Benefits of 2wT for ART Retention

Two-way texting (2wT) plays a crucial role in enhancing ART (Antiretroviral Therapy) retention among individuals with HIV in Sub-Saharan Africa, contributing significantly to the broader efforts to combat the HIV/AIDS epidemic in the region. The importance of 2wT lies in its ability to establish a continuous and interactive communication channel between healthcare providers and patients, fostering a supportive environment for individuals undergoing ART. 

Improved Medication Adherence: 
2wT allows healthcare providers to send medication reminders and follow-up messages directly to patients. This regular communication helps reinforce the importance of adherence to the prescribed ART regimen. Interactive text messages can address concerns or side effects, providing an opportunity for patients to seek guidance or clarification, leading to better medication management.

Timely Health Monitoring:
Through two-way texting, healthcare providers can collect real-time data on patients’ health status. Patients can share information about any symptoms, side effects, or changes in their condition, enabling prompt intervention if necessary. Regular health check-ins via 2wT can facilitate early detection of potential issues, preventing complications and promoting overall well-being. 

Behavioral Support and Counseling:
2wT allows for the delivery of behavioral interventions and counseling services. Healthcare providers can send motivational messages, educational content, and mental health support resources to empower patients in managing their HIV/AIDS condition. The interactive nature of two-way communication provides a confidential platform for patients to express concerns, ask questions, and receive emotional support, fostering a sense of connection and trust. 

Appointment Reminders and Follow-ups:
2wT can be used to send automated appointment reminders, reducing the likelihood of missed clinic visits. Follow-up messages can inquire about the patient’s experience during the appointment and address any issues or questions that may have arisen. Improved appointment adherence ensures regular medical monitoring, adjustment of treatment plans when needed, and timely identification of potential barriers to retention. 

Reducing Stigma and Isolation:
Text messages can be crafted to deliver messages that reduce HIV-related stigma and dispel misconceptions. By promoting understanding and acceptance, 2wT contributes to a supportive environment that encourages individuals to remain engaged in their care without fear of judgment.  Group messaging or support networks through 2wT can create a sense of community, reducing feelings of isolation among those living with HIV/AIDS. 

Data-Driven Decision-Making:
The data collected through 2wT interactions can be analyzed to identify patterns, trends, and challenges in ART retention. This information enables healthcare providers and policymakers to make informed decisions, allocate resources effectively, and tailor interventions to specific needs. 

The integration of two-way texting as a tool for ART retention in Sub-Saharan Africa holds immense potential to positively impact HIV/AIDS care. By leveraging technology to facilitate continuous communication, address individual needs, and foster a supportive healthcare environment, 2wT contributes to reducing HIV transmission, improving the quality of life for individuals with HIV/AIDS, and ultimately reducing AIDS-related deaths in the region. 

2wT for ART Retention in Malawi

In sub-Saharan Africa, where HIV is a significant health concern, only 67% of people with HIV continue their antiretroviral therapy (ART). Staying in care is becoming more challenging, affecting both individual health and efforts to control the HIV epidemic. The healthcare system across sub-Saharan Africa faces limitations, including a shortage of healthcare workers and providing ART services struggles to meet global targets due to these constraints. In research studies, mobile health (mHealth) innovations through text messaging show promise in improving ART retention and reducing viral load. However, these innovations are not widely tested or proven effective in real-world settings with limited resources.  

There is an urgent need for mHealth innovations that can effectively retain more patients on ART at a lower cost, especially in large public ART clinics across sub-Saharan Africa. The Lighthouse Trust, the largest public ART provider in Malawi, operates two major clinics with a combined 35,000 ART patients. These clinics use electronic medical records and a patient retention program called Back to Care (B2C), which successfully traces patients who miss appointments. However, B2C faces challenges due to high demand and limited healthcare worker capacity. Only 33% of eligible patients are traced, and over 20% of traced clients transfer. This affects ART retention and viral suppression. Additionally, poor data quality reduces the effectiveness of B2C. 

To address these challenges, the University of Washington’s International Training and Education Center for Health (I-TECH) and the Lighthouse Trust, with support from the Malawi Ministry of Health and Medic Mobile, are implementing a proactive patient retention system using two-way texting. This system uses 2wT between healthcare staff and new ART patients to enhance engagement and adherence to care. 

The study tested the effectiveness of the 2wT intervention using a quasi-experimental design, comparing outcomes between two groups of new ART patients: those supported by 2wT and a retrospective comparison group. The study demonstrated improved retention at a lower cost, and the 2wT intervention is being integrated into the electronic medical records system, automating enrollment and management for new clients in both clinics. This transition from research to practice aims to establish a locally-led, technology-supported improvement in ART retention, filling a gap in routine, high-volume, public settings. The integration of 2wT into the electronic records system sets the stage for scaling up and replicating the approach nationally and across sub-Saharan Africa.