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Currently submitted to: JMIR Formative Research

Date Submitted: Oct 1, 2019
Open Peer Review Period: Oct 1, 2019 - Nov 11, 2019
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Technical and Psychosocial challenges of mobile health usage for antiretroviral therapy (ART) adherence among People living with HIV in a resource limited setting: Case series.

  • Kennedy Michael Ngowi; 
  • Furaha Lyamuya; 
  • Blandina Mmbaga; 
  • Eva Muro; 
  • Zawadiel Hillu; 
  • Rob E. Aarnoutse; 
  • Mirjam A.G. Sprangers; 
  • Peter Reiss; 
  • Pythia T. Nieuwkerk; 
  • Mary Shirima; 
  • Ilse Marion Sumari de Boer; 



Mobile communication has been found to improve ART-adherence among people living with HIV (PLHIV). In our ongoing randomized clinical trial, we used two mobile communication strategies i.e., sending SMS and real-time medication monitoring (RTMM), to monitor adherence to ART and to intervene on adherence if indicated among PLHIV in Tanzania. We noticed a remarkable discrepancy between self-reported adherence and adherence recorded by SMS or RTMM among some of the first trial participants.


Our objective was to explore reasons for those discrepancies.


Adult PLHIV suspected of low levels of adherence were randomized to receiving adherence monitoring and reminders to take ART using 1) SMS versus 2) RTMM versus 3) a control group in two HIV treatment centers in Tanzania. During bi-monthly study visits PLHIV self-reported their level of adherence, received feedback about their level of adherence based on SMS or RTMM monitoring, and discussed strategies to overcome problems with adherence with HIV nurses. For this report, we selected PLHIV who had completed all follow-up visits and consistently self-reported a markedly different level of adherence to the nurse than was recorded by SMS or RTMM. These PLHIV were invited to a face-to-face interview to explore reasons for this discrepancy.


Twenty-six participants had completed follow-up. Six reported discrepancies and had an average of 46% adherence based on SMS/RTMM monitoring , while self-report recorded good adherence . Five participants insisted that their adherence to ART was good but four of them admitted that their adherence to properly using the monitoring device was low. Three participants mentioned concerns about involuntary disclosure of HIV status as main reason for low adherence to ART and/or device use. Two participants were still depending on other reminder cues despite receiving SMS or RTMM reminders. Poor network coverage caused apparently low adherence in one participant.


Concerns about involuntary disclosure of HIV status was a main reason for low adherence to ART and/or proper adherence monitoring device use. Some participants still depended on reminders such as alarms despite receiving SMS or RTMM reminders illustrating the need for education and close monitoring when using new digital technologies in resource limited settings.


Please cite as:

Ngowi KM, Lyamuya F, Mmbaga B, Muro E, Hillu Z, Aarnoutse RE, A.G. Sprangers M, Reiss P, T. Nieuwkerk P, Shirima M, de Boer IMS

Technical and Psychosocial challenges of mobile health usage for antiretroviral therapy (ART) adherence among People living with HIV in a resource limited setting: Case series.

JMIR Preprints. 01/10/2019:14649

DOI: 10.2196/preprints.14649


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