Lessons Learned From the Implementation of Seek, Test, Treat, Retain Interventions Using Mobile Phones and Text Messaging to Improve Engagement in HIV Care for Vulnerable Populations in the United States

Abstract

In the United States, little is known about interventions that rely on mobile phones and/or text messaging to improve engagement in HIV care for vulnerable populations. Domestic studies using these technologies as part of the National Institute on Drug Abuse “Seek, Test, Treat, Retain” research initiative were queried regarding intervention components, implementation issues, participant characteristics, and descriptive statistics of mobile phone service delivery. Across five studies with 1,135 predominantly male, minority participants, implementation challenges occurred in three categories: 1) service interruptions; 2) billing/overage issues, and; 3) the participant user experience. Response rules for automated text messages frequently frustrated participants. The inability to reload minutes/texting capacity remotely was a significant barrier to intervention delivery. No study encountered confidentiality breaches. Service interruption was common, even if studies provided mobile phones and plans. Future studies should attend to the type of mobile phone and service, the participant user experience, and human subjects concerns.

Jail, an unappreciated medical home: Assessing the feasibility of a strengths-based case management intervention to improve the care retention of HIV-infected persons once released from jail

“…A recent analysis that included participants from this cohort showed that sending text messages to individuals recently released from jail likely has a negligible effect on linkage to care. [ 28 ]…”

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

“…Other study participants could not understand how to load credit onto their mobile phones or the parameters of their service plans (Smillie et al, 2014). The demographic of these study participants showed being within an economically disadvantaged group could mean that they were not able to pay for their mobile phone credit and therefore could not receive any messages (Christopoulos et al, 2017).…”

“…The second barrier associated with technical issues, was service interruption due to a poor credit balance as reported by Christopoulos et al, (2017), Smillie et al, (2014) and Swenderman et al, (2015). All three studies found that where participants used their own mobile phones, the inability to pay for these phones created an issue within the research.…”

“…All the papers used within this theme identify that fear of exposure of an HIV diagnosis was more likely if sensitive information is sent by text message. 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.…”

“…Some participants were unable to receive and send messages after using up all their 'talk time minutes'. To counteract this, the study by Christopoulos et al, (2017) provided $25 credit on an 'Obama phone' for the purposes of their study. Other study participants could not understand how to load credit onto their mobile phones or the parameters of their service plans (Smillie et al, 2014).…”