A Video-Observed Treatment Strategy to Improve Adherence to Treatment Among Persons Who Inject Drugs Infected With Hepatitis C Virus: Qualitative Study of Stakeholder Perceptions and Experiences.

BACKGROUND: Direct-acting antiviral medications have the potential to eliminate the hepatitis C virus (HCV) epidemic among people who inject drugs; yet, suboptimal adherence remains a barrier. Directly observed treatment (DOT), an effective strategy for optimizing adherence, has been frequently implemented in opioid treatment programs but less commonly in community health settings due to the heavy burden of daily visits. An alternative is video-observed therapy (VOT), which uses mobile health technology to monitor adherence. VOT has not been widely studied among people who inject drugs with HCV. OBJECTIVE: This qualitative study, part of a larger implementation evaluation, investigates stakeholder perceptions and experiences with VOT in Project HERO (Hepatitis C Real Outcomes), a multisite pragmatic trial testing treatment delivery models for people who inject drugs with HCV. Our goal was to understand the potential barriers and facilitators to the implementation of the VOT technology. METHODS: Qualitative interviews were conducted with 27 Project HERO study staff and 7 patients. Interviews focused on perceptions and experiences with the VOT app and barriers and facilitators to implementation. Team meeting minutes over the first 2 years of the project were transcribed. A coding system was developed and applied to the data. We summarized thematic data and compared participant perceptions to generate a close understanding of the data. RESULTS: Frequent barriers to VOT included mechanical failure, stolen or lost phones, and a steep learning curve for participants and study staff. In sites with older and less technically skilled participants, staff found it difficult to implement the VOT app. Research staff found that the routine monitoring of app use led to closer engagement with participants. This was both a benefit and a potential threat to the validity of this pragmatic trial. Patient participants reported mixed experiences. CONCLUSIONS: VOT may be a useful alternative to DOT for some patients, but it may not be feasible for all. Significant staff involvement may be required.

An integrative medicine approach to asthma: who responds?

OBJECTIVES: The objectives of this study were to develop a better understanding of which patients with chronic illness tend to respond to integrative medicine interventions, by identifying a set of characteristics or qualities that are associated with a positive outcome in a randomized clinical trial of an integrative medicine approach to asthma that incorporated journaling, yoga breathing instruction, and nutritional manipulation and supplementation. DESIGN: The study used qualitative analysis using a grounded-theory approach comparing a group of responders in the parent trial (based on the Asthma Quality of Life Scale) to a group of nonresponders. RESULTS: Twelve (12) responders and 8 nonresponders were interviewed. Responders demonstrated an attitude of "change as challenge;" a view of themselves as "independent" and "leaders;" an ability to accept one's illness while still maintaining a feeling of control over one's choices; a connection to the deeper context or meaning of complementary and alternative medicine (CAM) interventions, as opposed to just "previous experience" of CAM; and a sense of determination, commitment, and "willingness to fight" for what one needs from the health care system. Nonresponders were more often uncertain and anxious in their relationship to their asthma, tending to fall back on denial, and lacking a connection to the deeper context or philosophy of CAM interventions. CONCLUSIONS: It is possible to identify a set of characteristics that may predict a positive response to an integrative/lifestyle approach to asthma. These characteristics should be examined prospectively using both quantitative and qualitative methods in future integrative medicine clinical trials.