JMIR Publications

ABSTRACT

Background:

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. The World Health Organization (WHO) recommends use of mobile phone health technologies (mHealth) to engage patients in care and ensure high levels of adherence to antiretroviral therapy (ART). Existing mHealth interventions can be adapted and tailored to the context and population served.

Objective:

To create a locally tailored intervention using a mobile phone platform to support treatment adherence for HIV patients on antiretroviral therapy (ART) in the Philippines.

Methods:

A mixed-methods approach guided by the Behavior Change Wheel (BCW) framework was used to adapt an existing mHealth adherence support platform for the local setting and target population. Literature review, retrospective clinical record review, and focus group discussions with patients were conducted to understand the drivers of ART adherence and tailor the intervention accordingly. The resulting intervention was pilot tested for eight weeks, followed by focus group discussions with patients who received the intervention to assess the acceptability of the design.

Results:

Key issues contributing to nonadherence included side effects, lack of behavioral skills for pill taking, social support, metal health, and substance use. Patients identified mHealth as an acceptable mode of intervention delivery, and wanted the mHealth services to be highly personalizable. The study team, clinicians, and software developers integrated these findings into the intervention, which included a menu of services: pill reminders, health tips, adherence feedback, appointment reminders, and symptom reporting. During the pilot phase, technical issues in the interactive voice response system (IVRS) were identified and addressed. Patients who participated in the pilot phase expressed a preference for short message service (SMS) over IVRS. Patients responded positively to the appointment reminders and health tips, while patient feedback on daily/weekly pill reminders and adherence feedback was mixed.

Conclusions:

The mobile phone-based SMS and IVRS intervention was acceptable to MSM in Manila, Philippines, and qualitative analysis suggested the intervention helped promote ART adherence and appointment attendance.