Mobile phones and caring for people living with HIV in Iran: exploring the role of context

Thesis

Living with HIV requires lifelong engagement with medical care. However, consistent engagement with antiretroviral therapy can be undermined by multiple forces at the international, national, sociolegal, institutional, and individual levels. Programmes that are aimed at improving engagement with HIV care are introduced into complex care settings that can interact dynamically with the contexts of daily living with HIV. Recently, there has been a surge of research evaluating mobile health (mHealth) support to promote treatment continuity. Such mHealth approaches have shown short-term efficacy in controlled settings, but the long-term effectiveness in real-life contexts remains unclear. This is in part because the current body of public health literature predominantly views mHealth through a deterministic lens that examines whether an mHealth programme produces a specific outcome, without examining the recursive relationship and complex interactions with multilevel contexts of HIV care that influence whether such outcomes will occur. Importantly, when moving programmes across settings, it is vital to understand how the programme works, when, why, in what context, and for whom. In this thesis, I adopt a realist lens of enquiry to examine how mHealth interacts with context in such a way to trigger desired mechanisms that in turn can produce intended outcomes. To do so, I collect primary data from Iran and use secondary evidence from various global settings. In DPhil paper I, I contextualise the condition of living with HIV and engaging with antiretroviral therapy in Iran. In DPhil paper II, I conceptualise how specific mHealth features can change the contexts of engaging with HIV care in Iran. In DPhil paper III, I propose a protocol for a pilot trial and a nested realist evaluation of HamRaah, an evidence-based mHealth programme that is viewed by stakeholders to be suited to the contexts of living with HIV and treatment retention gaps in Iran. In DPhil paper IV, I use secondary evidence from various global settings to produce a refined programme theory that explains how, when, for whom, and in what contexts human-supported mHealth can enhance engagement with HIV care.

Authors: Ameli, V

• DOI: 10.5287/ora-xogxee7mx
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: Iran; digital health; adherence to treatment; engagement with care; HIV; mHealth; therapeutic relationship
• Subjects: Highly active antiretroviral therapy; Wireless communication systems in medical care