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We evaluated a behaviourally-informed two-way text messaging intervention to increase re-engagement in care following missed visits. We conducted an individual-level randomised controlled trial between February and March 2023 in Capricorn District, South Africa. Adults aged\u2009\u2265\u200918 years who had missed an ART visit by &gt;\u200928 days were randomised to (1) a standard one-way text message, or (2) behaviourally-informed two-way text messages. The primary outcome was return to care within 45 days, analysed as (1) intention to treat, and (2) restricted to successful message delivery. 3,695 participants were randomised: 1,845 to the one-way message group and 1,850 to the two-way message group. 27.9% (515\/1845) of participants sent a one-way message and 27.2% (503\/1850) sent a two-way message returned for an ART visit within 45 days (proportion difference: -0.7%, p-value: 0.622). In an analysis restricted to participants whose text message was delivered, 28.3% (310\/1094) in the one-way message group compared to 28.3% (304\/1076) in the two-way message group returned to care (proportion difference: -0.09%, p-value: 0.966). 19.5% (210\/1076) responded to the two-way message. The two most reported reasons for missed appointments were being out of town (41.0%) and still having medication (31.0%.). Behaviourally-informed two-way text messages did not improve return to care over one-way messages. However, they elicited reasons for disengagement. Additional research is needed on the mode, content and timing of two-way messages intended to increase return to care.<\/jats:p>\n                  <jats:p>\n                    <jats:italic>Clinical Trial Number<\/jats:italic>\n                    : PACTR202202748760768 &amp; DOH-27-042022-6703. 28 February 2022.\n                  <\/jats:p>","DOI":"10.1007\/s10461-025-04808-6","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T09:45:23Z","timestamp":1752227123000},"page":"3661-3672","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Behaviourally-Informed Two-Way Text Messaging to Improve Return to HIV Care in South Africa: Evidence from a Randomised Controlled Trial"],"prefix":"10.1007","volume":"29","clinical-trial-number":[{"clinical-trial-number":"pactr202202748760768","registry":"10.18810\/pactr"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8710-2824","authenticated-orcid":false,"given":"Christine","family":"Njuguna","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preethi","family":"Mistri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Long","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candice","family":"Chetty-Makkan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan","family":"Maughan-Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Buttenheim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Schmucker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Pascoe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsha","family":"Thirumurthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cara","family":"O\u2019Connor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Mutasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Rees","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"4808_CR1","unstructured":"Johnson LF, Dorrington RE. 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