Table 3.

Implementation considerations for smartphone-based VL self-testing

Theme	Subtheme	Quotes/Examples
1. End user(s) / setting	Determine user and use case through shared decision making between patient and provider	“… it’s really interesting to be able to have someone just check in and see how their medicines are working, especially if they’re unable to get into clinic or… maybe like in someone who’s restarted on medicines, and they want to see if their VL’s coming down… I think it would have to be kind of a shared decision making between the provider and the patient on whether or not this type of monitoring would be right for them.” (Brooke, provider)
	Offer device as a POC option at provider’s office	“… going to get labs was a barrier where if you could do it… in the office… it’s just so much more accessible to people.” (Josephine, Provider)
2. Testing frequency	Place limits on testing frequency (user shouldn’t test too frequently)	“it’s great to empower people with a certain perspective, we got to place limits on it. I don’t see that happening with this, but it’s more like, you know, it’s it lets people, you know, test at home, communicate directly with physicians, but But yeah, you just have to play some limits on on how patients use it.” (Adam, provider) “… it would be almost more like a PRN or an as needed thing in my mind. Like, here I’m writing you this order for so many self tests per year and you can use those at your discretion like for maybe four tests a year, six tests a year you know, if you feel like you need to check that, but it’s not a replacement for coming to your medical visits.” (Sarah, provider)
3. Cost	Obtain insurance coverage and low cost for patients (PLHIV participants reported willingness to pay for $0-$100 as a co-pay for the device)	“… if it was something that was free, I would, I would use it.” (Nolan, PLHIV) “Depending on the price point and if I could get it through my insurance, yeah, I definitely would [pay for it]. Ideally, if I could get it through my insurance and have a small copay for it” (Eli, PLHIV)
	Use additional methods to obtain funding	“How much? How much is this device going to cost? How will it be distributed? You know, will the cost of the device be taken care of by NASO or Ryan White or Medicare, Medicaid all of that,” (Eli, PLHIV)
4. Privacy	Leverage current security technologies in healthcare	“It has the same security measures as anything else. And we have applications for like, our bank accounts and credit cards and all that. So like this I mean, it’s health. You know, it’s health information. But we already have, you know, I have an app that accesses my EMR so I can pull up patient’s charts through that. That’s all secure by the same, you know, face ID and encryption and things.” (Adam, provider)
5. Data reporting	Consider how/what self-testing data to report to state/national surveillance groups	“Like that needs to get reported, like it needs to come back. Those results need to go to their provider, and then they need to go to the state because we’re looking at like community viral suppression across the state and ending the epidemic.” (Josephine, provider)
6. Partnerships	Partner with Health Departments and provider to rollout	“… working really closely with, with providers of HIV care, even local health departments would be would be something to do to kind of help market this as a public health intervention.” (Brooke, provider)
	Associate with reliable institution(s) to facilitate trust in device	“And then also like the app tied to some sort of institution that like I trust. For instance, if it was tied to university, I would trust it more than like, a private company or something… If it was tied to a hospital, I would trust that… But if it’s just like some sort of, I don’tdo not know, company I’ve never heard of or. I would trust it less.” (Nolan, PLHIV)
7. User-testing	Conduct more user testing with handheld prototype	“… like a prototype, like being able to come back and say, “Hey, this is what we developed. What about it works, it doesn’t work for you.” (Adam, provider)

PLHIV = person living with HIV; VL = viral load.