We also used weekly messages like the Kenyan trials, but did not observe any significant benefits. Both Kenyan trials ran for up to one year, while our trial ended at 6 months. The duration of our trial might not have been sufficient to observe a significant effect. Another important difference is the fact that both Kenyan trials enrolled participants who had recently initiated ART. The median duration on ART at baseline in this study was 31 and 22 months for the intervention and control groups respectively. This may also explain the negative results, . We speculate that the SMS may be more effective in treatment-naı¨ve populations. While the risk of disclosure of status has been mentioned in some studies, this is the first study documenting a case of withdrawal for privacy reasons. In Cameroon, there is still a lot of stigma associated with HIV, and it is a known cause of poor adherence. Although we did not include the term “HIV” in the content of the text messages, we did include “medications” and gave a clinic number which could arouse suspicion by non-participants reading the message. Interestingly, we had a very high proportion of clients in this study who reported having disclosed their status to their families. This may have reflected a selection bias for enrolment, and larger benefits may have been observed in individuals who do not realize the support of disclosing. Confidentiality and disclosure are important Perifosine considerations for the scale-up of text message interventions. High levels of satisfaction have been documented in other text message trials, particularly in those which offer two way communication. While the majority of participants in our trial were satisfied with the text messages, a considerable number did not want the intervention to continue. A study conducted prior to this trial reported that patients would like to receive messages with a wide variety of characteristics in terms of timing, content and source. Some participants might not have wanted to continue if the messages weren’t tailored to their needs. Yet, more than 80% would recommend it to their friends. Further research is needed on how best to tailor text messages. It is unclear whether the content of the message played a role in the outcomes, as other trials with no motivational component have reported improvements in adherence. The ancillary analyses reported above need to be considered as secondary and therefore interpreted with caution in the light of our main findings. In conclusion, motivational text messages did not significantly improve adherence to ART among treatment experienced patients in Cameroon after 6 months. Although interactive SMS associated with access to health advice has demonstrated to be effective in at least one large clinical trial, and is reflected in current guidelines more work needs to be done to determine how motivational content can be delivered by SMS alone. Text messages may come with a small risk of disclosure of status. Further trials are critical to determine what interventions should be taken to scale. The miRNAs play a crucial role in several biological processes and act as regulators of development, differentiation and cell survival. miRNAs function by pairing with mRNAs of protein-coding genes and regulating their post-transcriptional expression. A great number of studies have indicated that miRNA expression profiles classify human cancers.