Acceptability of a Mobile Phone Support Tool (Call for Life Uganda) for Promoting Adherence to Antiretroviral Therapy Among Young Adults in a Randomized Controlled Trial: Exploratory Qualitative Study

Abstract

Background Adherence to treatment is critical for successful treatment outcomes. Although factors influencing antiretroviral therapy (ART) adherence vary, young adults are less likely to adhere owing to psychosocial issues such as stigma, ART-related side effects, and a lack of access to treatment. The Call for Life Uganda (CFLU) mobile health (mHealth) tool is a mobile phone–based technology that provides text messages or interactive voice response functionalities through a web interface and offers 4 modules of support. Objective This study aims to describe the acceptability and feasibility of a mobile phone support tool to promote adherence to ART among young adults in a randomized controlled trial. Methods An exploratory qualitative design with a phenomenological approach at 2 study sites was used. A total of 17 purposively selected young adults with HIV infection who had used the mHealth tool CFLU from 2 clinics were included. In total, 11 in-depth interviews and 1 focus group discussion were conducted to examine the following topics: experience with the CFLU tool (benefits and challenges), components of the tool, the efficiency of the system (level of comfort, ease, or difficulty in using the system), how CFLU resolved adherence challenges, and suggestions to improve CFLU. Participants belonged to 4 categories of interest: young adults on ART for the prevention of mother-to-child transmission, young adults switching to or on the second-line ART, positive partners in an HIV-discordant relationship, and young adults initiating the first-line ART. All young adults had 12 months of daily experience using the tool. Data were analyzed using NVivo version 11 software (QSR International Limited) based on a thematic approach. Results The CFLU mHealth tool was perceived as an acceptable intervention; young adults reported improvement in medication adherence, strengthened clinician-patient relationships, and increased health knowledge from health tips. Appointment reminders and symptom reporting were singled out as beneficial and helped to address the problems of forgetfulness and stigma-related issues. HIV-related stigma was reported by a few young people. Participants requested extra support for scaling up CFLU to make it more youth friendly. Improving the tool to reduce technical issues, including network outages and a period of software failure, was suggested. They suggested that in addition to digital solutions, other support, including the promotion of peer support meetings and the establishment of a designated space and staff members for youth, was also important. Conclusions This mHealth tool was an acceptable and feasible strategy for improving ART adherence and retention among young adults in resource-limited settings. Trial Registration ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080

Stakeholders’ Perceptions of Benefits of and Barriers to Using Video-Observed Treatment for Monitoring Patients With Tuberculosis in Uganda: Exploratory Qualitative Study

“…Previous VDOT studies conducted in India, the United States, and Vietnam have also reported similar mixed concerns with privacy [ 24 , 25 , 39 ]. The importance of preserving confidentiality, guarding against unintended disease disclosure, and stigma also emerged as prominent themes in studies on acceptance of mobile health (mHealth) interventions among people living with HIV in rural and urban Uganda [ 26 , 30 , 45 ]. Indeed, the use of any mHealth interventions in monitoring treatment should be ethically comparable with the standard of care [ 38 ].…”

Para além da busca ativa: motivações para retorno ao tratamento de HIV [Beyond active search: motivations for returning to HIV treatment] [Más allá de la búsqueda activa: motivaciones para volver al tratamiento del VIH]

“…Dedde modo, com a finalidade de reduzir as taxas de abandono, favorecer a adesão e retenção ao tratamento e melhorar o cuidado das PVHIV, diferentes estratégias podem ser utilizadas pelos profissionais da saúde. Por exemplo, estudo realizado em Uganda junto a PVHIV mostrou que a utilização de mensagens de texto e ligação como meio de educação em saúde levaram a maior adesão à medicação, fortalecimento de vínculo com os profissionais e o aumento do conhecimento sobre o cuidado com a saúde 30 .…”

Perceptions and Attitudes Toward an Interactive Voice Response Tool (Call for Life Uganda) Providing Adherence Support and Health Information to HIV-Positive Ugandans: Qualitative Study

“…This substudy also complements our parent study that was conducted to determine the impact of IVR technology on Medical Outcomes HIV Quality of Life scores and viral suppression at 12 months, which showed better study outcomes and higher quality-of-life scores for participants with higher use of the CFLU tool than for low users [ 45 ]. It further complements another study (qualitative) by the team that explored the acceptability of a mobile phone support tool (CLFU) for promoting adherence to ART among young adults in a substudy of the RCT [ 48 ]. However, our study explored similarities and differences in the experiences, perceptions, and attitudes of people living with HIV regarding the CFLU tool among 3 categories based on the proportion of calls responded to.…”

“…At baseline, participants in the intervention arm were trained on how to initiate and receive calls, and the messages were provided in four languages: English, Luganda, Kiswahili, and Runyankore. A description of how the tool was introduced to the participants is detailed in 2 separate study publications that include the RCT study and the qualitative exploratory study findings [ 45 , 48 ]. At baseline, all patients underwent a quality-of-life assessment, which was repeated at months 6, 12, and 24.…”