Interactive Mobile Phone HIV Adherence Support for Men Who Have Sex With Men in the Philippines Connect for Life Study: Mixed Methods Approach to Intervention Development and Pilot Testing

Abstract

Background The HIV epidemic in the Philippines is one of the fastest growing epidemics globally, and infections among men who have sex with men are rising at an alarming rate. The World Health Organization recommends the use of mobile health (mHealth) technologies to engage patients in care and ensure high levels of adherence to antiretroviral therapy (ART). Existing mHealth interventions can be adapted and tailored to the context and population served. Objective This study aims to create a locally tailored intervention using a mobile phone platform to support treatment adherence for HIV patients on ART in the Philippines. Methods A mixed methods approach guided by the Behavior Change Wheel framework was used to adapt an existing mHealth adherence support platform for the local setting and target population. A literature review, retrospective clinical record review, and focus group discussions with patients were conducted to understand the drivers of ART adherence and tailor the intervention accordingly. The resulting intervention was pilot-tested for 8 weeks, followed by focus group discussions with patients who received the intervention to assess the acceptability of the design. Results Key issues contributing to nonadherence included side effects, lack of behavioral skills for pill taking, social support, mental health, and substance use. Patients identified mHealth as an acceptable mode of intervention delivery and wanted mHealth services to be highly personalizable. The study team, clinicians, and software developers integrated these findings into the intervention, which included a menu of services as follows: pill reminders, health tips, adherence feedback, appointment reminders, and symptom reporting. During the pilot phase, technical issues in the interactive voice response system (IVRS) were identified and addressed. Patients who participated in the pilot phase expressed a preference for SMS text messaging over the IVRS. Patients responded positively to the appointment reminders and health tips, whereas patient feedback on daily and weekly pill reminders and adherence feedback was mixed. Conclusions The mobile phone–based SMS text messaging and IVRS intervention was acceptable to men who have sex with men in Manila, the Philippines, and qualitative analysis suggested that the intervention helped promote ART adherence and appointment attendance.

A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol

“…Many mHealth interventions for medication adherence among PWH have been tested in recent years within the US [ 53 – 65 ] and abroad [ 66 – 77 ]. Past studies have identified usability, acceptability and feasibility of mHealth designed for PWH [ 53 , 55 , 60 , 61 , 67 , 69 , 73 , 74 ] and some have demonstrated efficacy in improving adherence to ART in the short-term [ 32 , 53 , 55 , 60 , 66 , 70 , 73 , 74 ]. Among mHealth interventions for PWH in the US, limited studies have recruited or plan to recruit Latino populations specifically [ 32 , 53 – 55 , 57 , 58 , 60 , 61 , 63 , 64 ].…”

Delivering an mHealth Adherence Support Intervention for Patients With HIV: Mixed Methods Process Evaluation of the Philippines Connect for Life Study

“…Behavior change techniques related specifically to ART adherence were informed by the information-motivation-behavioral skills model of ART adherence [ 53 ]. Each service in the intervention package was designed to address ≥1 of the 3 main components that drive behavior in the Capability Opportunity Motivation–Behavior model, as outlined in Figure 2 [ 47 , 48 ].…”

“…The FGDs were transcribed, transcripts were manually coded using a deductive coding methodology to group responses by topic areas in the FGD guide, subtopics were assigned through line-by-line coding, and data were consolidated in a structured template that enabled identification of salient themes. Results from the FGDs in the formative and pilot phases informed the content and structure of the intervention and helped to identify implementation issues early in the project [ 47 ].…”

“…Clinicians at the study site developed new content for the voice and SMS text messages, which were recorded by a local voice talent agency. During the formative study and intervention development stage, a series of focus groups were conducted to engage with patients at the clinic about their adherence behaviors and preferences for configuration and content, and their feedback was incorporated to ensure that the intervention was tailored to the target population [47][48][49].…”

Virtual case management: a differentiated approach to HIV prevention, treatment, and care

“…The mobile application provides participants one-on-one virtual communication with case managers, appointment reminders, services support information, and educational articles [ 43 ]. A similar interactive mHealth intervention being tested in the Philippines provides MSM with medication adherence reminders, adherence feedback, symptom reporting, and health tips [ 44 ]. The Adam's Love platform described above has been used to support more comprehensive case management where potential clients for PrEP were provided online counseling, appointment bookings, and quick response code e-tickets to present at check-in.…”