Organization: Anova Health Institute
Study objective: This study will assess the role of the FebriSol adherence scratch card in improving ART adherence among PLHIV accessing ART at public health facilities in Gauteng, South Africa.
Intervention description: The FebriSol adherence scratch card, co-designed with Indlela@HE2RO, Anova Health Institute and Studio Fundi is a behavioural science-based tool designed to help recipients of care (ROC) adhere to their chronic medication plans. This low-cost and user-friendly scratch card functions as a calendar sticker that can be placed in a visible location within a ROC’s home (such as on a cupboard, mirror, fridge or even their pill bottle). After taking their daily medication, the ROC scratches off the day’s coating with a fingernail to reveal a green checkmark, providing positive reinforcement and a visual tracker of their adherence patterns.
During the one-month intervention period, as well as offering the standard of care, healthcare providers at study sites will provide people living with HIV (PLHIV) on ART a six-month supply of the FebriSol scratch cards to try out. HCPs will either show a short instructional video or use a leaflet to explain how the scratch cards work. This approach is designed to mimic a real-world, routine intervention implementation.
Evaluation description: This is a multi-method study that includes:
- Surveys and qualitative in-depth interviews with ROC and healthcare providers to explore the scratch card’s real-world usability, acceptability and feasibility
- A cohort evaluation of retention in care and viral load suppression to determine whether there is evidence suggesting adherence benefit from a 6-month supply of FebriSol adherence scratch cards
Study outcomes:
Primary aim:
- Acceptability, appropriateness/usability and feasibility of using the behaviourally informed FebriSol adherence scratch cards in public primary health care facilities, from the perspectives of ROC and healthcare providers.
Secondary aim:
- Return to care/retention at 3 and 6 months after receiving the FebriSol adherence scratch card
- Viral suppression at 3 and 6 months after receiving the FebriSol adherence scratch card
Study site: Five primary health care facilities in the City of Johannesburg, South Africa.
Target population: Adult PLHIV (18 years and older) accessing ART at public health facilities and healthcare providers offering ART services to PLHIV
Sample size & analysis:
Primary Aim:
The study will enrol 150 ROCs and 10 HCPs across all study sites. In-depth telephonic interviews will be conducted with a subset of 40 ROCs, comprising 20 who report using the scratch card and 20 who report not using it, as well as all participating healthcare providers.
Secondary Aim:
Based on historical site data we estimate that study sites have an average of ~800 ART visits per month (rounded up to 1,000 to account for site variation). We anticipate that approximately 5,000 ART ROC will be offered FebriSol adherence cards across 5 study sites during a 1 month (20 working days) implementation period.
Overall Data Analysis:
Survey data will be analysed using STATA or similar software and descriptive statistics reported, while a two-proportion z-test will compare self-reported adherence between baseline and follow-up. Audio recordings from all interviews will be uploaded into qualitative data analysis software for thematic analysis. For the cohort evaluation, t-tests, Chi-square tests and regression models will be used to estimate the effect of the intervention on the main study outcomes.
Duration: 9 months
