Social Sciences and Humanities Open (Jan 2022)
Factors influencing ART adherence, acceptability and potential use of “Call for life IVR tool” among young people in rural Uganda
Abstract
Background: Young people (15–24 years) living with HIV have lower viral load suppression rates compared to older adults. The main causes of poor viral load suppression are; non-compliance to clinic visits, lack of HIV & ART knowledge, inconsistent swallowing of pills, and poor pill adherence. Persistent viremia is associated with the development of drug resistance and low immunity, which increases the risk of opportunistic infections and death.The World Health Organization defines mobile health (mHealth) as “medical or public health practice supported by mobile devices including mobile phones”. WHO recommends mHealth interventions to support HIV adherence. Although young people living with HIV continue to have poor HIV outcomes, the implementation and utilization of mHealth technology for anti-retroviral therapy adherence is still low.As part of an intervention to improve HIV outcomes: We explored the acceptability and need for Call for Life Interactive Voice Response (IVR) support to strengthen retention in care; and enablers and barriers to ART adherence among young people living with HIV in a rural district of western Uganda. Methods: Between June 2020 and March 2021, we conducted six focus group discussions and nine individual interviews with two groups of young people: those initiated on ART for a period less than three months, and those initiated on ART for more than three months. Data were analysed using a thematic approach informed by the social-ecological model. Selected quotes are used to highlight key findings. Results: Mechanisms across multiple levels of the social-ecological model contributed to the ART adherence barriers and enablers: at the individual, relationship, organisational/facility and societal levels. The call for life–IVR needs at the individual level were daily pill reminders, health education, symptom reporting and management. The organisational level needs were appointment reminders, positive living counselling, and nutrition in HIV infection. While at the societal level, the needs were; provision of prevention of HIV transmission to unborn babies and spouses, information; and planning for clinic reviews. Conclusion: The findings underscore the potential of mHealth support to reduce lifelong barriers to ART adherence, improve HIV knowledge; support management of HIV related symptoms and provision of ART.
