Evaluating B-OK bottles to improve evidence-based HIV medication adherence counseling
Philadelphia, PA

The main objective of this project was to advance the United States Ending the HIV Epidemic (EHE) Initiative: A Plan for America to Reduce New HIV Infections by applying behavioral economic approaches to assess a simple yet powerful visual aid (the B-OK bottle tool) as an implementation strategy to improve the effectiveness of treatment adherence support (TAS) by Philadelphia medical case managers (MCMs) at Ryan White funded agencies. We carried out a focused, one-year assessment of the feasibility, acceptability, and appropriateness of the B-OK bottles as an implementation strategy with both medical case managers (MCMs) and with clients who are served by MCMs. The study was funded by an EHE Supplement grant from Penn’s Center for AIDS Research (CFAR).

This study included two specific aims. Aim 1 evaluated feasibility, acceptability, and appropriateness of the B-OK bottles among MCMs at three Ryan White-funded agencies engaging with PLWH across the care continuum in Philadelphia. We conducted four focus groups using think-aloud and other contextual inquiry techniques.

Aim 2 evaluated responses to the B-OK bottles among PLWH who receive services at one of three agencies in Philadelphia, including (a) changes in awareness, knowledge, attitudes and intentions related to HIV transmission and treatment; and (b) acceptability for use during MCM. Using an explanatory sequential mixed-methods design, we first conducted a pre-post survey to evaluate changes in awareness, knowledge, attitudes, and intentions following engagement with the B-OK bottles, then assessed acceptability and elicited mental models generated from exposure to the B-OK bottles through in-depth interviews with a purposive sample of patients who completed the surveys.

This project will inform a broader implementation of this strategy within MCM agencies in Philadelphia and a future large-scale trial.

See below for reactions to the B-OK bottles from our study participants (People Living with HIV and Medical Case Managers in Philadelphia).


HIV, U=U, HIV testing, medication adherence, prevention, antiretrovirals

Aaron Richterman, MD, MPH University of Pennsylvania
Harsha Thirumurthy, PhD Co-Director
Tamar Klaiman University of Pennsylvania
Kathleen Brady City of Philadelphia – Department of Public Health
  • City of Philadelphia – Department of Public Health
  • National Institutes of Health / U.S. Department of Health and Human Services