JMIR Publications

ABSTRACT

Background:

Men who have sex with men (MSM) were disproportionately affected by the HIV epidemic and reported to have lower medication adherence for antiretroviral treatment (ART). Our research team developed an app-based case management service with multiple components to improve medication adherence among MSM initiating ART.

Objective:

The aim of this study is to conduct a process evaluation for the implementation of innovative app-based intervention guided by Linnan and Steckler’s framework.

Methods:

The study was carried out alongside a randomized controlled trial. Eligible participants were HIV-positive MSM aged 18 or above planning to initiate treatment on the day of recruitment. The app-based intervention had four components: online communication with case managers, educational articles delivery, supportive service information retrieval, and hospital visit reminders. Process evaluation indicators, including dose delivered, dose received, and fidelity were reported for each intervention component. Logistic regression was used to investigate the association between intervention uptake and ART medication adherence among the intervention group.

Results:

A total of 344 MSM were recruited from March 19th, 2019, to January 13th, 2020, and 172 were randomized to the intervention group. In month-one follow-up, 45% of the participants in the intervention group had adequate ART adherence compared with 42.3% in the control group. In the intervention group, 124 engaged in online communication with case managers, and 158 participants read at least one of the delivered articles. The primary concern captured in the online conversation was the side effects of the medication (30.6%). Participants ever expressing negative emotions (OR=0.01, 95% Confidence Interval (CI) 0.00–0.39) and ever having conversations about HIV and ART-related knowledge (OR=0.01, 95% CI 0.00–0.60) were less likely to have adequate adherence. Participants displaying excessive reading behavior (OR=5.77, 95% CI 1.09–30.63) and reading more articles about general introduction to the disease and treatment (OR=2.13, 95% CI 1.02–4.45) were more likely to have adequate adherence.

Conclusions:

The intervention was well-received. Delivering educational resources of interest may enhance medication adherence by increasing patients’ knowledge about the disease. The online communication component could serve as an instant information exchange channel between healthcare providers and patients facilitating medical decision making. Clinical Trial: Clinicaltrial.gov: NCT03860116; Registered on Mar 1, 2019.