Behavioural Text Messaging to Improve Retention in Care for Patients on Antiretroviral Therapy in Gauteng province in South Africa.

Partner organization: The Aurum Institute



Study objective: To rapidly determine whether text messages framed according to behavioural economics principles increase the likelihood that recipients of care 1) attend their clinic appointment and 2) return to the clinic within 28 days of a missed appointment.



Intervention description: One-way text messaging combined with behavioural economics (BE) principles will be sent to recipients of care that are registered to receive ART with upcoming appointments or that have missed an appointment.


Intervention arms will include voice call attempts and one-way text messages sent by clinic Tracers and Case Officers to recipients of care in two scenarios: 

  • Approximately 3-7 days in advance of a clinic appointment for collecting ART supplies or collection of a specimen for viral load testing
  • Approximately 24 hours after a missed clinic appointment; a missed appointment is defined as not attending an appointment on the day that it was scheduled


The following BE principles will be incorporated into the framing of text messages: loss aversion, social comparison/social norms and altruism framing. 



Evaluation description: Individually randomised trial with the four arms. Each time there is an upcoming or missed clinic visit, the recipient of care will be randomized to one of four follow-up communication strategies, or study arms, by Tracers and Case Officers:

  • Standard of care (SOC) telephonic contact
  • Standard of care (SOC) telephonic contact + loss aversion text message
  • Standard of care (SOC) telephonic contact + social norms text message
  • Standard of care (SOC) telephonic contact + altruism text message



Study outcomes

  • Attending clinic on a scheduled appointment day.
  • Attending clinic appointment within 28 days of missed appointment.



Study site: 3-4 Aurum-supported clinics in Ekurhuleni District, Gauteng Province. Clinics will be purposively selected based on which have the highest number of clients with missed appointments.



Target population:

Inclusion criteria:

  • Registered to receive ART 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.



Sample size: A total of 3,200 patients will be recruited: 1,600 patients with an upcoming appointment and 1,600 patients who miss a clinic visit.



Duration: 9 months.