Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 21, 2022
Date Accepted: Jan 31, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A Video Observed Treatment (VOT) Strategy to Improve Adherence to Treatment Among PWID infected with Hepatitis C Virus: Stakeholder Perceptions and Experiences
ABSTRACT
Background:
New direct acting antiviral medications have the potential to eliminate the Hepatitis C Virus (HCV) epidemic among people who inject drugs; yet suboptimal adherence remains a barrier. Directly observed treatment (DOT), an effective strategy for optimizing adherence, has been frequently implemented in opioid treatment programs, but less commonly in community health settings due to the heavy burden of daily visits. An alternative is video-observed therapy (VOT), which uses mobile health technology to monitor adherence. VOT has not been widely studied in PWID with HCV.
Objective:
This mixed methods study, part of a larger implementation evaluation, investigates stakeholder perceptions and experiences with VOT in Project HERO, a multi-site pragmatic trial testing treatment delivery models PWID with HCV. Our goal was to understand potential barriers to implementation of the VOT technology.
Methods:
Qualitative interviews were conducted with 27 Project HERO study staff and 7 patients. Interviews focused on perceptions/experiences with the VOT app and barriers/facilitators to implementation. Team meeting minutes over the first two years of the project were transcribed. A coding system was developed and applied to the data. We summarized thematic data and compared participant perceptions to generate a close understanding of the data.
Results:
Frequent barriers to VOT included mechanical failure, stolen/lost phones, and a steep learning curve for participants and study staff. In sites with older and more cognitively impaired participants, staff found it difficult to implement the VOT app. Research staff found that routine monitoring of the app use led to closer engagement with participants. This was both a benefit and a potential threat to validity in this pragmatic trail. Patient participants reported mixed experiences.
Conclusions:
VOT may be a useful alternative to DOT for some patients, but it may not be feasible for all. Significant staff involvement may be required.
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