RCT of a Text Messaging Adherence Assessment & Intervention Tool for Rural HIV+ Drug Users

Active illicit drug use, regardless of diagnostic category (i.e., abuse or dependence), along with medication non-adherence, are the problematic behaviors targeted for change in this study. The investigators will develop and test an innovative mobile-phone delivered text messaging intervention designed to reduce drug use and increase HIV medication adherence.

In the first phase of our work (quarters 1-2), the investigators will use qualitative, formative methods with user input to develop the assessment and intervention contents, while our technology partner develops the mobile phone application shell with which the investigators will conduct initial pre-coding usability testing. Focus groups will be used to inform the final design of the text messaging application, and participant input will provide important information to help us determine the number and rate of messages.

The investigators plan to recruit 1-2 focus groups from three participating clinics and will spend a day to two days in each location to conduct the groups and to conduct individual interviews with participants who prefer a private interview. In the past, the investigators have succeeded in recruiting groups of 5-8 participants by using flyers, word of mouth, and reminders from providers to prompt participants to call our study staff to arrange participation. The investigators also have typically scheduled groups with several weeks' notice, in both daytime and evening hours, to accommodate the schedules of employed and unemployed participants. The investigators plan to provide lunch or snacks, and to compensate participants for their time.

The purpose of the focus groups and individual interviews is to develop the content of the phone application, and to address their adherence barriers and drug use patterns, so that the investigators can program messages (queries) that are the most appropriate for this population. Other topics to be covered in focus groups and individual interviews will include preferred rate of messaging, types of messages desired, use of language and terms that participants understand for random and scheduled queries, followed by iterative user testing of the pre-programming shell of the program to determine whether they understand the flow, understand all terms and symbols, etc. The investigators will gather quantitative (count) data as well as qualitative (free response) data, which the investigators will analyze for rates and themes, respectively. Themes will be derived by analysis of transcripts of interviews and focus group sessions, then grouped into related categories to determine common and unusual concerns of participants. The investigators will ensure that the program addresses all common issues, and the investigators will decide on a case by case basis whether and how to incorporate unusual issues. However, unusual issues may be important ones, representing likely crisis intervention topics to plan for. The count data will provide raw numbers in which to anchor the thematic data. Given that people who text may send and receive 50 or more messages per day routinely, it does not seem overly burdensome to request that they respond to the system 5 times per day, but this issue will be addressed directly in the focus groups. This formative work will be used to generate appropriate content and structure for the intervention that best fits the needs of this unique rural, HIV+, drug using population.

The revision of our existing text messaging tool, Stem, will take approximately 6 months, proceeding iteratively. The investigators will iteratively test the acceptability and usability of components of the tool with the target population before finalizing its programming by conducting guided sessions with participants who will review the program via screenshots. The resulting product will be the novel mobile phone application, Text, which the investigators will test with users on the phones in their homes for a 2 week period in quarter 2 to identify any remaining programming needs to finalize the system for the pilot trial.