Understanding viral non-suppression among people with HIV engaged in a mobile health program.

By consistently taking medication, people with HIV (PWH) can attain viral suppression, improving their health and reducing transmission risk. PositiveLinks (PL) is a clinic-deployed mobile platform designed to improve engagement in care for PWH by enabling them to track their medications, connect with peers, and communicate with providers. This project investigated the experience of PL users who had recent periods of viral non-suppression to understand how these high-risk episodes can be predicted and prevented. Fifteen participants completed mental health measures and in-depth interviews. Two members of the study team independently coded interview transcripts and resolved any discrepancies. The codebook was developed iteratively until thematic saturation and intercoder reliability were achieved. Participants revealed mental health and substance use concerns. Frequent stressors highlighted were relationship challenges, financial difficulties, and unstable living situations. Relationship challenges were a common barrier to care, along with competing priorities, transportation and finances. In contrast, positive relationships, motivation, positive interactions with clinic staff, and social programs facilitated regaining viral suppression. Participants highlighted the importance of strong patient-provider relationships and social support in overcoming barriers to care. We identified factors that impact medication adherence, which will inform efforts to mitigate and prevent viral non-suppression and thus improve health outcomes.