Table 2 Overview of provider perceptions of adherence support approaches
| Â | Â | Effect on patient-provider relationship | Effect on provider workflow | Threat of status disclosure | Access and ability | Suggestions for customization |
|---|---|---|---|---|---|---|
Text message | Facilitators | Patient can form a relationship with provider they text (1)a | Providers can automate (1) and access adherence data (1) | Offers more privacy than call options (2) | Most patients able to text (9) | Personalize the text message (2) Combine with the signaling pill box (1) Use to help patients start a routine and then stop (3) |
Barriers | Fear of becoming a nuisance to patients after repeated messages (1) | Burdens providers to text many patients at all hours (5) | Risk of disclosure to others who have access to patient’s phone (4) | Some patients lack a phone or have limited texting ability (2) | ||
Video check with provider | Facilitators | Patient can develop a close relationship with provider (12) | NA | NA | NA | Valuable at particular times in pregnancy (2) Use for limited period while patient is developing a routine (3) Assure the person calling has a relationship with the patient (1) Train patients to use the technology (1) |
Barriers | Patient may feel uncomfortable being watched (1) | A lot of work for provider to call all patients every day to watch them take their pills (9) | Possibility patient is around others who are not aware of HIV status at time of video call (5) | Patient must have and understand technology necessary for video calls (4) | ||
Automated video check | Facilitators | NA | Requires less labor and money, but gives the same amount of adherence data (7) | NA | NA | Tailor interaction to the patient and change it regularly to retain engagement (1) Calls start with a provider and transition to automated over time (1) |
Barriers | Lack of opportunity to connect with provider (4) | NA | Possibility patient is around others who are not aware of HIV status at time of video call (1) | Patient must have and understand technology necessary for video calls (4) | ||
Signaling pill bottle | Facilitators | Patient can be proud to show adherence record to provider (1) | Little work for providers to do with this intervention (2) | NA | Method of getting and taking pills does not change (1) | Have someone call the patient if pill cap is not opened (2) Add a second reminder if pill cap is not opened (1) Send a text message along with the reminder light (2) |
Barriers | Signaling distrust by tracking adherence (1) | Someone must organize data (1) | Flashing light can attract unwanted attention to medication (9) | NA | ||
Signaling pill | Facilitators | Patient gets additional support without having to reach out for it (1) | Tech does the work of checking up on patients for the provider (2) | NA | NA | Only useful for a short period of time (1) |
Barriers | signaling distrust by tracking adherence (2) | someone must monitor adherence data (1) | concerns about tracking device being tied to HIV status (2) | need a smart phone and comfort with technology (2) |