Results
Viral suppression
SAID
Between July 2016 and December 2017, 135 women were screened, of whom 119 (88%) were enrolled (Fig. 
Consort Diagram for Participants had a mean age of 33.9 (standard deviation [
Enrollment socio-demographic and clinical characteristics by study conditionMarriedNever MarriedWidowed/Divorced10.9 (13)21.0 (25)58.0 (69)5.0 (3)21.7 (13)61.7 (37)16.9 (10)20.3 (12)54.2 (32)Years of SchoolMean (SD)Christian % (n)Muslim % (n)Other % (n)69.7 (83)14.3 (17)0.8 (1)68.3 (41)13.3 (8)1.7 (1)71.2 (42)15.3 (9)0.0 (0)Condomless sexAbstinent29.4 (35)18.5 (22)31.7 (19)13.3 (8)27.1 (16)23.7 (14)100% condom# sex acts (Median, IQR)# sex partners (Median, IQR)61.5 (56)2.0 (1.0, 5.0)2.0 (1.0, 5.0)62.0 (31)3.0 (1.0, 5.3)2.0 (1.0, 5.3)61.0 (25)2.0 (1.0, 3.0)1.0 (1.0, 3.0)At the primary endpoint analysis at six months, viral suppression was observed in 35/51 (69%) women in the intervention arm compared to 34/54 (63%) women in the control arm (Table 
Viral suppression (*Relative Risk from log binomial generalized linear modelPerfect adherence by VAS was higher in intervention participants compared to control participants during every month of the intervention. The greatest difference, and the only one that was statistically significant, was adherence in the first month following initiation of the ART regimen (53/57 [93%] versus 37/52 [71%], RR 1.31, 95% CI 1.08, 1.58; Table 
Adherence outcomes over the six month intervention period by study conditionMonth 1Month 2Month 3Month 4Month 5Month 682.6 (90/109)88.0 (88/100)89.8 (88/98)86.0 (86/100)83.5 (81/97)83.5 (81/97)93.0 (53/57)88.2 (45/51)90.2 (46/51)88.0 (44/50)89.8 (44/49)87.2 (41/47)71.2 (37/52)87.8 (43/49)89.4 (42/47)84.0 (42/50)77.1 (37/48)80.0 (40/50)1.311.011.011.051.161.091.08, 1.580.87, 1.160.88, 1.150.89, 1.230.97, 1.400.91, 1.300.010.910.900.590.090.32*Relative Risk from log binomial generalized linear model.Relative to women in the control arm, women in the intervention arm endorsed higher values on the LW-IMB-AAQ [Participant-level feasibility was assessed by the rate of response for text messages. Each woman in the intervention arm was sent 50 text messages during the six-month study period. All intervention participants responded to at least one message. The average overall response rate was 1,595/2,900 (55%). The response rate decreased slightly over time, with 402/638 (63%) messages eliciting a response during the first month compared to 191/406 (47%) messages eliciting a response during month six (Fig. 
Proportion of responses to study text messages over the six month intervention periodInterviews focused on participant-level acceptability were conducted with 91 of 106 women who completed the study, including 48/50 (96%) intervention and 43/56 (77%) control participants. Overall, women reported feeling highly motivated to adhere to ART for their health (36%, 33/91), children (22%, 20/91), and longevity (20%, 18/91). All women reported that the clinic cared about their wellbeing, with several women mentioning that they felt like they “received good attention,” and were appreciative of staff “provid[ing] hope” and “encouragement.”Among intervention participants, feedback about the intervention content was overwhelmingly positive. One woman summarized: “The messages [I] was receiving gave me hope. I felt I was not alone.” All intervention participants felt that the text messages improved their overall wellbeing and ART adherence, indicating that they “helped motivate me to take my drugs” and “reduced [the] stress [of taking ART].” When asked what message content was most meaningful, the most common responses included religion (10/48, 20%), children and families (6/48, 13%), and support from clinic staff (3/48, 6%). For example, “The messages telling me I am important and needed in the lives of my children and being told I am beautiful motivate me a lot.” None of the women expressed dissatisfaction about the message content and all stated that they found the intervention helpful. Five (10%) women had suggestions for making the content of the text messages more meaningful and increasing the effectiveness of the intervention. Two (4%) suggested increasing the religious messaging and two (4%) suggested that “messages should be sent only on weekdays” because “if you asked a question on Saturday…you have to wait until Monday [to get a call].”The structure of the intervention was generally well-received. Forty-four (92%) participants indicated that the message frequency was “good,” while two (4%) suggested there were too few messages and two (4%) suggested there were too many. Six (12%) women reported difficulty responding to messages due to lack of airtime credit. Three (6%) women felt that nurses took too long to call them back when they had a question. One said, “When I ask or reply with a question, I would prefer to talk then and there so that if there is a problem it is solved immediately.” In addition, two (4%) women suggested that nurses should respond to questions via text.Women consistently reported that they appreciated the measures taken to protect their confidentiality. For example, one woman reported that referring to ART as blood pressure medication “guaranteed confidentiality.” Sixteen (33%) women in the intervention arm volunteered that at least one person was curious about their study text messages, but there was no inadvertent disclosure. To ensure confidentiality, one woman shared that she deleted the text messages after reading them.