Mobile Health Intervention for HIV Improves Retention in Care, Patient Outcomes

Mobile health interventions have the potential to help people living with HIV improve engagement in care, promote medication adherence, and in turn, improve patient outcomes, according to study findings.

Through the use of a smartphone app, researchers observed that participants became more engaged with their HIV care, resulting in improved linkage to and consistency of care, increased CD4 counts, and decreased viral loads. In addition to clinical outcomes, participants also reported that the app helped them overcome social and geographic isolation, which often act as barriers to care.

“Among young people with HIV, desired features of mobile health applications include the ability to connect to a community of other people living with HIV, connect with healthcare providers, track personal data, and obtain news and education about their health,” wrote the researchers.

To test the efficacy of such an intervention, the researchers designed and piloted PositiveLinks, a smartphone-based intervention. The app included a variety of features, including: daily queries of stress, mood, and medication adherence; weekly quizzes on general and HIV-specific knowledge; appointment reminders; and a community message board. Also utilizing incentives for app usage, participants who responded to 100% of the queries were entered into a monthly raffle to win a $50 gift certificate.

The researchers targeted those in the rural south, where there are prominent disparities in HIV care. A total of 77 participants were recruited between September 2013 and May 2015.

The mean response to the daily queries about medication adherence, mood, and stress were 50%, 47%, and 47%, respectively, at 6 months, and 41%, 39%, and 39%, respectively, at 12 months. For the weekly quizzes, there was a 43% response rate at 6 months and a 27% response rate at 12 months. There was a mean of 12.2 posts per participant to the community message board at 6 months and a mean of 19 posts at 12 months.

After 1 year, nearly 40% of participants were still actively using the app.

At the beginning of the study, half (51%) of participants were retained in care. By 6 months into the intervention, 88% were retained in care. While there was a small dip by 12 months, 81% of participants were still retained in care.

Visit constancy also improved significantly, from 22% having the highest constancy at baseline, compared to 36% at 6 months and 51% at 12 months. Researchers also observed increased CD4 counts from 522 cells/mm³ at baseline to 581 at 6 months and 614 at 12 months. Crucial for achieving viral suppression, viral loads decreased from 12,682 copies/mL at the beginning of the study to 14,912 at 6 months and 12,890 at 12 months.

“Mobile health interventions have the potential to improve retention in care and clinical outcomes for people living with HIV,” the authors concluded. “Long-term benefits can be achieved through a smartphone app connected to a clinical care setting and can reach vulnerable patients.”

Reference:

Dillingham R, Ingersoll K, Flickinger T, et al. Retention in HIV care and clinical outcomes with 12-month follow-up [published online June 1, 2018]. AIDS Patient Care STDS. doihttps://doi.org/10.1089/apc.2017.0303.