Participant characteristics.

Background
Retaining clients on antiretroviral therapy (ART) is challenging, especially during the first year on ART. Mobile health (mHealth) interventions show promise to close retention gaps. We aimed to assess reach (who received the intervention?) and effectiveness (did it work?) of a hybrid two-way texting (2wT) intervention to improve ART retention at a large public clinic in Lilongwe, Malawi.
Methods
Between August 2021—June 2023, in a quasi-experimental study, outcomes were compared between two cohorts of new ART clients: 1) those opting into 2wT who received automated, weekly motivation short messaging service (SMS) messages and response-requested appointment reminders; and 2) a matched historical cohort receiving standard of care (SoC). Reach was defined as “the proportion clients ≤6 months of ART initiation eligible for 2wT”. 2wT effectiveness was assessed in time-to-event analysis. Retention was presented in a Kaplan-Meier plot and compared between 2wT and SoC using a log-rank test. The effect of 2wT on ART dropout (lost to follow-up or stopped ART) was estimated using Fine-Gray competing risk regression models, adjusting for sex, age and WHO HIV stage at ART initiation.
Results
Of 1,146 clients screened, 501 were eligible for 2wT, a reach of 44%. Lack of phone (393/645; 61%) and illiteracy (149/645; 23%) were the most common ineligibility reasons. Among 468 participants exposed to 2wT, 12-month probability of ART retention was 91% (95% CI: 88% - 94%) compared to 76% (95% CI: 72% - 80%) among 468 SoC participants (p<0.001). Compared to SoC, 2wT participants had a 65% lower hazard of ART dropout at any timepoint (sub-distribution hazard ratio 0.35, 95% CI: 0.24–0.51; p<0.001).
Conclusions
2wT did not reach all clients. For those who opted-in, 2wT significantly increased 12-month ART retention. Expansion of 2wT as a complement to other retention interventions should be considered in other low-resource, routine ART settings.

研究背景
维持艾滋病患者接受抗逆转录病毒疗法（antiretroviral therapy, ART）颇具挑战，尤其是在疗法启动后的首年内。移动健康（mobile health, mHealth）干预手段有望填补治疗保留率的缺口。本研究旨在评估一项双向短信（two-way texting, 2wT）混合干预方案在马拉维利隆圭一家大型公立诊所中提升ART治疗保留率的覆盖范围（即哪些患者接受了该干预）与有效性（即该干预是否起效）。
研究方法
2021年8月至2023年6月期间，本研究采用类实验设计，对两队列新增ART患者的结局进行对比：① 选择参与双向短信干预的患者，该组会收到自动化的每周激励性短消息服务（short messaging service, SMS）信息，以及带有回复要求的就诊提醒；② 匹配的历史对照队列，仅接受标准诊疗方案（standard of care, SoC）。覆盖范围定义为「ART启动后≤6个月、符合双向短信干预纳入标准的患者比例」。采用生存时间分析评估双向短信干预的有效性。治疗保留率通过卡普兰-迈耶曲线（Kaplan-Meier plot）呈现，并通过对数秩检验（log-rank test）对比双向短信干预组与标准诊疗组的差异。采用Fine-Gray竞争风险回归模型，校正患者性别、年龄及ART启动时的世界卫生组织（WHO）HIV感染分期，以评估双向短信干预对ART治疗脱落（失访或停止ART治疗）的影响。
研究结果
本研究共筛查1146名患者，其中501名符合双向短信干预的纳入标准，覆盖比例为44%。无法提供手机号（393/645；61%）与识字障碍（149/645；23%）是最常见的不符合纳入标准的原因。在468名接受双向短信干预的患者中，ART治疗12个月保留率为91%（95%置信区间：88%~94%）；而标准诊疗组的468名患者12个月保留率为76%（95%置信区间：72%~80%），组间差异具有统计学意义（p<0.001）。与标准诊疗组相比，双向短信干预组患者在任意时间点的ART治疗脱落风险降低65%（亚分布风险比为0.35，95%置信区间：0.24~0.51；p<0.001）。
研究结论
双向短信干预未能覆盖所有符合条件的患者。但对于选择参与该干预的患者而言，其可显著提升12个月ART治疗保留率。在其他资源匮乏的常规ART诊疗场景中，可考虑将双向短信干预作为其他治疗保留干预手段的补充方案进行推广。