App improves HIV care management and virus suppression

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A health app designed at the University of Virginia for recently-diagnosed HIV patients not only has improved care management and co-ordination but helped them suppress the virus.

The effectiveness of the PositiveLinks app, developed by Dr Rebecca Dillingham, an associate professor of medicine at UVA, was highlighted in a study which reinforces the contention among connected health experts that a personalised mHealth platform – which some call “warm technology” – can enhance patient engagement and improve clinical outcomes.

The study tracked 77 patients who’d been recently diagnosed with HIV and sought care at UVA’s Ryan White Clinic in Charlottesville. They were given an app, managed by the clinic, that enabled them to submit and receive information on a daily basis.

After 12 months, the study reported, the number of patients reporting regular visits to the clinic jumped from 51% to 81%, with a high of 88% at six months. In addition, the number of patients who’d suppressed the virus increased from 47% at the onset of the study to 87% at six months to 79% after one year.

Just as important, researchers found that users were comfortable with using the app – an important consideration considering the population it addresses.

According to the study, users accessed the app, on average, 188 times through the first six months and 312 times by the end of the year – at which time 40% of those enrolled in the study were still answering daily questions.

Dillingham and her colleagues say the app appeals to users because it not only offers relevant information, including appointment reminders, delivered by the clinic’s programme coordinator, but also enables them to discreetly and securely chat with others going through the same situation.

“They can offer and receive tips about living with HIV, about the rest of life, and about how to interact with clinical services available,” Dillingham said. “They can have all this interaction without having to reveal their identity or their disease status, which is important in many contexts but particularly for some of our patients who live in rural communities where stigma levels associated with HIV infection remain high.”

She also noted that users like to receive information by text message. “The texting-like format of the messaging is more in line with the way many people communicate today,” she said. “We hear over and over again that it is harder and harder to reach people with a phone call, sometimes especially one that comes from a number associated with a healthcare organisation.”

In the study, Dillingham and her colleagues said the app proved popular with users because they saw it as “warm technology,” or personalized technology that allows them to share their emotions (as opposed to “cold technology,” which is impersonal).
The app, they wrote is “not just a stand-alone app, but a pathway to human contact.”

“The concept of warm technology emphasises human connection and allowed the … intervention to take mobile strategies a step further, enhancing patients’ relationships with their care setting and virtual community.”

The next iteration of the app platform will bring healthcare providers into the mix.

According to Dillingham, PositiveLinks can review self-reported data weekly and alert users and/or providers if they spot any trends. She and her colleagues are now working on a provider-facing app that would enable the patient’s care team to review that data, once the patient gives his or her assent, and communicate with the patient when necessary.

Abstract
Mobile health interventions may help People Living with HIV (PLWH) improve engagement in care. We designed and piloted PositiveLinks, a clinic-affiliated mobile intervention for PLWH, and assessed longitudinal impact on retention in care and viral suppression. The program was based at an academic Ryan White Clinic serving a nonurban population in Central Virginia. The PL intervention included a smartphone app that connected participants to clinic staff and provided educational resources, daily queries of stress, mood and medication adherence, weekly quizzes, appointment reminders, and a virtual support group. Outcomes were analyzed using McNemar’s tests for HRSA-1, visit constancy, and viral suppression and nonparametric Wilcoxon signed-rank tests for CD4 counts and viral loads. Of 77 participants, 63% were male, 49% black non-Hispanic, and 72% below the federal poverty level. Participants’ achievement of a retention in care benchmark (HRSA-1) increased from 51% at baseline to 88% at 6 months (p < 0.0001) and 81% at 12 months (p = 0.0003). Visit constancy improved from baseline to 6 months (p = 0.016) and 12 months (p = 0.0004). Participants’ mean CD4 counts increased from baseline to 6 months (p = 0.0007) and 12 months (p = 0.0005). The percentage of participants with suppressed viral loads increased from 47% at baseline to 87% at 6 months (p < 0.0001) and 79% at 12 months (p = 0.0007). This study is one of the first to demonstrate that a mobile health intervention can have a positive impact on retention in care and clinical outcomes for vulnerable PLWH. Next steps include integration with clinical practice and dissemination.

Authors
Dillingham Rebecca, Ingersoll Karen, Flickinger Tabor E, Waldman Ava Lena, Grabowski Marika, Laurence Colleen, Wispelwey Erin, Reynolds George, Conaway Mark, Cohn Wendy F

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