Implementation of a Mobile Health Strategy to Improve Linkage to and Engagement with HIV Care for People Living with HIV, Tuberculosis, and Substance Use in Irkutsk, Siberia

Abstract

In Irkutsk, Siberia, there is a high prevalence of HIV and tuberculosis (TB) coinfection. Mobile health (mHealth) strategies have shown promise for increasing linkage to and engagement in care for people living with HIV (PLWH) in other contexts. We evaluated outcomes for a cohort of PLWH, TB, and substance use in Irkutsk after participation in a multi-feature mHealth intervention called MOCT. Sixty patients were enrolled during hospitalization for TB. We evaluated participant app usage, linkage to HIV care postdischarge, perception of self-efficacy related to HIV care, and HIV-related clinical outcomes at 6 months. We also performed an exploratory analysis to compare a subset of 49 patients with a pre-intervention cohort matched for age and gender. Participants demonstrated engagement with app features examined at 6 months. The majority linked to HIV care by 6 months (83%). Self-scoring of confidence in ability to communicate with HIV providers improved from baseline (median score 8, scale 1–10) to 6 months (10, p = 0.004). A higher proportion of the MOCT subset refilled antiretroviral therapy (69% vs. 43% in pre-intervention cohort, p = 0.01), with fewer deaths in the MOCT subset at 6 months (1 death vs. 10 deaths in pre-intervention cohort, p = 0.02) and a decreased likelihood of developing the composite outcome of death/failure to achieve viral suppression at 6 months (adjusted odds ratio = 0.33, p = 0.029). This study demonstrates preliminary intervention uptake and improvement in short-term outcomes for an urban cohort of PLWH, TB, and substance use enrolled in a multi-feature mHealth intervention, a novel strategy for the context. Clinical Trial Registration Number: NCT03819374.

Process evaluation for the adaptation, testing and dissemination of a mobile health platform to support people with HIV and tuberculosis in Irkutsk, Siberia

“…The cohort and additional usage details are described elsewhere. 28 Patients’ perceptions of the platform’s usability and acceptability were assessed following 6 months of participation in the intervention ( table 2 ). The survey was completed by 47 participants (seven patients were lost to follow-up, two were deceased by six months, one did not attend the 6-month assessment and three attended the assessment but did not complete the survey).…”

“…Pilot study participants demonstrated improved rates of linkage to care at the AIDS Centre and ongoing engagement with the platform by six months as well as better rates of medication refill and a lower propensity towards developing the composite outcome of death and failure to achieve viral suppression at six months. 28 Following contextual evaluation of patient and provider perceptions and platform testing and modification, the programme has been implemented across the Irkutsk oblast (a federal region similar to a state or province). Enrolment has expanded to four TB Referral Hospital filial (affiliated) clinics following hospital administrative approval and engagement of clinic leadership.…”

“…We identify several aspects of the project design and conduct that may have contributed to the successful uptake and high linkage rates observed following pilot testing. 28 Specifically, the team members were well-informed from prior experience and stakeholder feedback about the care systems already in place in Irkutsk. In addition, they iterated continuously from the planning to expansion and dissemination phases.…”

“…The platform provided a unique opportunity to prevent discontinuity of care following discharge from the TB Referral Hospital. 28 Various features were similarly helpful in preventing service disruptions related to COVID-19 for participants later in implementation. Conservative models estimate that COVID-19 related disruption in HIV and TB services in high-burden settings could increase HIV-related death by 10% and TB-related death by 20% in the five years following the pandemic.…”

“…A pilot study was conducted to test the adapted platform in a subset of patients at risk for disengagement, with HIV and TB coinfection as well as substance use. 28 Patients admitted for active TB treatment at the TB Referral Hospital were offered enrolment from April 2018 to November 2019. Inclusion criteria included adults aged 18–64 years diagnosed with HIV (by laboratory testing for new diagnoses and chart review for patients with documented history), a history of using substances at the time of enrolment (confirmed by chart review or self-report), and residence in Irkutsk city.…”