Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 12, 20-37
eCollection

Why It Worked: Participants' Insights Into an mHealth Antiretroviral Therapy Adherence Intervention in China

Affiliations

Why It Worked: Participants' Insights Into an mHealth Antiretroviral Therapy Adherence Intervention in China

Lora L Sabin et al. Open AIDS J.

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.

Keywords: ART adherence; Behavior change; China; HIV treatment; Intervention trial; mHealth.

Figures

Fig. (1)
Fig. (1)

Similar articles

See all similar articles

Cited by 3 PubMed Central articles

References

    1. Bangsberg D.R., Hecht F.M., Charlebois E.D., et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000;14(4):357–366. - PubMed
    1. Bangsberg D.R., Perry S., Charlebois E.D., Clark R.A., Roberston M., Zolopa A.R., Moss A. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15(9):1181–1183. doi: 10.1097/00002030-200106150-00015. - DOI - PubMed
    1. Hogg R.S., Heath K., Bangsberg D., Yip B., Press N., O’Shaughnessy M.V., Montaner J.S. Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up. AIDS. 2002;16(7):1051–1058. doi: 10.1097/00002030-200205030-00012. - DOI - PubMed
    1. Howard A.A., Arnsten J.H., Lo Y., Vlahov D., Rich J.D., Schuman P., Stone V.E., Smith D.K., Schoenbaum E.E., HER Study Group A prospective study of adherence and viral load in a large multi-center cohort of HIV-infected women. AIDS. 2002;16(16):2175–2182. doi: 10.1097/00002030-200211080-00010. - DOI - PubMed
    1. Arnsten J.H., Demas P.A., Grant R.W., Gourevitch M.N., Farzadegan H., Howard A.A., Schoenbaum E.E. Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. J. Gen. Intern. Med. 2002;17(5):377–381. doi: 10.1007/s11606-002-0044-3. - DOI - PMC - PubMed

LinkOut - more resources

Feedback