Texting to improve the health of people living with HIV and TB

Place: Mozambique
Status: Implementation complete.

Behavioral Challenge

How can we help people with HIV and TB to overcome hassles and embarrassment to go to the health clinic—and continue going—even when they start to feel better?


People who are coinfected with both HIV and Tuberculosis (TB) face many challenges. First, they are likely to feel very sick, which makes going to the clinic for treatment and medicine difficult.  Being HIV positive still carries a stigma in most communities, and therefore many people are hesitant to go for treatment because they are afraid to be seen by friends or neighbors. Yet, appointment and medicine adherence is critical if they are to get better. Finally, after a few weeks on TB treatment, many people start to feel significantly better—even though they are not yet healthy—and are likely to drop off treatment before the full regimen is complete.

 To address some of these challenges, with USAID funding and design support from the Social and Behavioral Science Team (SBST), ARK and EGPAF designed an SMS reminder program that would send timed appointment reminders and motivational messages to people living with HIV and TB. 


With support from the SBST, we designed the SMS reminders to have an increased level of personalization. Rather than a simple text reminder (“don’t forget your appointment”), messages noted where that person was in their treatment cycle and recognized them for making so far.  

Sample text: Congratulations! You’ve completed 3 weeks of treatment- only a few more weeks to go! We know going to the clinic isn’t easy but you’re doing it! 

In addition, specific messages were designed to be sent at the moment that most people drop off treatment. These messages recognized that the person might be feeling better but was not yet fully healthy.  

Sample text: Congratulations– you’ve completed 4 weeks of treatment! We know you may be feeling better, but you are not completely healthy yet! Continue to come to your appointments- don’t lose all the good health you’ve gained!

Can we put this sample SMS and the one above it in a little phone image so it looks like a text on a phone?

Evaluation Design

This is randomized control trial with some people assigned to the SMS message treatment and others in a control group without SMS messages.