Abstract
Antiretroviral therapy treatment adherence support by medical case managers is an evidence-based practice, but effectiveness may be constrained by limited understanding of antiretroviral therapy's benefits among people with HIV. We used mixed methods to evaluate the pre-implementation context of the B-OK Bottles ("B-OK") - a visual aid designed to correct HIV mental models - as an implementation strategy for treatment adherence support by medical case managers in Philadelphia. We assessed outcomes of acceptability, feasibility, and appropriateness among medical case managers and people with HIV. We conducted case manager focus groups at four agencies, and enrolled clients of case managers at these agencies. Clients received the B-OK intervention, a survey, and individual interviews. Among clients, we assessed implementation scales: Acceptability of Intervention Measure, Feasibility of Intervention Measure, and Intervention Appropriateness Measure. During focus groups, medical case managers (N = 29) found B-OK to be highly acceptable and feasible, and that it would be appropriate as a conversation starter. Individual interviews (N = 52) also demonstrated high degrees of B-OK acceptability, feasibility, and appropriateness for use by case managers. Medical case managers and people with HIV felt that B-OK could improve individual motivation for medication adherence. However, participants also identified other substantial barriers to adherence besides knowledge and understanding. Quantitative results were consistent with our qualitative findings, with high scores on implementation scales. This study suggests that B-OK would be acceptable, feasible, and appropriate as an implementation strategy for treatment adherence support by medical case managers, but that a multifaceted approach is likely needed to achieve optimal adherence.