Background: High, sustained adherence to HIV antiretroviral therapy (ART) is critical for achieving viral suppression, which in turn leads to important individual health benefits and reduced secondary viral transmission. Electronic adherence monitors record a date-and-time stamp with each opening as a proxy for pill-taking behavior. These monitors can be combined with interventions (eg, data-informed adherence counseling, SMS-based adherence support, and/or alarms) and have been shown to improve adherence in multiple settings. Their use, however, has largely been limited to the research context. Objective: The goal of the research was to use the Consolidated Framework for Implementation Research (CFIR) to understand factors relevant for implementing a low-cost electronic adherence monitor and associated interventions for routine HIV clinical care in Uganda. Methods: We conducted in-depth qualitative interviews with health care administrators, clinicians, and ART clients about likes and dislikes of the features and functions of electronic adherence monitors and associated interventions, their potential to influence HIV care, suggestions on how to measure their value, and recommendations for their use in routine care. We used an inductive, content analysis approach to understand participant perspectives, identifying aspects of CFIR most relevant to technology implementation in this setting. Results: We interviewed 34 health care administrators/clinicians and 15 ART clients. Participants largely saw the monitors and associated interventions as favorable and beneficial for supporting adherence and improving clinical outcomes through efficient, differentiated care. Relevant outside factors included structural determinants of health, international norms around supporting adherence, and limited funding that necessitates careful assessment of costs and benefits. Within the clinic, the adherence data were felt likely to improve the quality of counseling and thereby morale, as well as increase the efficiency of care delivery. Existing infrastructure and care expenditures and the need for proper training were other noted considerations. At the individual level, the desire for good health and a welcomed pressure to adhere favored uptake of the monitors, although some participants were concerned with clients not using the monitors as planned and the influence of poverty, stigma, and need for privacy. Finally, participants felt that decisions around the implementation process would have to come from the Ministry of Health and other funders and would be influenced by sustainability of the technology and the target population for its use. Coordination across the health care system would be important for implementation. Conclusions: Low-cost electronic adherence monitoring combined with data-informed counseling, SMS-based support, and/or alarms have potential for use in routine HIV care in Uganda. Key metrics of successful implementation will include their impact on efficiency of care delivery and clinical outcomes with careful attention paid to factors such as stigma and cost. Further theory-driven implementation science efforts will be needed to move promising technology from research into clinical care. Clinical Trial: ClinicalTrials.gov NCT03825952; https://clinicaltrials.gov/ct2/show/NCT03825952

This is the abstract only. Read the full article on the JMIR site. JMIR is the leading open access journal for eHealth and healthcare in the Internet age.

中文翻译：

---

影响乌干达例行HIV护理电子抗逆转录病毒疗法依从性监测和相关干预措施实施的因素：定性研究。

背景：对HIV抗逆转录病毒疗法（ART）的高度持续坚持对于实现病毒抑制至关重要，这反过来又可带来重要的个人健康益处并减少继发性病毒传播。电子依从性监控器会记录每次打开时的日期和时间戳记，以作为服药行为的代理。这些监视器可以与干预措施结合使用（例如，数据通知的依从性咨询，基于SMS的依从性支持和/或警报），并已显示可以在多种环境中改善依从性。但是，它们的使用在很大程度上仅限于研究环境。目的：该研究的目的是使用合并实施研究框架（CFIR）来了解与在乌干达实施低成本电子依从性监测器和常规HIV临床护理相关干预措施有关的因素。方法：我们与医疗保健管理员，临床医生和ART客户进行了深入的定性访谈，探讨了电子依从性监测器和相关干预措施的特征和功能的喜恶，其对HIV护理的影响潜力，如何衡量其价值的建议，以及在常规护理中使用它们的建议。我们使用归纳式的内容分析方法来了解参与者的观点，并确定与该环境下技术实施最相关的CFIR方面。结果：我们采访了34位医疗保健管理员/临床医生和15位ART客户。参与者在很大程度上认为监测器和相关干预措施对通过有效，有区别的护理支持依从性和改善临床结局是有利和有益的。外部相关因素包括健康的结构性决定因素，支持依从性的国际规范以及资金有限，需要仔细评估成本和收益。在诊所内，依从性数据可能会改善咨询质量，从而提高士气，并提高护理效率。其他值得注意的考虑因素是现有的基础设施和医疗保健支出以及对适当培训的需求。在个人层面上，尽管一些参与者担心客户未按计划使用监护仪，以及贫困，污名和隐私需求的影响，但对身体健康的渴望和对坚持监护仪的可喜压力促使监护仪的使用成为可能。最后，与会人员认为，围绕实施过程的决策必须由卫生部和其他出资者做出，并且会受到该技术的可持续性和使用该技术的目标人群的影响。整个卫生保健系统之间的协调对于实施至关重要。结论：低成本的电子依从性监测与数据通知咨询，基于SMS的支持和/或警报相结合，具有在乌干达进行常规HIV护理的潜力。成功实施的关键指标将包括它们对护理服务效率和临床结果的影响，同时要特别注意污名和成本等因素。需要进一步的理论驱动的实施科学努力，才能将有前途的技术从研究转向临床护理。临床试验：ClinicalTrials.gov NCT03825952；https://clinicaltrials.gov/ct2/show/NCT03825952

这仅仅是抽象的。阅读JMIR网站上的全文。JMIR是互联网时代电子健康和医疗保健领域领先的开放获取期刊。