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The results of this paper will be disseminated as peer-reviewed publications, at conferences and as part of a doctoral thesis.This individual patient data meta-analysis may provide important insights into the effects of text messaging on ART adherence in different subpopulations, with important implications for programme implementation involving such interventions and future research.

It will also provide the most accurate estimation of the extent to which, and the subpopulations in whom, we can expect text messages to improve adherence.

Forest plots will be graphed for all pooled effects.

An individual patient random-effect meta-analysis will be conducted to determine the overall effect of text messaging on adherence, with ‘study’ as a random effect, to model variation across studies and to account for clustering within a study.27 This analysis will be repeated for secondary outcomes.

Key among the developments to control HIV is the advent of antiretroviral therapy (ART).

ART has been shown to slow down disease progression, prevent transmission and boost immunity; however, its success depends on patients achieving high levels of medication adherence.2 Even though some evidence suggests that patients with lower levels of adherence can still achieve viral suppression,3 7 ART adherence can be influenced by a number of factors broadly categorised into patient-related factors, medication characteristics, health system characteristics and disease characteristics.8–13 More specifically, females, people aged above 50 years and the more educated are more likely to be adherent to ART.9 16 There is an emerging evidence that mobile phones can play an important role in healthcare delivery, especially in resource-limited settings.17 The appeal of using phones to promote adherence has grown as phone ownership rates continue to rise in sub-Saharan Africa and elsewhere.18 Short message service (SMS) is a particularly useful application that can be used to collect or share information and to enhance communication between health personnel and patients in a low-cost manner.19 With regard to patient management, mobile phone text messages have been demonstrated to induce positive behaviour changes in domains such as smoking cessation, physical activity and self management of high blood pressure, diabetes and asthma.20 Other studies report high levels of satisfaction among participants.21 22 In light of these, one can expect SMS texting to serve as reminders to take medication, provide greater connectedness with a provider or provide encouragement to remain adherent to ART.

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The final data set will include the following baseline covariates: age (years), gender (male/female), level of education (none, primary, secondary or higher) and duration on ART (months).

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