# Designing text-messaging (SMS) in HIV programs: ethics-framed recommendations from the field

## TL;DR

This paper provides ethical guidelines for using text messages in HIV programs to protect patient privacy and safety.

## Contribution

The paper introduces new ethical recommendations for SMS-based HIV interventions based on field experience in Southern Africa.

## Key findings

- SMS interventions in HIV programs should prioritize minimizing unwanted disclosure of HIV status.
- Ethical principles from the Belmont Report guide the design of safer SMS services for HIV care.
- Field experience in Southern Africa informs best practices for mHealth in HIV programs.

## Abstract

Text messages (SMS) are being increasingly integrated into HIV programs across Southern Africa to improve patient adherence, linkage to care and provide psycho-social support. Careful attention needs to be paid to the design of SMS-based interventions for clients of HIV-care services to ensure that any potential harm, such as unwanted disclosure of HIV status, is minimized. In this article we propose a set of best practice recommendations to ensure that any SMS-based intervention considers ethical principles to safeguard safety, autonomy and confidentiality of its targeted HIV-positive beneficiaries. This analysis draws from our operational experience in Southern Africa in the design and conduct of mHealth interventions in the frame of HIV projects. The recommendations, framed in the context of the Belmont Report's three ethical pillars, may contribute to more safely operationalize any SMS service integrated into an HIV program if adopted by mHealth planners and implementers. We encourage actors to report on the ethical and methodological pathways followed when conducting SMS-based innovations to improve the wellbeing and quality provision of HIV-care for their targeted clients.