Using a Mobile Health Intervention to Support HIV Treatment Adherence and Retention Among Patients at Risk for Disengaging with Care

Abstract

Less than half of the 1.2 million HIV-infected individuals in the United States are in consistent medical care, with only a third receiving treatment resulting in viral suppression. Novel interventions to improve engagement are necessary to ensure medical adherence, improve long-term outcomes, and reduce HIV transmission. Mobile health (mHealth) strategies including cell phone and text messaging have shown success in the developing world for medical adherence, yet mHealth interventions have not been developed and evaluated to improve retention in HIV care in the United States. We conducted a 6-month pilot study investigating the use of a clinic-based bi-directional texting intervention to enhance engagement in HIV care among those with higher risk of loss to follow up, including those with a recent HIV diagnosis or those re-engaging in HIV care at a large urban clinic in New England.

A Rapid Review of eHealth Interventions Addressing the Continuum of HIV Care (2007–2017)

“…Other foci included retention (8.9%, k = 4) and linkage to care (2.2%, k = 1). Two studies (4.4%) focused on both adherence and retention [19, 20], one study (2.2%) focused on both linkage and re-engaging clients back into care outcomes [21], and one study (2.2%) focused on both care retention and virologic suppression [22]. The studies included samples of PLWH experienced with HIV treatment (k = 18), non-adherent to ART (k = 13), or treatment naïve (k = 6).…”

“…Most of the interventions (k = 20) using cognition as a mechanism of change were focused on ART adherence for their clients. Other interventions using cognition as a change mechanism focused on both ART adherence and virologic suppression (k = 4); one study [19] focused on both ART adherence and care retention, and one study focused on both care retention and virologic suppression [22]. All of the eHealth interventions using cognition were augmented with another change mechanism except for two studies [i.e., [43, 44] ].…”

“…Other interventions using access as a change mechanism focused on multiple LRC-related outcomes (k = 4). We discovered that most of the studies that included access as a change mechanism had preliminary or proven evidence of efficacy (k = 9) for improving HIV medication adherence [33, 35, 53]; linking to care after initial HIV diagnosis [21, 45]; care retention [21, 26], and multiple foci [20–22, 51]. Most of the studies using access that reported preliminary or proven evidence of efficacy used devices that involved bi-directional communication between client and provider (meaning that either provider or client can initiate interaction) [33, 51, 53].…”

Development of an mHealth platform for HIV Care: Gathering User Perspectives Through Co-Design Workshops and Interviews (Preprint)

“…Both appointment management systems and medication management systems have been stressed as important functionalities for self-managing HIV and will be considered in the development of the EmERGE platform. In other studies options to exchange messages between patients and clinics are currently implemented through basic cell phone text messaging services [31].While two-way communication features have not yet been considered within the development of comprehensive HIV mHealth platforms based on interacting apps and web interfaces [17][18][19], our co-design participants did regard this as an important functionality to maintain relationships and exchange information and concerns. As a result, a messaging function has been developed and integrated into the EmERGE mHealth platform.…”

Using Path Analysis to Evaluate the Healthcare Empowerment Model Among Persons Living with HIV for Antiretroviral Therapy Adherence

“…From a patient perspective, this means being guided toward and having access to appropriate care based on his or her health condition(s); receiving assistance in attending medical visits with appointment reminders; access to affordable transportation and child care; and being able to communicate with one's healthcare providers in multiple ways that may include talking by phone, texting, or online correspondence in between visits. [37][38][39][40] Being well informed and having the ability to convey up-todate knowledge about a particular illness or condition are imperative for the empowered patients and their healthcare providers. Healthcare providers can make sure that PLWH clearly understand their illness/condition, have an awareness of all treatment options and the relative risks and benefits, and recognize how to navigate the healthcare system to receive the best care possible.…”