Swai Iraseni Ufoo, Ten Bergen Lisa Lynn, Mtenga Alan, Maro Rehema, Ngowi Kennedy, Mtesha Benson, Lekashingo Naomi, Msosa Takondwa, Rinke de Wit Tobias F, Aarnoutse Rob, Sumari-de Boer Marion
Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
UMC Amsterdam, Location AMC, Amsterdam, the Netherlands.
PLOS Digit Health. 2023 Oct 18;2(10):e0000232. doi: 10.1371/journal.pdig.0000232. eCollection 2023 Oct.
Optimal adherence (>95%) to antiretroviral treatment (ART) remains a challenge among children and adolescents living with HIV (CALHIV). Digital adherence tools (DAT) with reminder cues have proven feasible among adult people living with HIV (PLHIV), with some concerns about the risk of HIV status disclosure. We aimed to assess the needs, contents and acceptability of an SMS-based DAT among CALHIV. We first conducted a survey to understand potential barriers to using DAT among CALHIV, then tested the DAT intervention among purposively selected participants. The DAT intervention included using the Wisepill device, receiving daily reminder SMS and receiving adherence reports on how they had taken medication in the past month. The content of the reminder SMS differed over time from asking if the medication was taken to a more neutral SMS like "take care". Afterwards, we conducted exit interviews, in-depth interviews, and focus-group discussions. We analysed quantitative findings descriptively and used thematic content analysis for qualitative data. We included 142 children and 142 adolescents in the survey, and 20 of each used the intervention. Eighty-five percent (121/142) of surveyed participants indicated they would like to receive reminder SMS. Most of them (97/121-80%) of children and 94/121(78%) of adolescents would prefer to receive daily reminders. Participants who used the DAT mentioned to be happy to use the device. Ninety percent of them had good experience with receiving reminders and agreed that the SMS made them take medication. However, 25% experienced network problems. Participants preferred neutral reminder SMSs that did not mention the word 'medication', but preserved confidentiality. The provided adherence reports inspired participants to improve their adherence. None of the participants experienced unwanted disclosure or stigmatisation due to DAT. However, 5% of adolescents were concerned about being monitored daily. This study showed that DAT is acceptable and provided insight of the needed SMS content for a customized DAT for CALHIV.
在感染艾滋病毒的儿童和青少年（CALHIV）中，实现对抗逆转录病毒治疗（ART）的最佳依从性（>95%）仍然是一项挑战。带有提醒提示的数字依从性工具（DAT）已在成年艾滋病毒感染者（PLHIV）中证明是可行的，但人们对艾滋病毒感染状况暴露的风险存在一些担忧。我们旨在评估CALHIV中基于短信的DAT的需求、内容和可接受性。我们首先进行了一项调查，以了解CALHIV中使用DAT的潜在障碍，然后在有目的选择的参与者中测试了DAT干预措施。DAT干预措施包括使用Wisepill设备、接收每日提醒短信以及接收关于他们过去一个月服药情况的依从性报告。提醒短信的内容随时间而变化，从询问是否服药到更中性的短信，如“保重”。之后，我们进行了退出访谈、深入访谈和焦点小组讨论。我们对定量结果进行描述性分析，并对定性数据使用主题内容分析。我们在调查中纳入了142名儿童和142名青少年，每组各有20人使用了该干预措施。85%（121/142）的受访参与者表示他们希望收到提醒短信。其中大多数（儿童中的97/121 - 80%和青少年中的94/121 - 78%）希望收到每日提醒。使用DAT的参与者提到很高兴使用该设备。其中90%的人在接收提醒方面有良好体验，并同意短信促使他们服药。然而，25%的人遇到了网络问题。参与者更喜欢不提及“药物”一词但能保护隐私的中性提醒短信。提供的依从性报告激励参与者提高他们的依从性。没有参与者因DAT而经历不必要的暴露或污名化。然而，5%的青少年担心被每日监测。这项研究表明DAT是可接受的，并为针对CALHIV的定制DAT所需的短信内容提供了见解。
