JMIR Publications

ABSTRACT

Background:

Peripartum women living with HIV (WLWH) in South Africa are at high risk of dropping out of care, and also are a particularly mobile population, which may impact engagement in HIV care. With the rise of mobile phone use globally, there is an opportunity to use smartphones and global positioning system (GPS) location software to characterize mobility in real time.

Objective:

To develop a smartphone application (app) that could collect individual GPS locations to improve engagement in HIV care, we assessed attitudes towards this proposed app.

Methods:

We conducted 50 in-depth interviews (IDIs) with pregnant WLWH in Cape Town and Johannesburg, South Africa, and six focus group discussions (FGDs) with 27 postpartum WLWH in Cape Town. Through an open-ended question in the IDIs, we categorized “positive,” “neutral,” or “negative” reactions to the proposed app and identified key quotes. For FGD data, we grouped text into themes, then analyzed for patterns, concepts and associations and selected illustrative quotes.

Results:

In the IDIs, the majority of participants (76%, 38/50) responded favorably to the proposed app. Favorable comments related to the convenience of facilitated continued care (“So the clinic will know if you are in another province”), a sense of helpfulness on the part of the researchers and/or facility (“It would show me that I am cared for”), and the difficulties of trying to maintain care while traveling (“People sometimes travel unexpectedly and have not come to the clinic to get medication”). Of the four (8%) participants who responded negatively, comments primarily related to the individual’s responsibility for their own healthcare. The FGDs revealed four themes: facilitating connection to care, informed choice, disclosure (intentional or unintentional), and trust in researchers.

Conclusions:

WLWH participants were overwhelmingly positive about the idea of a GPS-based smartphone app to improve engagement in HIV care. Participants reported that they would welcome a tool to facilitate connection to care when traveling and expressed trust in the researchers and healthcare facility. Within the context of a rapid increase of smartphone use in South Africa, these early results warrant further exploration and critical evaluation following real-world experience with the app.