People leaving jail or prison with HIV face some of the steepest odds in modern medicine. The disruption of incarceration—of housing, income, relationships, and health insurance—collides with the unforgiving pharmacology of antiretroviral therapy, which demands near-perfect consistency to suppress the virus and prevent drug resistance. A new qualitative study published in BMC Public Health offers a rare, intimate look at what happens when researchers pair a human solution, peer navigation, with a technological one, smartphone-based directly observed therapy, to help criminal legal system-involved people with HIV stay on their medication during the precarious weeks and months after release. The findings are a mixture of encouragement and caution, revealing both the power of human connection and the stubborn persistence of structural barriers that no app can overcome.
The research team, led by investigators at Albert Einstein College of Medicine and Montefiore Medical Center in collaboration with The Fortune Society, a New York-based reentry services organization, conducted in-depth semi-structured interviews with participants enrolled in a pilot intervention known as DEPART-CLSI, which stands for Directly-observed-therapy Enhanced Peer-support to promote concordance with Antiretroviral Therapy among Criminal Legal System-Involved Individuals. The intervention combined two elements that have each shown promise individually: peer navigators, trained personnel with lived experience of the criminal legal system who help clients link to and remain engaged in HIV care, and mobile directly observed therapy, or mDOT, in which participants record themselves taking their antiretroviral medication using a smartphone application, allowing adherence to be verified remotely without requiring clinic visits or in-person observation.
Of eighteen pilot study participants, fifteen completed qualitative interviews. The demographic profile of the group underscores the compounding vulnerabilities faced by this population. Participants had a mean age of 50.3 years with a standard deviation of 10.92. Fourteen identified as cisgender men and one as a transgender woman. Eight participants identified as Black, five as Hispanic, one as White, and one as Biracial—a distribution reflecting the profound racial and ethnic disparities in both HIV incidence and incarceration rates in the United States. The housing circumstances were particularly stark: more than half of participants reported currently experiencing homelessness, and two-thirds reported living in group settings such as shelters. It is against this backdrop of instability that the researchers asked participants to reflect on their experiences with the intervention, using an interview guide and thematic analysis grounded in Social Cognitive Theory, a psychological framework that emphasizes the interplay between personal factors, behavioral capacity, and environmental influences in shaping health outcomes.
The analysis surfaced four overarching themes. First, structural barriers complicated engagement in HIV care. Participants described how the basic logistics of survival after release—securing shelter, food, and income—frequently took precedence over medical appointments, and how the chaotic circumstances of post-incarceration life made consistent routines difficult to maintain. Second, social support emerged as a critical ingredient for engagement in care. Participants spoke about the importance of having someone in their corner, whether family members, friends, or the study’s peer navigators, at a time when the transition from jail back to the community often leaves people isolated precisely when the risk of treatment interruption is highest.
The third theme was perhaps the most striking: participants highly valued the peer navigation component of the intervention. The qualitative data reveal why this human element may matter so much. Peer navigators occupy a unique position in the landscape of HIV care—they are neither clinical providers nor case managers in the traditional sense, but people who have navigated similar systems themselves and can establish a form of trust that institutional relationships often struggle to achieve. For study participants, this translated into practical assistance with appointments, medications, and services, but also into something harder to quantify: a relationship with someone who understood, from experience, the challenges of reentry.
The fourth theme, however, complicates any simple narrative about technology as a panacea. The mDOT component was helpful for some participants in maintaining concordance with their antiretroviral therapy, providing a structured daily ritual and a sense of accountability that supported medication-taking. Yet others encountered genuine difficulties with the technology itself. Some struggled to use the smartphone or navigate the application, and one participant’s remark gave the study its memorable title: “I got to do it on my own, I got to be my own app”—a statement that captures a complex emotional landscape in which self-reliance, pride, and ambivalence about technological mediation all converge. The intervention, the authors conclude, was not “one-size-fits-all.”
This finding carries significant implications for the design of mobile health interventions generally, and for the Ending the HIV Epidemic initiative in the United States specifically, which has made engagement of underserved populations a central priority. Digital adherence tools have been celebrated for their scalability and low marginal cost, and mDOT in particular addresses a longstanding weakness of traditional directly observed therapy, which requires patients to travel to clinics or receive home visits—a burdensome proposition for people with transportation barriers, unstable housing, or employment obligations. By allowing remote video-verified dosing, mDOT promises the rigor of observed therapy with far greater flexibility. But the study’s results are a reminder that flexibility on paper does not always translate to usability in practice, particularly for a population in which digital literacy, smartphone access, and the cognitive bandwidth available for learning new technology may all be constrained by the circumstances of poverty and recent incarceration.
The methodological choices of the study also merit attention. By anchoring the interview guide and thematic analysis in Social Cognitive Theory, the researchers positioned self-efficacy— individuals’ beliefs in their own capacity to execute behaviors—as a central analytic lens. This theoretical grounding helps explain the tension evident in participant accounts: mDOT can bolster self-efficacy by making adherence observable and achievable, but it can also feel like surveillance or an affront to autonomy, especially for people whose lives have been heavily regulated by carceral institutions. The title-giving quote about being one’s own app sits precisely at this intersection, suggesting that for some participants, the act of internalizing the accountability function of the technology was itself an assertion of independence.
The public health stakes of this research are considerable. People with HIV are disproportionately impacted by the criminal legal system, and while carceral settings can paradoxically provide transient stability for chronic disease management—regular meals, mandated medication times, on-site clinics—incarceration frequently disrupts continuity of care. The reentry period, when that artificial stability evaporates, is a moment of acute vulnerability. HIV care engagement and antiretroviral therapy concordance after incarceration are undermined by multiple interacting factors, including substance use disorder, limited social support, and structural conditions such as housing and economic instability. Interruption of therapy during this window risks virologic rebound, emergence of drug-resistant viral strains, forward transmission, and the individual health consequences of uncontrolled infection.
Against this risk profile, the study’s conclusion is measured but constructive. The combined intervention of peer navigation and mDOT appears acceptable to the population it aims to serve. Participants expressed genuine appreciation for both the peer navigator relationship and the mDOT application, and the technology demonstrably assisted medication concordance for a meaningful portion of the sample. At the same time, the authors are clear-eyed about the limits: some participants will need technological support—training, troubleshooting, perhaps simplified interfaces—to benefit from mDOT, and structural barriers ranging from homelessness to economic precarity will continue to complicate post-incarceration linkage to HIV care regardless of how well-designed an intervention may be.
For intervention designers and policy makers, the study suggests a hybrid model as the most defensible path forward: invest in the human infrastructure of peer navigation, which participants consistently valued, while deploying digital tools like mDOT as optional, flexibly supported enhancements rather than universal mandates. The technology should serve the participant’s own sense of agency—helping them, as one participant put it, to be their own app—rather than imposing a uniform digital ritual that some will find empowering and others will find alienating. As the United States continues to pursue the goals of the Ending the HIV Epidemic initiative, this study provides both a template and a warning: the most effective interventions for the most marginalized populations will be those that combine trust built through shared experience with technology that adapts to people’s lives, rather than demanding that people adapt to the technology.
Subject of Research: Experiences of criminal legal system-involved people with HIV using a peer navigator-led mobile directly observed therapy (mDOT) intervention to support antiretroviral therapy concordance after release from incarceration
Subject of Research: Medicine
Article Title: “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
Article References: Goldberger, A., Coe, J., Riback, L. R., Ackerman, M., Robinson, D., Antigua, J. R., Linder, M., Ricard, N., Day, R. F., Fox, A. D., & Akiyama, M. J. (2026). “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. BMC Public Health. https://doi.org/10.1186/s12889-026-29054-w
Image Credits: AI Generated
DOI: 10.1186/s12889-026-29054-w
Keywords: HIV, Peer navigation, Mobile directly observed therapy, mDOT, Antiretroviral therapy, Reentry, Incarceration, Criminal legal system, ART concordance, Mobile health intervention, Social Cognitive Theory, Qualitative research
Cite Scienmag News
APA MLA Chicago
Ophelia Keating. (September 8, 2026). Peer navigators using mobile DOT help justice-involved people with HIV. Scienmag. https://scienmag.com/peer-navigators-using-mobile-dot-help-justice-involved-people-with-hiv/
Ophelia Keating. “Peer navigators using mobile DOT help justice-involved people with HIV.” Scienmag, 8 September 2026, https://scienmag.com/peer-navigators-using-mobile-dot-help-justice-involved-people-with-hiv/. Accessed 8 September 2026.
Ophelia Keating. “Peer navigators using mobile DOT help justice-involved people with HIV.” Scienmag. September 8, 2026. https://scienmag.com/peer-navigators-using-mobile-dot-help-justice-involved-people-with-hiv/
Copy citation Download RIS
Tags: addressing health disparities in formerly incarcerated populationsbarriers and facilitchallenges of HIV medication adherence post-releasecollaboration between medical centers and reentry organizationsDEPART-CLSI pilot intervention for HIV adherenceHIV peer navigationHIV peer navigation after incarcerationhuman connection and technology in HIV careimpact of incarceration on HIV treatment continuityimpact of reentry programs on HIV health outcomesinnovative solutions for HIV medication adherence during reentrymobile directly observed therapy for justice-involved individualspeer support in reentry programspost-incarceration HIV treatment adherencequalitative study on HIV care in justice-involved populationsqualitative study on HIV treatment support strategiesreentry services for HIV-positive individualsrole of peer support in HIV treatment continuitysmartphone-based directly observed therapy for justice-involved individualssmartphone-based health interventions for HIVstructural barriers to HIV care after releasestructural barriers to HIV care among formerly incarceratedtechnological interventions for HIV medication adherencetechnology-assisted medication management for formerly incarcerated people
