“Fresh start” text messaging to motivate recipients of care with treatment interruptions to re-initiate antiretroviral therapy in the Capricorn District, South Africa

Organization: Anova Health Institute



Study objective: To test whether highlighting temporal landmarks in messaging will increase the number of care recipients returning to antiretroviral treatment after a treatment interruption of at least 28 days.



Intervention description: “Fresh start” text messaging will be used to motivate care recipients with treatment interruptions to return to care. There will be three study groups:


  • Standard of care (SOC) – with no SMS 
  • Standard SMS
  • “Fresh start” message on specific date


The “fresh start” effect is a behavioural economics tool used to motivate aspirational or health behaviours at a time (or temporal landmark) when people may be most motivated to engage in those behaviours to achieve personal goals (Dai, Milkman and Riis, 2014). Temporal landmarks may include:


  • Transition points in a social timetable (start of a new week, month, year)
  • Momentous life events (birthday, wedding)
  • Significant public events (a national election, public holidays)



Evaluation description: This is an individually randomised control study. A list of people living with HIV (PLHIV) with missed clinic visits will be generated from Tier.Net. Care recipients who have missed their last scheduled clinic appointment will be randomised into one of the three study groups.



Study outcomes: The primary outcome will be the proportion of care recipients re-initiating ART within 45 days of the first SMS text message being sent.



Study site: The study will include care recipients from  approximately 103 public sector primary health clinics in the Capricorn District, Limpopo Province where study outcomes will be tracked on Tier.Net.



 Target population: All care recipients aged 18 years and above who have previously initiated ART and have missed their last scheduled clinic appointments by more than 28 days.



Sample size & analysis: The sample will be stratified into care recipients with treatment interruptions less than 6 months and greater than 6 months. A sample size of 1,605 care recipients will be included into each of the three study arms for both of these strata to give a total sample size of 9,630 (1,650 x 3 groups x 2 strata) recipients of care.


We will measure differences between the groups using Chi square statistics. Intention to treat analysis will be used for the primary outcome.



Study duration: 15 months