***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The WelTel Kenya1 trial demonstrated that text message support improved adherence to antiretroviral therapy ( ART ) and suppression of HIV-1 RNA load . The intervention involved sending weekly messages to patients inquiring how they were doing ; participants were required to respond either that they were well or that there was a problem . Objectives 1 ) Describe problems participants identified through mobile phone support and reasons why participants did not respond to the messages ; 2 ) investigate factors associated with indicating a problem and not responding ; and 3 ) examine participant perceptions of the intervention . Design Secondary analysis of WelTel Kenya1 trial data . Methods Reasons participants indicated a problem or did not respond were extracted from the study log . Negative binomial regression was used to determine participant characteristics associated with indicating a problem and non-response . Data from follow-up question naires were used to describe participant perceptions of the intervention . Results Between 2007 and 2009 , 271 participants generated 11,873 responses ; 377 of which indicated a problem .  Health issues were the primary reason for problem responses ( 72 % ) . Rural residence ( adjusted incidence rate ratio [ IRR ] 1.96 ; 95%CI 1.19–3.25 ; p = 0.009 and age were associated with indicating a problem ( adjusted IRR 0.63 per increase in age group category ; 95%CI 0.50–0.80 ; p<0.001 ) . Higher educational level was associated with a decreased rate of non-response ( adjusted IRR 0.81 ; 95%CI 0.69–0.94 ; p = 0.005 ) . Of participants interviewed , 62 % ( n = 129 ) stated there were no barriers to the intervention ; cell phone issues were the most common barrier . Benefits included reminding patients to take medication and promoting a feeling that “ someone cares ” . Conclusions The WelTel intervention enabled frequent communication between clinicians and patients during the WelTel Kenya1 trial . Many patients valued the service for the support it provided , with health-related concerns comprising the majority of problems identified by participants . Few sociodemographic characteristics were associated with participant engagement in the intervention Background The World Health Organization now recommends parasitological confirmation for malaria case management . Rapid diagnostic tests ( RDTs ) for malaria are an accurate and simple diagnostic to confirm parasite presence in blood . However , where they have been deployed , adherence to RDT results has been poor , especially when the test result is negative . Few studies have examined adherence to RDTs distributed or purchased through the private sector . Methods The Rapid Examination of Malaria and Evaluation of Diagnostic Information ( REMEDI ) study assessed the acceptability of and adherence to RDT results for patients seeking care from private sector drug retailers in two cities in Oyo State in south-west Nigeria . In total , 465 adult participants were enrolled upon exit from a participating drug shop having purchased anti-malaria drugs for themselves . Participants were given a free RDT and the appropriate treatment advice based on their RDT result . Short Message Service ( SMS ) text messages reiterating the treatment advice were sent to a r and omly selected half of the participants one day after being tested . Participants were contacted via phone four days after the RDT was conducted to assess adherence to the RDT information and treatment advice . Results Adherence to RDT results was 14.3 percentage points ( P-val < 0.001 ) higher in the treatment group who were sent the SMS . The higher adherence in the treatment group was robust to several specification tests and the estimated difference in adherence ranged from 9.7 to 16.1 percentage points . Further , the higher adherence to the treatment advice was specific to the treatment advice for anti-malarial drugs and not other drugs purchased to treat malaria symptoms in the RDT-negative participants who bought both anti-malarial and symptom drugs . There was no difference in adherence for the RDT-positive participants who were sent the SMS . Conclusions SMS text messages substantially increased adherence to RDT results for patients seeking care for malaria from privately owned drug retailers in Nigeria and may be a simple and cost-effective means for boosting adherence to RDT results if and when RDTs are introduced as a commercial retail product Background Low rates of adherence to artemisinin-based combination therapy ( ACT ) regimens increase the risk of treatment failure and may lead to drug resistance , threatening the sustainability of current anti-malarial efforts . We assessed the impact of text message reminders on adherence to ACT regimens . Methods Health workers at hospitals , clinics , pharmacies , and other stationary ACT distributors in Tamale , Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment . The messaging system automatically r and omized self-enrolled individuals to the control group or the treatment group with equal probability ; those in the treatment group were further r and omly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals . The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation . We estimated the impact of the messages on treatment completion using logistic regression . Results 1140 individuals enrolled in both the study and the text reminder system . Among individuals in the control group , 61.5 % took the full course of treatment . The simple text message reminders increased the odds of adherence ( adjusted OR 1.45 , 95 % CI [ 1.03 to 2.04 ] , p-value 0.028 ) . Receiving an additional message did not result in a significant change in adherence ( adjusted OR 0.77 , 95 % CI [ 0.50 to 1.20 ] , p-value 0.252 ) . Conclusion The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment . Further research is needed to develop the most effective text message content and frequency . Trial Registration Clinical Trials.gov This paper presents the results of a qualitative study to investigate the perceptions and experiences of health workers involved in a a cluster-r and omized controlled trial of a novel intervention to improve health worker malaria case-management in 107 government health facilities in Kenya . The intervention involved sending text-messages about paediatric outpatient malaria case-management accompanied by “ motivating ” quotes to  health workers ’ mobile phones . Ten malaria messages were developed reflecting recommendations from the Kenyan national guidelines . Two messages were delivered per day for 5 working days and the process was repeated for 26 weeks ( May to October 2009 ) . The accompanying quotes were unique to each message . The intervention was delivered to 119 health workers and there were significant improvements in correct artemether-lumefantrine ( AL ) management both immediately after the intervention ( November 2009 ) and 6 months later ( May 2010 ) . In-depth interviews with 24 health workers were undertaken to investigate the possible drivers of this change . The results suggest high acceptance of all components of the intervention , with the active delivery of information in an on the job setting , the ready availability of new and stored text messages and the perception of being kept ‘ up to date ’ as important factors influencing practice . Applying the construct of stages of change we infer that in this intervention the SMS messages were operating primarily at the action and maintenance stages of behaviour change achieving their effect by creating an enabling environment and providing a prompt to action for the implementation of case management practice s that had already been accepted as the clinical norm by the health workers . Future trials testing the effectiveness of SMS reminders in creating an enabling environment for the establishment of new norms in clinical practice as well as in providing a prompt to action for the implementation of the new case-management guidelines are justified Objective : There is limited evidence on whether growing mobile phone availability in sub-Saharan Africa can be used to promote high adherence to antiretroviral therapy ( ART ) . This study tested the efficacy of short message service ( SMS ) reminders on adherence to ART among patients attending a rural clinic in Kenya . Design : A r and omized controlled trial of four SMS reminder interventions with 48 weeks of follow-up . Methods : Four hundred and thirty-one adult patients who had initiated ART within 3 months were enrolled and r and omly assigned to a control group or one of the four intervention groups . Participants in the intervention groups received SMS reminders that were either short or long and sent at a daily or weekly frequency .  Adherence was measured using the medication event monitoring system .  The primary outcome was whether adherence exceeded 90 % during each 12-week period of analysis and the 48-week study period . The secondary outcome was whether there were treatment interruptions lasting at least 48 h. Results : In intention-to-treat analysis , 53 % of participants receiving weekly SMS reminders achieved adherence of at least 90 % during the 48 weeks of the study , compared with 40 % of participants in the control group ( P = 0.03 ) . Participants in groups receiving weekly reminders were also significantly less likely to experience treatment interruptions exceeding 48 h during the 48-week follow-up period than participants in the control group ( 81 vs. 90 % , P = 0.03 ) . Conclusion : These results suggest that SMS reminders may be an important tool to achieve optimal treatment response in re source -limited setting INTRODUCTION We will be unable to achieve sustained impact on health outcomes with community health worker (CHW)-based interventions unless we bridge the gap between small scale efficacy studies and large scale interventions . Effective strategies to support the management of CHWs are central to bridging the gap . Mobile phones are broadly available , particularly in low and middle income countries ( LAMIC 's ) , where the penetration rate approaches 100 % . In this article we describe how mobile phones may be combined with mobile web-based technology to assist in the management of CHWs in two projects in South Africa . METHODS This paper is a descriptive one , drawing lessons from two R and omised Controlled Trials ( RCT ' s ) , outlining how a mobile phone information system can be utilized to enhance the quality of health interventions . We organized our comprehensive management and supervision system around a previously published management framework . The system is composed of mobile phones utilized by CHWs and a web-based interface utilized by CHW supervisors  . Computerized algorithms were design ed with intervention and assessment protocol s to aid in the real-time supervision and management of CHWs . RESULTS CHWs used mobile phones to initiate intervention visits and trigger content to be delivered during the course of intervention visits . Supervisors used the web-based interface for real-time monitoring of the location , timing , and content of intervention visits . Additional real-time support was provided through direct support calls in the event of crises in the field . CONCLUSION Mobile phone-based information system platforms offer significant opportunities to improve CHW-delivered interventions . The extent to which these efficiency gains can be translated into realized health gains for communities is yet to be tested OBJECTIVE South Africa has one of the highest human immunodeficiency virus ( HIV ) prevalence rates in the world , but despite the well-established benefits of HIV counseling and testing ( HCT ) , there is low uptake of HCT . The study aim ed to investigate the effectiveness of using short message services ( SMSs ) to encourage HCT while interrogating the impact of altering SMS content and dosage ( the number of SMSs ) . MATERIAL S AND METHODS About 2,533 participants were recruited via an SMS sent to 24,000 mobiles r and omly sample d from a pre-existing data base . Recruits were r and omly allocated to four intervention groups that received 3 or 10 informational ( INFO ) or motivational ( MOTI ) SMSs , and a control group . After the intervention , participants were prompted to go for HCT , and postintervention assessment was done after 3 weeks . RESULTS In comparison with the control , receipt of 10 MOTI messages had the most impact on uptake of HCT with a 1.7-fold increased odds of testing ( confidence interval 95 % ; p=0.0036 ) . The lack of efficacy of three SMSs indicates a threshold effect , that is , a minimum number of MOTI SMSs is required . INFO SMSs , whether 3 or 10 were sent , did not have a statistically significant effect . The cost can be calculated for the marginal effect of the SMSs , that is , the cost to get people to test over and above those who were likely to test without the intervention . Use of 10 MOTI SMSs yielded a cost-per-tester of $ 2.41 . CONCLUSIONS While there are method ological issues apparent in our study , the results demonstrate the potential of SMSs to influence the uptake of HCT , the importance of appropriate content , and the need to determine a threshold for SMS-based interventions . These results indicate a potential for SMSs to be used more generally for interventions encouraging people to take health-related actions , and the need for further research in this field . The reasonable cost-per-tester is promising for the scale-up of such an intervention Background Effective use of proven treatments for high blood pressure , a preventable health risk , is challenging for many patients . Prompts via mobile phone SMS-text messaging may improve adherence to clinic visits and treatment , though more research is needed on impact and patient perceptions of such support interventions , especially in low-re source setting s. Method An individually-r and omised controlled trial in a primary care clinic in Cape Town ( 2012–14 ) , tested the effect of an adherence support intervention delivered via SMS-texts , on blood pressure control and adherence to medication , for hypertensive patients . ( Trial registration : Clinical Trials.gov NCT02019823 ) . We report on a qualitative evaluation that explored the trial participants ’ experiences and responses to the SMS-text messages , and identified barriers and facilitators to delivering adherence support via patients ’ own mobile phones . Two focus groups and fifteen individual interviews were conducted 
    Output:
    
Results Review of these texts reveals ambivalence in the appraisal of mHealth ; essentially , the critical stance in general analyses/overviews is absent from project assessment s. Especially weak evidence concerning sustainability and scalability is stressed in overviews .
Project assessment s are more optimistic .
Their analysis suggests a causal connection between simplicity and success .
Effective interventions are thus characterized by straightforward design and modest objectives .
Greatest impediments of impact are general technology-related issues and intervention inappropriateness due to insufficient underst and ing of beneficiaries and specific context of use ( circumstantial complications ) .
Conclusion Distinguishing between these two categories of complications helps to break the deadlock that marks the mHealth debate and add nuance to cl aims that mHealth 's evidence base is weak .