Tailoring a mobile health text-messaging intervention to promote antiretroviral therapy adherence among African Americans: A qualitative study.

Elizabeth C Pasipanodya,Joel Trambley,John Kua,Rogelio Garcia,Verna Gant,Caitlin W.-M Watson,Jessica L Montoya,Martin Hoenigl,David J Moore,María J Marquine,Tamara Taggart

doi:10.1371/journal.pone.0233217

Elizabeth C Pasipanodya, Joel Trambley + Show 9 more

Open Access

https://doi.org/10.1371/journal.pone.0233217

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Abstract

African Americans are disproportionately affected by HIV and socio-structural barriers that impact antiretroviral (ART) adherence. Two-way text-messaging interventions have shown promise in supporting adherence in US studies of mostly White people living with HIV (PLWH). However, culturally-appropriate tailoring is necessary to maximize intervention effectiveness among other racial/ethnic groups. Thus, to refine an existing text-messaging intervention, we examined barriers and facilitators to ART adherence among African Americans and perspectives on features to integrate into the extant intervention. Three focus groups, two with African American PLWH (n = 5 and n = 7) and one with providers of care (n = 11) were conducted; transcripts of audio-recordings were thematically analyzed. Adherence supports operated at individual, interpersonal, and structural/environmental levels (e.g., using reminders and pill organizers, wanting to protect partners from HIV, and positive interactions with providers). Adherence barriers also operated at multiple ecological levels (e.g., poor mental health, fear of disclosure of HIV status, and unstable housing). Participant-suggested features for refinement included: i) matching content to participants’ comfort with receiving messages referencing HIV or medication-taking, ii) culturally-tailoring content for African Americans, iii) tracking adherence, and iv) encouraging adherence interactions between patients and providers. Feedback from both patients and providers is foundational to designing effective ART interventions among African American PLWH.

Highlights

Seventy percent of the 1.2 million people living with HIV (PLWH) in the United States are racial/ethnic minorities and African Americans are most affected by HIV
Twelve African American PLWH participated in two patient focus groups (n = 5 and n = 7, respectively) and 11 providers of clinical care participated in a provider group between February and March 2017
Thematic analyses of focus groups involving African American PLWH and providers of care indicated that barriers and supports to antiretroviral therapy (ART) adherence operate at multiple ecological levels to impact ART adherence

Summary

Introduction

Seventy percent of the 1.2 million people living with HIV (PLWH) in the United States are racial/ethnic minorities and African Americans are most affected by HIV. Socio-structural barriers, including limited access to health insurance and quality healthcare, poverty, discrimination and stigma, inadequate supportive housing, and insufficient services for mental health and substance use concerns, have been identified as important factors reducing rates of ART adherence among African Americans [7, 8]. Many of the previously-stated socio-structural barriers that impact adherence limit utilization and reach of auxiliary healthcare services, necessitating alternative methods of providing support [15, 16]. Much of the evidence supporting two-way text-messaging for ART adherence among US populations was accumulated in studies of predominantly White participants; interventions should be appropriately-tailored to meet the needs of specific PLWH populations to enhance their impact [22, 26]. We solicited and obtained feedback to modify an extant intervention (iTAB) to match the expressed needs and concerns of African American PLWH

Participants and procedure

Results

Discussion