but little is known about its efficacy in urban safety-net HIV clinics. Methods. We conducted a randomized controlled trial of a supportive and motivational text messaging intervention, Connect4Care (C4C), among viremic patients who had a history of poor retention or were new to the clinic. Participants were randomized (stratified by new or established HIV diagnosis status) to receive either of the following for 12 months: (1) thrice-weekly intervention messages, plus texted primary care appointment reminders and a monthly text message requesting confirmation of study participation or (2) texted reminders and monthly messages alone. Viral load was assessed at 6 and 12 months. The primary outcome was virologic suppression (<200 copies/mL) at 12 months, estimated via repeated-measures log-binomial regression, adjusted for new-diagnosis status. The secondary outcome was retention in clinic care. Results. Between August 2013 and November 2015, a total of 230 participants were randomized. Virologic suppression at 12 months was similar in intervention and control participants (48.8% vs 45.8%, respectively), yielding a rate ratio of 1.07 (95% confidence interval, .82-1.39). Suppression was higher in those with newly diagnosed infection (78.3% vs 45.3%). There were no intervention effects on the secondary outcome. Exploratory analyses suggested that patients with more responses to study text messages had better outcomes, regardless of arm. Conclusions. The C4C text messaging intervention did not significantly increase virologic suppression or retention in care. Response to text messages may be a useful way for providers to gauge risk for poor HIV outcomes.

AB - Text messaging is a promising strategy to support human immunodeficiency virus (HIV) care engagement, but little is known about its efficacy in urban safety-net HIV clinics. Methods. We conducted a randomized controlled trial of a supportive and motivational text messaging intervention, Connect4Care (C4C), among viremic patients who had a history of poor retention or were new to the clinic. Participants were randomized (stratified by new or established HIV diagnosis status) to receive either of the following for 12 months: (1) thrice-weekly intervention messages, plus texted primary care appointment reminders and a monthly text message requesting confirmation of study participation or (2) texted reminders and monthly messages alone. Viral load was assessed at 6 and 12 months. The primary outcome was virologic suppression (<200 copies/mL) at 12 months, estimated via repeated-measures log-binomial regression, adjusted for new-diagnosis status. The secondary outcome was retention in clinic care. Results. Between August 2013 and November 2015, a total of 230 participants were randomized. Virologic suppression at 12 months was similar in intervention and control participants (48.8% vs 45.8%, respectively), yielding a rate ratio of 1.07 (95% confidence interval, .82-1.39). Suppression was higher in those with newly diagnosed infection (78.3% vs 45.3%). There were no intervention effects on the secondary outcome. Exploratory analyses suggested that patients with more responses to study text messages had better outcomes, regardless of arm. Conclusions. The C4C text messaging intervention did not significantly increase virologic suppression or retention in care. Response to text messages may be a useful way for providers to gauge risk for poor HIV outcomes.

KW - HIV/AIDS

KW - mobile health

KW - retention in care

KW - text messaging (SMS)

KW - vulnerable populations.

UR - http://www.scopus.com/inward/record.url?scp=85054976481&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054976481&partnerID=8YFLogxK

U2 - 10.1093/cid/ciy156

DO - 10.1093/cid/ciy156

M3 - Article

AN - SCOPUS:85054976481

VL - 67

SP - 751

EP - 759

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 5

ER -