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Kennedy Ngowi,1,2 Francis Pima,1 Blandina Theophil Mmbaga,1,3,4 Rob E Aarnoutse,5 Peter Reiss,6,7 Pythia T Nieuwkerk,2 Mirjam Sprangers,2 Marion Sumari-de Boer1 1Kilimanjaro Clinical Research Institute, Moshi, Tanzania; 2Amsterdam UMC, Location AMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands; 3Kilimanjaro Christian Medical Center, Moshi, Tanzania; 4Kilimanjaro Christian Medical University College, Moshi, Tanzania; 5Radboudumc, Radboud Institute for Health Sciences & Department of Pharmacy, Nijmegen, The Netherlands; 6Amsterdam UMC, Location AMC, University of Amsterdam, Department of Global Health, And Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands; 7HIV Monitoring Foundation, Amsterdam, The NetherlandsCorrespondence: Kennedy NgowiKilimanjaro Clinical Research Institute, Moshi, TanzaniaTel +255758048649Email k.ngowi@kcri.ac.tzIntroduction: Digital Adherence Tools (DAT) to promote adherence to antiretroviral treatment (ART) for HIV are being increasingly adopted globally, however their effectiveness and acceptability in limited resource settings has been challenging. In this study, we examine the acceptability of DATs to improve adherence to ART.Methods: This study was part of a three-arm randomized controlled trial (REMIND) which investigated the effect of two different DAT’s: SMS text messages (SMS) or real-time medication monitoring (RTMM) on treatment adherence; compared to standard of care. Exit interviews and in-depth interviews were conducted at 48 weeks follow-up, to collect data on their experiences (successes, challenges, and barriers) and behaviours regarding the implementation of the interventions. Translated transcripts, memos and field notes were imported to NVivo software version 12. We used a thematic framework analysis which drew from Sekhon’s theoretical framework of acceptability (TFA), which comprises of seven constructs (affective attitude, perceived burden, perceived effectiveness, ethicality, self-efficacy, intervention coherence and opportunity costs).Results: Of the 166 participants enrolled, 143 (86%) were interviewed (68 in the SMS arm and 75 in the RTMM arm). Participants were highly satisfied (98%) with the DAT system and the majority of them reported it motivated them to take their medication (99%). The majority of participants reported they were confident in their ability to comply with the intervention and understood how the intervention worked (97%). Very few reported negatively about the devices (carrying the device), with only 6% reporting that they did not feel comfortable and 8% had ethical concerns with the SMS-content A few participants reported challenges with their connectivity/network and that the visits were too time-consuming. A few participants reported that they incurred extra cost for the sake of the study.Conclusion: Overall, the acceptability of these DATs was high. However, several factors may hamper their acceptability including the content and number of SMS, carrying the devices and the network availability.Keywords: adherence, SMS reminders, real-time medication monitoring, digital adherence tool, DAT, acceptability, ART

Background: The rapid increase in the use of mobile phones across sub-Saharan Africa over the past years have opened the door to the use of Digital adherence tools (DATs) to [...]