Protocol for a Study of Home-Based Hair Sample Collection to Monitor Antiretroviral Adherence Among a Multicultural...

Background Current blood-based antiretroviral (ARV) adherence measures reflect only short-term drug exposure, limiting their utility for assessing longitudinal adherence. Hair-based ARV concentration measurement offers an extended alternative but has not been adapted for multilingual populations or women at risk of HIV care disengagement. Objective To evaluate the feasibility and acceptability of home-based hair sample collection for ARV adherence monitoring among a racially, ethnically, and linguistically diverse cohort of women with HIV (WHIV) in South Florida. Methods This prospective mixed-methods study was conducted in three phases: theater testing of study procedures, hair sample collection, and qualitative data collection. Participants were WHIV enrolled from a Women's HIV Service at an academic medical center. Study consent and materials were delivered in English, Spanish, and Haitian Creole. Following an educational session on hair collection techniques, participants self-collected hair samples at home and mailed the samples to a laboratory for ARV concentration analysis. Feasibility and acceptability were further assessed through focus groups and individual interviews. Results Of 40 participants recruited, 37 consented and 34 hair samples have been received and submitted for ARV concentration analysis. A total of 24 participants completed qualitative data collection via focus groups (n = 8) and individual in-depth interviews (n = 16). Full quantitative and qualitative analyses are ongoing. Conclusion Preliminary findings suggest that home-based hair sample collection is feasible and acceptable among diverse WHIV. Culturally sensitive communication and participant-directed self-collection appear to facilitate engagement. Final results will inform the integration of hair-based adherence monitoring into HIV care for underrepresented populations.