B-OK: a visual and tactile tool for improving HIV mental models in a United States urban center

Lack of adherence to antiretroviral therapy (ART) and poor retention in care are significant barriers to ending HIV epidemics. Treatment adherence support effectiveness may be constrained by limited understanding of the benefits of ART. We evaluated a visual and tactile tool, the B-OK Bottles ("B-OK"), that incorporates human-centered design and behavioral economics principles and is designed to change and strengthen mental models about HIV. We enrolled 118 adults living with HIV who were clients of medical case managers in Philadelphia. All participants completed a pre-intervention survey, a B-OK intervention and a post-intervention survey. A subset (N = 52) completed qualitative interviews. Co-primary outcomes were differences pre- to post-intervention for 11 questions about HIV awareness, knowledge, attitudes, intentions and perception. Qualitative interviews were assessed using an integrated analysis approach. Participants had a median age of 55 years (IQR 47-60), 65% were male sex (N = 77), and 72% identified as non-Hispanic Black (N = 85). B-OK was associated with improved awareness and understanding of HIV terminology, changes in HIV treatment attitudes, and increased intention to rely on HIV treatment for transmission prevention. Qualitative interview results aligned with the quantitative findings. These findings provide a strong rationale to further evaluate the potential for B-OK to improve HIV treatment adherence support.