Mobile phone use for a social strategy to improve antiretroviral refill experience at a low-resource HIV clinic: patient responses from Nigeria

Abstract

In sub-Saharan Africa areas where antiretroviral drugs are not available through community pharmacies, clinic-based pharmacies are often the primary source of antiretroviral drug refills. Social pressure is mounting on treatment providers to adjust antiretroviral (ARV) refill services towards user-friendly approaches which prioritize patients’ convenience and engage their resourcefulness. By this demand, patients may be signalling dissatisfaction with the current provider-led model of monthly visits to facility-based pharmacies for ARV refill. Mobile phones are increasingly popular in sub-Saharan Africa, and have been used to support antiretroviral treatment goals in this setting. A patient-centred response to on-going social pressure requires treatment providers to view antiretroviral refill activities through the eyes of patients who are negotiating the challenges of day-to-day life while contemplating their next refill appointment. Using focus groups of five categories of adult patients receiving combination antiretroviral therapy, we conducted this cross-sectional qualitative study to provide insight into modifiable gaps between patients’ expectations and experiences of the use of mobile phones in facility-based antiretroviral refill service at a public HIV clinic in Nigeria. A notable finding was patients’ preference for harnessing informal social support (through intermediaries with mobile phones) to maintain adherence to ARV refill appointments when they could not present in person. This evolving social support strategy also has the potential to enhance defaulter tracking. Our study findings may inform the development of ARV refill strategies and the design of future qualitative studies on client-provider communication by mobile phones in under-resourced HIV treatment programs.

Effect of Text Messaging Plus Peer Navigation on Viral Suppression Among Youth With HIV in the iCARE Nigeria Pilot Study

“…First-line regimens = 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus efavirenz (17), dolutegravir (8), or nevirapine (1). Second-line regimens = 2 NRTIs plus atazanavir/ritonavir (11) or lopinavir/ritonavir (3).…”

“…Evidence-based interventions are needed to optimize ART outcomes in YWH. 9 Mobile phones are powerful tools for ART-related interventions, 10,11 and there were more than 190 million active mobile phone subscriptions in Nigeria in April 2020. 12 The widespread preference for text messaging among youth makes it uniquely promising for youth-directed interventions.…”

Adaptation of evidence-based approaches to promote HIV testing and treatment engagement among high-risk Nigerian youth

“…Approaches using mHealth have had positive effects across the HIV care continuum and have the advantage of simple interfaces for users, accessibility anywhere cell signals and/or Wi-Fi are available, relative affordability, and have been promoted specifically to reach stigmatized and disenfranchised populations [ 30 , 31 ]. Interventions using mHealth approaches in SSA have primarily focused on support for antiretroviral therapy (ART) adherence with evidence of feasibility and efficacy [ 32 – 36 ], but have not been widely evaluated among youth across the HIV care continuum. One SMS text message reminder intervention (designed to address “forgetting”), the Treatment Text intervention (TXTXT), has shown evidence of both feasibility and efficacy to promote ART adherence among YLH in the US [ 37 ], but has not yet been tested in SSA.…”

Adaptive Antiretroviral Therapy Adherence Interventions for Youth Living With HIV Through Text Message and Cell Phone Support With and Without Incentives: Protocol for a Sequential Multiple Assignment Randomized Trial (SMART)

“…Cell phone–delivered interventions that use voice calling may offer some of the advantages of text messaging (eg, youth-friendly delivery and modern applicability) but retain more of the important elements of human interaction (eg, social support and alliance). A recent qualitative study supports the use of cell phones as a strategy to maintain adherence to antiretroviral refill appointments at a public HIV clinic in Nigeria [42]. A pilot of cell phone support with incentives (CPS-I) in a cohort of highly nonadherent youth demonstrated significant improvements in adherence and VL during the 24-week intervention and 24-week postintervention [43].…”