Behavioural Text Messages to Improve Retention in Care in South Africa

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.

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.