Behavioural Text Messages to Improve Retention in Care in South Africa

  • days left to enroll
  • participants needed
  • sponsor
    University of Pennsylvania
Updated on 19 September 2021


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.


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.

Condition HIV/AIDS
Treatment Standard of Care (SOC) text message reminder to attend clinic appointment, Loss aversion framed text message reminder to attend clinic appointment, Social norms framed text message reminder to attend clinic appointment, Altruism framed text message reminder to attend clinic appointment
Clinical Study IdentifierNCT05010291
SponsorUniversity of Pennsylvania
Last Modified on19 September 2021


Yes No Not Sure

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
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If you are confirmed eligible after full screening, you will be required to understand and sign the informed consent if you decide to enroll in the study. Once enrolled you may be asked to make scheduled visits over a period of time.

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