{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T22:08:07Z","timestamp":1793052487034,"version":"4.5.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003252","name":"Lunds Universitet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003252","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The rapid expansion of mobile phone access has enabled low-cost SMS interventions to support adherence to antiretroviral therapy (ART). Although text messaging improves adherence and retention in HIV care, its cost-effectiveness for enhancing quality of life remains uncertain, particularly among adolescents in resource-limited settings. This study evaluated whether SMS reminders improve retention in care and quality-adjusted life years (QALYs) among adolescents living with HIV in Ethiopia. We hypothesized that SMS reminders would increase adherence and retention, leading to measurable gains in quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 6-month economic evaluation was conducted from the health system perspective, comparing daily SMS reminders plus standard care vs. standard care alone. HRQoL was measured using the EuroQol EQ-5D-3L instrument, which includes five domains: mobility, self-care, usual activity, pain\/discomfort, and anxiety\/depression. Utility values were derived using the Zimbabwean EQ-5D-3L value set as a proxy for Ethiopia and converted into QALYs. Costs were categorized as fixed (planning, system development, training) and variable (personnel, SMS communication, equipment, and overhead), valued in 2023 US dollars (USD; 1 USD = 54.7442 ETB). The Incremental Cost-Effectiveness Ratio (ICER) was calculated as \u0394Cost\/\u0394QALY. The WHO-CHOICE cost-effectiveness threshold (&amp;lt;3 \u00d7 GDP per capita; $3,636 for Ethiopia, 2023) guided interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Daily SMS reminders were cost-effective according to WHO thresholds, with an ICER of $1,037.00 per QALY gained. Accounting for potential retention improvements, the ICER decreased to $864.00 per QALY gained. Intervention participants had higher utility scores (0.9515 vs. 0.9030) and QALYs (0.4760 vs. 0.4510) compared to controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>SMS-based adherence interventions offer a cost-efficient approach to improving ART outcomes by enhancing adherence and retention. Anxiety\/depression and pain\/discomfort were key determinants of QALYs. Future research should assess long-term cost-effectiveness and scalability in resource-limited settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PACTR202107638293593.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1718940","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T06:47:36Z","timestamp":1769150856000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Economic evaluation of digital health interventions to improve quality-adjusted life years in adolescents living with HIV in Ethiopia"],"prefix":"10.3389","volume":"14","author":[{"given":"Abayneh","family":"Tunje","sequence":"first","affiliation":[{"name":"Department of Health Sciences, Faculty of Medicine, Lund University","place":["Lund, Sweden"]},{"name":"School of Public 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