Table 7.

Summary of qualitative results at check-in contact.

Theme or finding	Representative quote(s)
Effects of the SCAP intervention on motivation to achieve HIV viral suppression: Almost without exception, participants highly valued achieving and sustaining HIV viral suppression. Many noted the COVID-19 pandemic had increased their motivation to maintain good health, including becoming HIV virally suppressed. The SCAP intervention was experienced as something new and different from past programs they had engaged in.	The feeling, you know—I'm a much more healthier because, I mean, it was kind of touch and go when I got sick and everything. But that's when the coronavirus had hit, you know, and it was just really, really not a good place to be [not virally suppressed], at the time, you know?
The chance to earn a prize was a motivator for joining the study, but not a reason to change HIV management behavior. Some participants were adamant that in general there is not or at least should not be a direct link between financial incentives and motivation to adhere to ART, but that the possibility of winning the prize and receiving financial compensation was a major reason they participated in the project, particularly during the COVID-19 pandemic.	Well, it depends on the individual. It actually depends on why you're here. If you are here just for the money, that I can see why it's an issue, but if you are here for the benefit of the program and the money is just icing. You know, it's just a little incentive. This is coffee money for me, you know? I'm not looking to buy watches or phones off of the study money.
The counseling session was experienced as a conversation, and personal, individualized contact with staff was appreciated.	(The session was) just to kind of see where people are at, you know? It's kind of like a one-on-one therapy type of session.
Engagement with TMQQs and overall utility: Participants generally found the TMs informative and helpful overall. Some participants also reported actively engaging with the quizzes and/or information in their daily lives, and that the TMQQs prompted them to gather additional information about HIV management.	I think that's good, too, because then now I have to look it up, you know, so that puts me into research mode, and I'll look up stuff and then I'll find other stuff that I didn't know along the way.
TM Frequency: Participants responded favorably to receiving TMs, and noted being either satisfied with the quantity of messages, or even desiring to receive them more frequently. Some participants appreciated the brevity of the TM messages. Many participants reported having frequent difficulties with their cellular phone plans, most commonly attributed to exhausting their “minutes” and/or data plan allotment, and also the inability to make payments on time or at all.	Oh, I enjoy it [the TMQQs]. I think it should be more frequent like maybe Monday, Wednesday and Friday. Like have a question. And I think it's fun. I look forward to sometimes that text to answer questions, be reminded that there's other people out there that are like-minded and I hope the situation gets better. And it just makes me feel good, you know, that's all. [The TMQQs remind me there are] people who care about you, they're still thinking about you.
TM Content and Comprehensibility: Participants generally found TMs both “logical and informative,” and in some cases noted that receiving regular TMs served to remind them about taking HIV medication, and in some cases was a source of new information.	I think it's perfect just the way it's been, because it's not just focusing on one area. It's a multiple-choice of questions and situations, and it gets you to start thinking about some things and how you can apply this to your life, you know?
TM difficulty: A small number of participants expressed that, based on their preexisting knowledge about HIV, they found that TMQQs were not sufficiently challenging.	I've tried everything. I haven't missed nothing new, it sounds like—like what you told me about the injections that are coming [injectable ART]. That wasn't one of the questions. But like I said, somebody who hasn't [been well-informed], yeah, they might be quite helpful. But for somebody who has, like I have done all that, so no, it hasn't been. That's why I knew what the answers were! (laughs) […] I don't know. You are trying to be helpful, so like I said, for people who don't know, yes. For people who are more advanced, maybe you have to put some other things in there to try and change it up.
There was room for improvement in TMQQs: A small number of participants found some of the messages challenging or confusing. Since they wanted to earn their points, this caused stress. Yet, for most, even disagreeing with the wording of a question did not prevent them from actively engaging with the TMQQ.	What I like about them is that—very few of the questions are challenging to me. And that's only because I've done a lot of studying. I've been a peer educator. So a lot of those—it's funny how they're talking about—they just texted me. Hold on. I know I'm going to pass [get the QQ correct], anyway. It says: True or false question. Using a pill box will only make it harder to remember to take my medication? See, that's an opinionated question. That's a question based off an opinion. Because some people might feel that it's harder and some people might feel that it's easier. I don't like questions like this. “Only make it harder.” I don't know if it's going to make it harder. I can't speak for everybody. I'm going to look it up, though. I'm going to look it up. I want my 10 points.
TMQQs were perceived as impersonal by some: Some participants indicated the need for more open-ended, individually focused, and therapeutic questions, especially in the context of social isolation during COVID-19. Some participants offered suggestions regarding the relatively impersonal nature of some of the TMQQs. For these participants, TMQQs could be augmented with those that are more therapeutic and/or interpersonal. Specifically, participants expressed a desire for TMs that were more directly oriented to mental health issues, particularly as they pertain to the COVID-19 pandemic, and issues not directly related to HIV.	It could be more personal. […] Because this is just asking questions about [HIV], it could be more personal, I think personally [ask about] how do you feel and how do you live? I didn't see a person, I didn't see like a personal attachment. Just a true or false answer is not [personal contact]. […] And you want somebody to be interested in you—saying, yo, this is not just about a virus, because most people that's got the virus and go to programs hear about it all day. Are they knowledgeable of it? Not at all. They still beat around the bush. Some of them hear this and hear that and hear this. But do they know the facts? There's a difference. And then how the facts affect them.
Financial Incentives were appreciated: Participants overwhelmingly noted that the financial incentives provided by SCAP were not only appreciated, but were instrumental in being able to meet their daily needs, and reported finding the prize amounts to be appropriate or even generous, if the prize structure was not at least somewhat confusing (see below).	I think [the point system and financial incentives are] a good thing. It's a great motivational tool, you know? I think that it helps someone get more involved and more in tune to the overall [intervention] experience. And, I mean, it is nice getting a reward like this, basically considering, going back to the current situation that has affected so many areas of people's life [COVID-19], especially financially. You know, it's been a struggle.
The point system/prize wheel was confusing: Overall, participants' responses indicated a significant amount of confusion regarding the intervention's point system and related financial incentives, even when they nonetheless felt the messages served as a successful motivation tool in general.	I was confused about that. I mean I have the paper [an infographic describing the points and prizes]. It's somewhere in this house but I cannot get to them at this moment in time. However, I remember that if your count changes, if it goes up you get a certain amount of points or if you answer all the questions right you get a certain amount of points.
Some did to perceive the point system and allocation of prizes for all participants as fair. A modest number of participants questioned the overall fairness of the point system, suggesting that individuals who choose not to fully participate in the intervention should be rewarded less than those genuinely investing their time and energy. Most participants found the lottery prize interesting and exciting, but some suggested a fixed prize amount would be preferable. Since prize amounts were based on chance and points earned in TMQQs, this finding reflects the lack of clarity in the prize structure.	I'm going to be honest. I think it kind of sucks that I can be—if I'm getting 10, 10, 10, 10, then award me with what I'm actually winning. Why do I need to spin a wheel or something like that? Award me with—if I'm answering correctly, and I'm doing the right things, I would assume so. For those people who don't want to participate, why should they get rewarded at all? Because I try to make sure [to respond to the TMQQ]—like I said, my phone is acting up, and I try and make sure I always answer when you do text me, because I do want to participate in this. For me, like you said, for those who don't participate, I do not understand that [they would get any compensation]. They can get the question wrong. I understand that, too. That's fine. They still participated. But for those who don't answer at all, hey, that's not right for them still to get to spin.