Digital health technologies: Potential tools for promoting adherence to antiretroviral therapy among people living with HIV in Tanzania

Sufficiently high levels of adherence to ART are needed to achieve and maintain suppressed viral load. Despite the vast majority of people living with HIV(PLHIV) in Tanzania have access to ART, maintaining adherence to lifelong treatment thus seems to be a major challenge. Given the great penetration of mobile technology in Tanzania, digital health technology provides a unique opportunity to improve adherence to ART treatment. Therefore, this thesis investigates the impact of digital health technology as a potential tool to primarily support ART adherence and secondarily improve clinical outcomes among PLHIV in Tanzania. The first objective is to compare the effectiveness of two DATs, SMS and Real Time Medication Monitoring(RTMM), with standard care in promoting treatment adherence, using a randomized clinical trial, the so-called REMIND-HIV trial. Additionally, to examine the barriers and challenges participants encounter when using the DAT strategies. Lastly, to examine to what extent the adherence measures, including pharmacy refill counts, self-reported adherence and RTMM, predict virologic suppression. This thesis produced important findings on the effectiveness and implementation of DATs in influencing adherence to ART treatment. In our investigation, DATs have the potential to enhance the delivery of quality HIV care, particularly for communities that are hard-to-reach and having limited resources-settings. Furthermore, our studies indicate that DAT have the potential to raise awareness about the importance of ART adherence and improve patient-nurse communication during clinic visits. We recommend that several challenges learned from this study need to be considered to ensure that DATs are sustainable, feasible and acceptable