Abstract:
In sub-Saharan African areas where antiretroviral (ARV) drugs are not available through community
pharmacies, clinic-based pharmacies are often the primary source of ARV drug refills. Social pressure
is mounting on treatment providers to adjust ARV refill services towards user-friendly approaches
which prioritize patients’ convenience and engage their resourcefulness. By this demand, patients
may be signalling dissatisfaction with the current provider-led model of monthly visits to facilitybased
pharmacies for ARV refill. Mobile phones are increasingly popular in sub-Saharan Africa,
and have been used to support ARV treatment goals in this setting. A patient-centred response
to on-going social pressure requires treatment providers to view ARV refill activities through the
eyes of patients who are negotiating the challenges of day-to-day life while contemplating their
next refill appointment. Using focus groups of five categories of adult patients receiving
combination ARV therapy, we conducted this cross-sectional qualitative study to provide insight
into modifiable gaps between patients’ expectations and experiences of the use of mobile
phones in facility-based ARV refill service at a public HIV clinic in Nigeria. A notable finding was
patients’ preference for harnessing informal social support (through intermediaries with mobile
phones) to maintain adherence to ARV refill appointments when they could not present in
person. This evolving social support strategy also has the potential to enhance defaulter
tracking. Our study findings may inform the development of ARV refill strategies and the design
of future qualitative studies on client–provider communication by mobile phones in underresourced
HIV treatment programmes.
