A triaged real-time alert intervention to improve antiretroviral therapy adherence among young African American men who have sex with men living with HIV: focus group findings

Abstract

Background Among persons living with HIV, poorer antiretroviral therapy adherence has been reported in African Americans and disproportionate mortality reported in young African American men who have sex with men (AAMSM) compared to whites. We report the results of focus groups with young AAMSM living with HIV that explore their opinions about the acceptability and feasibility of a triaged real-time missed dose alert intervention to improve treatment adherence. The purpose of this study is to develop a theory-driven triaged real-time adherence monitoring intervention to promote HIV medication adherence in young AAMSM. Methods We performed five focus groups and two individual interviews among young HIV-positive AAMSM ( n = 25) in Chicago guided by the Technology Acceptance Model and explored perceptions regarding the monitoring concept including device issues and concerns about inclusion of support persons whose involvement is triggered by sustained missed doses. The purpose was to inform the development of this intervention in this population. Results Generally, the participants found the proposed intervention acceptable and useful. Privacy was a major concern for participants especially with attention to possible disclosure of their HIV status by receiving a medication-related text that someone else might view and could lead to unwanted attention. There was concern that the device could be confused with a taser. Approximately half of the men already had a close personal contact that helped them with medication taking. Some participants acknowledged that the notification might lead to friction. Conclusions A triaged real-time alert intervention to improve treatment adherence is acceptable and feasible among young AAMSM living with HIV.

Design and Delivery of Real-Time Adherence Data to Men Who Have Sex with Men Using Antiretroviral Pre-exposure Prophylaxis via an Ingestible Electronic Sensor

“…among individuals living with HIV that have examined reactions to messaging surrounding ART adherence detected by a smart pill bottle (52,53), participants in the present study described the importance of detecting nascent nonadherence events and providing adherence supports during these times. These data suggest that the DPS can be deployed in the real world as both a clinical and research tool geared towards providing direct measures of PrEP adherence.…”

Understanding Technology Fit Among People with HIV Based on Intersections of Race, Sex, and Sexual Behavior: An Equitable Approach to Analyzing Differences Across Multiple Social Identities

“…al [55] found similar levels of computer and tablet use, albeit with a smaller sample size. Some potential reasons why our sample had lower use of digital technologies but higher willingness to use those same digital technologies for HIV-related purposes may include: limited access to the technology [56], limited technology literacy [57], lack of confidence/comfort with technologies [58], and privacyrelated concerns [30,59]. Because more people are willing to ever use digital technologies for HIV-related purposes than currently use those technologies, future interventions should focus on both increasing access to technologies and creating HIV-specific content for computer and tablets.…”

Mobile phone interventions to promote adherence to HIV treatment: mitigating the challenges

“…Research by Dworkin et al,(2009) relied upon an electronic pill counter as an alert system for their study in conjunction with an MPI. The design of the pill counter caused some issues, and this is evident by study participants stating "I thought it was a taser".…”

“…Privacy was an important factor in the study by Christopoulos et al, (2017) and the researchers ensured that there was no mention of the word 'HIV' in any of the sent text messages during the study. This was an important factor identified in Dworkin's et al, (2009) study who referred to a suggestion by a study participant that messages could use other language instead to describe HIV.…”

“…Additionally, Dworkin et al, (2009) report that if study participants omitted medication for seven consecutive days, a healthcare professional would contact them to help resolve any problems preventing treatment adherence. The disadvantage here is that such a model could censure, rather than support a person with HIV.…”