“I got to do it on my own, I got to be my own app”: experiences with peer navigator-led mobile directly observed antiretroviral therapy among criminal legal involved individuals with HIV: a theory-informed qualitative study

People with HIV (PWH) are disproportionately impacted by the criminal legal system. While carceral settings can provide transient stability for HIV and other chronic conditions, incarceration frequently disrupts continuity of care. HIV care engagement and antiretroviral therapy (ART) concordance are impacted after incarceration by multiple factors including substance use disorder (SUD), limited social support, and structural factors such as housing and economic instability. Peer navigators can improve linkage to and retention in HIV care during the reentry period, and technology-enhancements may increase engagement in existing peer navigation services. We conducted a qualitative study with criminal legal-involved (CLSI) PWH who had recently been released from incarceration and were enrolled in a pilot study that integrated mobile directly observed therapy (mDOT) with peer navigation. The interview guide and thematic analysis were informed by Social Cognitive Theory. Semi-structured interviews focused on understanding barriers to and facilitators of ART concordance and engagement in HIV care among CLSI PWH, and experiences with this peer navigator-led intervention. Fifteen of 18 pilot study participants completed qualitative interviews. Their mean age was 50.3 (SD 10.92), 14 identified as cisgender men and 1 identified as a transgender woman. Just over half of participants identified as Black ( n = 8), one third identified as Hispanic ( n = 5), one individual as White ( n = 1), and one as Biracial ( n = 1). Greater than half reported currently experiencing homelessness ( n = 8), and two-thirds reported living in a group setting such as a shelter ( n = 10). There were 4 overarching themes: (1) Structural barriers complicated engagement in HIV care; (2) Social support was important for engagement in HIV care; (3) Participants highly valued peer navigation; and (4) mDOT assisted with ART concordance for some participants while others had challenges with smartphone and application use. Participants faced several barriers to care in the post-incarceration period. Participants valued social support and expressed appreciation for both the peer navigator and mDOT application; however, the intervention was not “one-size-fits-all” as some participants found it challenging to use the smartphone and mDOT application. Overall, the intervention appears acceptable, but some participants may need technological support and structural barriers will continue to complicate post-incarceration linkage to HIV care.