Evaluating the acceptability, appropriateness and feasibility of behaviourally informed ART adherence scratch cards among adult people living with HIV

Organization: Anova Health Institute



Study objective: Suboptimal adherence to antiretroviral therapy (ART) has been associated with treatment failure, the development of resistant strains and advanced HIV disease. One behavioural barrier could be forgetfulness. Environmental cues have the potential to stimulate an individual to take action, engage in repetitive behaviour and build habits like taking medication daily to improve ART adherence. The FebriSol scratch card is a medication adherence tool that may be adapted and placed in visible locations to serve as a reminder to take ART medication daily.


This study will evaluate the user experience, acceptability, appropriateness and feasibility of the behaviourally informed scratch cards among adult people living with (PLHIV) who are enrolled in a case management programme and case managers in public health settings in Gauteng, South Africa.



Intervention description: We will evaluate the use of a behaviourally informed scratch-card-calendar sticker developed for care recipients to keep track of their chronic medication and adhere to their treatment plan. This adherence tool is designed to be used once per day and features 28-day-of-the-week labels that run in a loop. The recipient of care can stick the scratch card somewhere within their home where they would see it every day (such as on a mirror or fridge or even their pill bottle). With its easy peel coating, the sticker can be removed without leaving any marks. The scratch card is then used in 2 easy steps (1) the recipient of care takes their daily prescribed medication (2) the recipient of care scratches off the day’s coating to reveal a green tick which provides positive reinforcement. This is then repeated the next day and recipients of care can see at a glance if they have missed taking the day’s medication.



Evaluation description: This study will be conducted in two phases.

  • Phase 1: An investigation to assess the user experience acceptability of the FebriSol card among PLHIV who are enrolled in the Indlela Behavioural Hub (B-Hub). We will also investigate the acceptability, appropriateness and feasibility of the scratch cards with case managers who are enrolled in the B-Hub.
  • Phase 2: Results from the qualitative investigation will inform a randomised controlled trial.



Study outcomes: Primary outcomes for Phase 1:

  • User experience and acceptability of using the scratch cards amongst PLHIV
  • Acceptability, appropriateness and feasibility of the scratch cards among case managers
    Primary outcome for Phase 2 will be confirmed after the qualitative evaluation


Study site:

Phase 1: Participants enrolled in the Indlela B-Hub in Johannesburg, Gauteng Province

Phase 2: TBD



Target population:

Phase 1: Adult PLHIV (18 years and older) and case managers working in public health facilities
Phase 2: TBD



Sample size:

Phase 1:  In-depth interviews and questionnaires will be conducted with 25-30 care recipients and 10-15 case managers


Data analysis:
Audio recordings of discussions for both care recipients and case managers will be uploaded to NVivo for further thematic analysis.
Responses to the  questionnaires will be scored, and an average calculated for further comparison.


Phase 2: TBD




Duration: 6 months