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Accepted for/Published in: JMIR Cardio

Date Submitted: Nov 21, 2024
Open Peer Review Period: Nov 21, 2024 - Jan 16, 2025
Date Accepted: Apr 30, 2026
(closed for review but you can still tweet)

The final, peer-reviewed published version of this preprint can be found here:

Bidirectional Automated Texting for Cardiovascular Health Among People Living With HIV: Observational Cohort Analysis of a Stepped-Wedge Cluster Randomized Controlled Trial

Sanders M, Harrington D, Stujo E, Thomas M, Holder T, Tian Y, Johnson B, Cassells A, Tobin JN, Fiscella K

Bidirectional Automated Texting for Cardiovascular Health Among People Living With HIV: Observational Cohort Analysis of a Stepped-Wedge Cluster Randomized Controlled Trial

JMIR Cardio 2026;10:e69098

DOI: 10.2196/69098

PMID: 42447296

Bidirectional automated texting to improve cardiovascular health among people with HIV: Findings from a Stepped-wedge cluster randomized controlled trial

  • Mechelle Sanders; 
  • Donald Harrington; 
  • Emma Stujo; 
  • Marie Thomas; 
  • Tamier Holder; 
  • Yiqi Tian; 
  • Brent Johnson; 
  • Andrea Cassells; 
  • Jonathan N. Tobin; 
  • Kevin Fiscella

ABSTRACT

Background:

Bidirectional automated texting (BAT) is a low-cost, highly scalable means for communicating with people living with HIV (PLWH). Little is known regarding capabilities, constraints, and factors that affect low-income PLWH engaging with texting.

Objective:

To determine factors that affect PLWH to engage with texting around CVD, particularly among those with low incomes

Methods:

We used data from an implementation trial to assess patients’ capabilities and technological constraints and how these factors affected their engagement in a BAT program to address the “Million Hearts” ABCS of cardiovascular health (Aspirin therapy, Blood Pressure Control, Cholesterol Management and Smoking Cessation).

Results:

Of the 471 participants, almost all owned a smartphone (94%) and had monthly incomes of less than $1500 (69%). Eighty-one percent engaged with the BAT intervention at least once. In our unadjusted model, perceived texting ability, primary language spoken, income and race were associated with sending at least one text. After adjusting for potential confounders, among those who ever texted, expert self-perceived texting ability was the only factor associated with the number of texts sent (p=0.04).

Conclusions:

Nearly all participants in the study managed to engage with the BAT at least once. The BAT intervention for ABCS appears to be an effective intervention for PLWH that is accessible across a range of socioeconomic status levels. Clinical Trial: ClinicalTrials.gov NCT03902431


 Citation

Please cite as:

Sanders M, Harrington D, Stujo E, Thomas M, Holder T, Tian Y, Johnson B, Cassells A, Tobin JN, Fiscella K

Bidirectional Automated Texting for Cardiovascular Health Among People Living With HIV: Observational Cohort Analysis of a Stepped-Wedge Cluster Randomized Controlled Trial

JMIR Cardio 2026;10:e69098

DOI: 10.2196/69098

PMID: 42447296

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