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  • PA-234 Digital adherence tools with personalized adherence feedback: a promising guide for adherence counselling among children and adolescents living with HIV in Tanzania. A mixed-methods study

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PA-234 Digital adherence tools with personalized adherence feedback: a promising guide for adherence counselling among children and adolescents living with HIV in Tanzania. A mixed-methods study
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  1. Iraseni Ufoo Swai1,2;,
  2. Lisa Lynn ten Bergen3,4,
  3. Kennedy Ngowi1,3,
  4. Takondwa Msosa2,5,
  5. Tobias F Rinke de Wit2,3,6,
  6. Rob Aarnoutse7,
  7. Marion Sumari-de Boer1,3,8,9
  1. 1Kilimanjaro Clinical Research Institute, Tanzania, United Republic of
  2. 2UMC Amsterdam, The Netherlands
  3. 3Amsterdam Institute for Global Health and Development, The Netherlands
  4. 4Vrije Universiteit Amsterdam, The Netherlands
  5. 5Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Malawi
  6. 6PharmAccess Foundation, the Netherlands
  7. 7Radboud University Medical Centre, Department of Pharmacy, Research Institute for Medical Innovation, The Netherlands
  8. 8Institute of Public Health, Kilimanjaro Christian Medical University College, Tanzania
  9. 9Knowledge, Innovation and Technology Group, Wageningen University and Research, The Netherlands

Abstract

Background Adherence to treatment is a challenge to people living with HIV (PLHIV). Therefore, interventions are highly needed to assist PLHIV in adhering well to medication. Digital adherence tools (DAT) that offer real-time intervention are promising due to their ability to timely detect non-adherence and provide an opportunity for counselling. We tested DAT to understand the need for tailored adherence feedback among children and adolescents living with HIV (CALHIV) in Kilimanjaro, Tanzania.

Methods We conducted a mixed methods study among CALHIV with their caregivers. Participants completed a survey at study entry to collect disease, treatment, and adherence background information. Then, they used the DAT for one month. The DAT included (1) using Wisepill box that records lid opening as medication intake, (2) receiving reminder SMS and (3) receiving adherence feedback after one month based on reports generated by the DAT. The feedback sessions lasted for maximum 30 minutes and focused on identifying possible solutions to the non-adherence patterns. After that, we conducted exit interviews, in-depth interviews and focus group discussions. We did descriptive and thematic content analysis.

Results We included 20 children (0–14 years) and 20 adolescents (15–19 years). Median adherence measured with DAT was 98.5% among children and 72% among adolescents. Most participants understood the feedback graph, liked the feedback content and thought receiving adherence feedback and counselling would improve their future adherence. Participants explained that feedback reports provided great accuracy in discussing adherence behaviour with counsellors and nurses. However, 25% of adolescents did not agree with the feedback as it indicated they did not open the pillbox while they had. This was mostly due to technical and connectivity challenges.

Conclusion DAT with personalized feedback on adherence is a promising intervention to improve counselling and disease management among CALHIV. Our upcoming randomized clinical trial will assess in detail its effectiveness in improving adherence.

https://doi.org/10.1136/bmjgh-2023-EDC.126

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