Process evaluation of an interactive mHealth adherence support intervention for HIV patients: lessons learned in the Philippines Connect for Life Study (Preprint)

Abstract

The Philippines HIV epidemic is one of the fastest growing globally, and infections among men who have sex with men (MSM) are rising at an alarming rate. Connect for Life Philippines is a mobile health intervention to support ART adherence in this key population through individualized voice calls and short message services (SMS).

The objective of this process evaluation was to assess the reach, dose delivered and received, fidelity, acceptability of the intervention and to describe contextual factors affecting implementation.

Participants received a personalized combination of automated pill reminders, appointment reminders, health tips, and adherence feedback messages delivered by voice call or SMS at the patient’s preferred time/day. To measure the fidelity and dose of the intervention, call and SMS logs from the mHealth platform were analyzed. Usability and acceptability information was collected via questionnaires at three time points during the 48-week study. Qualitative feedback was collected in monthly process reports, comments fields in the questionnaires, and in focus group discussions.

The 462 study participants received 25,375 IVRS calls and 8,234 SMS during the study. Due to technical issues, intervention fidelity was low, with only 18.8% of participants receiving the pill reminders via voice call and others receiving a scaled-back SMS intervention. After 48 weeks in the study, 64% of participants reported that they would be quite likely or very likely to recommend the program to a friend and 53% of participants reported that they benefitted quite a bit or very much from the intervention. Participants who were on ART for less than 6 months at the start of the study and participants who received the daily or weekly pill reminder feature were more likely to report that they benefitted from the intervention (p=0.02 and p=0.013, respectively).

Mobile health interventions are useful to support adherence as they have low replication costs and are highly adaptable to specific cultural contexts. The Connect for Life intervention had high participant satisfaction and acceptability. However, poor reliability of local telecommunications networks had a large impact the intervention usability, fidelity and dose received.