Porting CONSORT checklist are available as supporting information; see Checklist S1 and Protocol S1.ParticipantsParticipants were recruited from the Yaounde Central Hospital ?(YCH) Accredited Treatment Centre (ATC). The adult prevalence of HIV in Cameroon was 5.3 in 2009 [15]. The YCH is a referral hospital with a capacity of 381 beds, and staffed by 95 doctors and 270 nurses [16]. The ATC registers approximately 40 new cases per week and caters to approximately 6500 regular MNS site clients. It is the largest HIV/AIDS management clinic in Cameroon and enabled rapid recruitment. We included subjects who were 22948146 aged above 21 years; owned a mobile phone; who could read text 12926553 messages; and who had been on ART for at least one month. Only those who providedOutcomesOur primary outcome was adherence, measured using three methods: a Visual Analogue Scale (VAS); Self Report (SR); and Pharmacy Refill Data (PRD). Our Secondary outcomes were clinical: weight, body mass index (BMI), opportunistic infections (OI); QOL: Measured using the SF-12 QOL assessment form [12]; all cause mortality and retention in the trial.Sample sizeOur study was designed to detect a 20 increase in adherence in the intervention arm. Sample size was calculated 
using WINPEPI (PEPI- for-windows) version 9.5 software [19]. DetailsText Messages for Adherence in HIVof the assumptions used to arrive at a sample of 198, taking into account an attrition rate of 
20 are reported in the protocol [13]. In brief, the study had 80 power to detect a statistically significant relative risk (alpha set at a = 0.05) using a two-tailed chi-squared test and assuming 60 and 80 adherence rates in the control and intervention groups respectively. Based on other studies using SMS to improve adherence [20] and reported adherence rates in Cameroon [21], it was estimated that at least a 20 increase in adherence was necessary to achieve adherence rates above 95 .Randomization, 223488-57-1 biological activity allocation concealment and implementationUsing a parallel group design, eligible and consenting patients were randomized to intervention and control arms with a 1:1 allocation ratio. A computer generated randomization list was established using random block sizes of 2, 4 and 6, by the Father Sean O’Sullivan Research Centre Biostatistics Unit at St Joseph’s Healthcare/McMaster University (http://www.thecem.net/ sjhsrn.php) in Canada. The allocation codes were then sequentially affixed to the phone numbers of consecutively recruited participants by trained research staff at the YCH ATC. This sequence was sent to the research centre by email, and concealed in a password-protected computer until interventions were assigned.BMI and the presence of an OI) were performed using standard binary logistic regression techniques to investigate the residual impact of these characteristics on the primary outcome. We included the interaction term for the intervention variable and the following covariates: age group, gender, level of education and regimen. These covariates are reported to affect adherence rates to ART [11]. Goodness-of-fit was assessed by examining the residuals for model assumptions and the Hosmer and Lemeshow test of goodness-of-fit. The p-values for the interaction terms are reported. All analyses were performed using SPSS (Statistical Package for the Social Sciences) version 16.0 for Windows and WINPEPI [19].Results Recruitment, baseline data and participant flowBetween November and December 2010, 228 patients were approached for.Porting CONSORT checklist are available as supporting information; see Checklist S1 and Protocol S1.ParticipantsParticipants were recruited from the Yaounde Central Hospital ?(YCH) Accredited Treatment Centre (ATC). The adult prevalence of HIV in Cameroon was 5.3 in 2009 [15]. The YCH is a referral hospital with a capacity of 381 beds, and staffed by 95 doctors and 270 nurses [16]. The ATC registers approximately 40 new cases per week and caters to approximately 6500 regular clients. It is the largest HIV/AIDS management clinic in Cameroon and enabled rapid recruitment. We included subjects who were 22948146 aged above 21 years; owned a mobile phone; who could read text 12926553 messages; and who had been on ART for at least one month. Only those who providedOutcomesOur primary outcome was adherence, measured using three methods: a Visual Analogue Scale (VAS); Self Report (SR); and Pharmacy Refill Data (PRD). Our Secondary outcomes were clinical: weight, body mass index (BMI), opportunistic infections (OI); QOL: Measured using the SF-12 QOL assessment form [12]; all cause mortality and retention in the trial.Sample sizeOur study was designed to detect a 20 increase in adherence in the intervention arm. Sample size was calculated using WINPEPI (PEPI- for-windows) version 9.5 software [19]. DetailsText Messages for Adherence in HIVof the assumptions used to arrive at a sample of 198, taking into account an attrition rate of 20 are reported in the protocol [13]. In brief, the study had 80 power to detect a statistically significant relative risk (alpha set at a = 0.05) using a two-tailed chi-squared test and assuming 60 and 80 adherence rates in the control and intervention groups respectively. Based on other studies using SMS to improve adherence [20] and reported adherence rates in Cameroon [21], it was estimated that at least a 20 increase in adherence was necessary to achieve adherence rates above 95 .Randomization, allocation concealment and implementationUsing a parallel group design, eligible and consenting patients were randomized to intervention and control arms with a 1:1 allocation ratio. A computer generated randomization list was established using random block sizes of 2, 4 and 6, by the Father Sean O’Sullivan Research Centre Biostatistics Unit at St Joseph’s Healthcare/McMaster University (http://www.thecem.net/ sjhsrn.php) in Canada. The allocation codes were then sequentially affixed to the phone numbers of consecutively recruited participants by trained research staff at the YCH ATC. This sequence was sent to the research centre by email, and concealed in a password-protected computer until interventions were assigned.BMI and the presence of an OI) were performed using standard binary logistic regression techniques to investigate the residual impact of these characteristics on the primary outcome. We included the interaction term for the intervention variable and the following covariates: age group, gender, level of education and regimen. These covariates are reported to affect adherence rates to ART [11]. Goodness-of-fit was assessed by examining the residuals for model assumptions and the Hosmer and Lemeshow test of goodness-of-fit. The p-values for the interaction terms are reported. All analyses were performed using SPSS (Statistical Package for the Social Sciences) version 16.0 for Windows and WINPEPI [19].Results Recruitment, baseline data and participant flowBetween November and December 2010, 228 patients were approached for.
