JMIR Publications

ABSTRACT

Background:

Antiretroviral therapy (ART) is effective in reducing HIV-related morbidity and mortality, and transmission among people with HIV (PWH). Adherence and persistence to ART, however, is crucial for successful HIV treatment outcomes. PWH who are cocaine users have poor access to HIV services and lower retention in care.

Objective:

The goal of this study was to examine the feasibility and acceptability of an mHealth intervention on ART adherence among cocaine using PWH.

Methods:

This project, titled Project SMART, used a wireless technology-based intervention, including cellular-enabled electronic pillboxes called TowerView Health® and smartphones to provide reminders and feedback on adherence behavior. This 12-week pilot (randomized control trial) with four arms provided three types of feedback: automated feedback, automated + clinician feedback, and automated feedback + social network feedback.

Results:

Between June 2017 to January 2020, this study screened 182 participants, out of which 80 successfully completed baseline, 71 enrolled to the intervention, and 57 completed the study. Study challenges included data loss due to untimely closure of the pillbox company, high drop-out rate (19.7%) likely due to the complexity of this study and burden of research components on the study population.

Conclusions:

Implementing mHealth interventions for high-risk and marginalized populations is important in order to provide easy access to adherence services and scaling back the cost of personnel. Managing multi-component interventions come with certain challenges such as finding stable companies with adequate technology and financial support, and minimizing research-related burden for study population. The ability to adapt to these challenges posed by evolving technologies is important in conducting feasibility studies.