Abstract
Background:Few Antiretroviral Therapy (ART) adherence trials investigate the reasons for intervention success or failure among HIV-positive individuals.Objectives:To conduct qualitative research to explore the reasons for effectiveness of a 6-month mHealth (mobile health) trial that improved adherence among ART patients in China. The intervention utilized Wireless Pill Containers (WPCs) to provide, real-time SMS reminders, WPC-generated adherence reports, and report-informed counseling.Methods:We conducted in-depth interviews with 20 intervention-arm participants immediately following the trial. Sampling was purposeful to ensure inclusion of participants with varied adherence histories. Questions covered adherence barriers and facilitators, and intervention experiences. We analyzed data in nVivo using a thematic approach.Results:Of participants, 14 (70%) were male; 7 (35%) had used injectable drugs. Pre-intervention, 11 were optimal adherers and 9 were suboptimal adherers, using a 95% threshold. In the final intervention month, all but 3 (85%) attained optimal adherence. Participants identified a range of adherence barriers and facilitators, and described various mechanisms for intervention success. Optimal adherers at baseline were motivated by positive adherence reports at monthly clinic visits-similar to receiving A+ grades. For suboptimal adherers, reminders facilitated the establishment of adherence-promoting routines; data-guided counseling helped identify strategies to overcome specific barriers.Conclusion:Different behavioral mechanisms appear to explain the success of an mHealth adherence intervention among patients with varying adherence histories. Positive reinforcement was effective for optimal adherers, while struggling patients benefitted from reminders and data-informed counseling. These findings are relevant for the design and scalability of mHealth interventions and warrant further investigation.
Highlights
Interventions to improve adherence to Antiretroviral Therapy (ART) medication regimens among people living with HIV (PLHIV) are critical to achieve optimal outcomes
The three who failed to achieve optimal adherence were: 1) a young male who was suboptimal at baseline; 2) a middle-aged male who was optimal at baseline; and 3) a middle-aged female who was suboptimal at baseline
When I play computer games, I cannot stop. -Male, 22, baseline suboptimal. This qualitative study aimed at exploring the reasons that an Mobile health (mHealth) ART adherence intervention trial in China proved successful in helping HIV-positive participants who were suboptimal adherers to improve their adherence, and in supporting maintenance of high adherence among those who began the trial with optimal adherence
Summary
Interventions to improve adherence to Antiretroviral Therapy (ART) medication regimens among people living with HIV (PLHIV) are critical to achieve optimal outcomes. Successful intervention approaches have included elements such as providing information to patients, engaging them in discussions of cognition and adherence expectations, directly-observed therapy, nutrition support, and drug-use treatment [22]. Mobile health (mHealth) interventions that use real-time monitoring strategies for ART are a new approach that allow early identification of adherence lapses [23 - 25]. MHealth adherence interventions have been shown to be effective in resource-limited settings, and among certain populations, such as people who inject drugs (PWID), that often face specific challenges to achieving optimal adherence [25 - 27]. Few Antiretroviral Therapy (ART) adherence trials investigate the reasons for intervention success or failure among HIV-positive individuals
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