Young People, ART and Adherence (YPAA) Trial

Adherence to antiretroviral therapy (ART) among young people living with HIV (YPLWH) is lower than other age-groups, which leads to viral non-suppression, increased morbidity and an overall poor quality of life. Nonadherence to ART is the strongest known predictor of viral non-suppression, emergence of drug resistance, increased risk of HIV transmission, disease progression, and death. Identifying patterns of treatment adherence is a crucial initial step to developing effective intervention strategies targeting adherence in young people.Electronic monitoring devices (EMDs) combine objective data collection with detailed day-to-day information about medication intake and can be used for early identification of those at risk of treatment failure. EMD monitoring with feedback can be used as motivation for patients to improve their adherence behaviour and has been used in research settings in children (10 years and younger) and adults. However, its use has been very limited in YPLWH in both research and in clinical practice. The aim of this project is to investigate the effect of EMD-informed text message reminders with adherence feedback for 6 months on ART adherence in YPLWH aged 16-24 years, at risk of HIV virologic failure. 200 YPLWH, taking ART for at least 6 months will be recruited from 3 HIV outpatient clinics in Harare, Zimbabwe. Participants will be randomised 1:1 using block randomisation of variable lengths to use an EMD with text message reminders and focused adherence feedback or standard of care for 6 months.