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Bielick C, Canan C, Ingersoll K, Waldman AL, Schwendinger J, Dillingham R. Three-Year Follow-up of PositiveLinks: Higher Use of mHealth Platform Associated with Sustained HIV Suppression. AIDS Behav 2024:10.1007/s10461-024-04405-z. [PMID: 38869759 DOI: 10.1007/s10461-024-04405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
PositiveLinks (PL) is a mHealth platform to support care engagement by people with HIV (PWH). Daily reminders prompt the user to report medication adherence, mood, and daily stress. Higher response rate to PL check-ins has been associated with better suppression of viral load over 6-18 months. We conducted a retrospective chart review for a three-year period collecting demographic information, average mood and stress scores, and all viral loads obtained in usual patient care. We performed multivariable logistic regression modeling to identify factors associated with loss of viral load suppression and a time-to-event survival analysis until first unsuppressed viral load stratified by PL usage. Of the 513 PWH included, 103 had at least one episode of viral non-suppression. Low users of PL were more likely to have an unsuppressed viral load with an adjusted Odds Ratio (aOR) of 5.8 (95% CI 3.0-11.5, p < 0.001). Protective factors included older age (aOR 0.96; 95% CI 0.93-0.98, p = 0.003) and income above the federal poverty level (FPL) (aOR 0.996; 95% CI 0.995-0.998, p < 0.001). High PL use was also associated with better viral load suppression (VLS) over time (p < 0.0001 ((aHR) of 0.437 (95% CI 0.290-0.658, p < 0.001)) after adjusting for age and FPL. High stress scores were related to subsequent loss of viral suppression in an exploratory analysis. High check-in response rate on the PL app, older age, and higher income are associated with sustained VLS over time. Conversely, lack of response to check-ins or increased reported stress may signal a need for additional support.
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Affiliation(s)
- Catherine Bielick
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
| | - Chelsea Canan
- Division of Disease Prevention, Virginia Department of Health, Richmond, VA, USA
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Ava Lena Waldman
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Jason Schwendinger
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
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Markazi-Moghaddam N, Balaye Jame SZ, Nikoomanesh M, Rezapour R. A Systematic Review and Meta-Analysis of Health Care Quality in Iran Based on the Comprehensive Quality Measurement in Health Care Model. Int J Prev Med 2023; 14:10. [PMID: 36942033 PMCID: PMC10023840 DOI: 10.4103/ijpvm.ijpvm_238_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/15/2021] [Indexed: 01/26/2023] Open
Abstract
Background Comprehensive assessment of health care quality is the first step in improving care and achieving health service goals. Therefore, this study aimed to conduct a systematic review and meta-analysis of health care quality in Iran based on the Comprehensive Quality Measurement in Health Care model. Methods In this study, the databases of PubMed, Scopus, Web of Science, Iranian Scientific Information Database (SID), MagIran, and Google Scholar were searched using English and Iran keywords without time limit. STATA 16 software and a random effect model were used for conducting meta-analysis. Results Of the 750 articles found, 20 were finally included; 13 of which were related to service quality, five to customer quality, and four to technical quality. Overall mean score of service quality was 7.79 [95% CI 7.43-8.15, df = 12, I2 = 98.48, P value < 0.000] out of 10, and overall mean score of customer quality was 73.20 ± 4.56 [95% CI 65.18-81.22, df = 5, I2 = 99.34, P value < 0.001] out of 100. Among the 12 dimensions of service quality, the confidentiality dimension (9.55 ± 0.12) had the highest mean score and the group support dimension (5.92 ± 0.901) had the lowest score. In general, from the viewpoint of service receivers, the technical quality is relatively favorable. Conclusions According to the results of this study, the quality of health care in Iran is significantly far from ideal. Therefore, planning to improve providing health care is essential.
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Affiliation(s)
- Nader Markazi-Moghaddam
- Critical Care Quality Improvement Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Health Management and Economics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Sanaz Zargar Balaye Jame
- Department of Health Management and Economics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
- Address for correspondence: Dr. Sanaz Z. B. Jame, Department of Health Management and Economics, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran. E-mail:
| | - Mahdi Nikoomanesh
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ramin Rezapour
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Coulson NS, Buchanan H. The Role of Online Support Groups in Helping Individuals Affected by HIV and AIDS: Scoping Review of the Literature. J Med Internet Res 2022; 24:e27648. [PMID: 35881456 PMCID: PMC9364165 DOI: 10.2196/27648] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/29/2021] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Online support groups provide opportunities for individuals affected by HIV and AIDS to seek information, advice, and support from peers. However, whether and how engagement with online support groups helps individuals affected by HIV and AIDS remains unclear, as does the nature of the evidence on this topic. Objective This scoping review sought to explore whether engagement with HIV and AIDS–related online support groups benefits members in terms of psychosocial well-being and illness management, whether members experienced any negative aspects of these groups, and what types of social support are exchanged within HIV and AIDS–related online support groups. Methods A scoping review of English-language articles (including both qualitative and quantitative studies) was undertaken using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The databases searched included MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL (Cochrane Register of Controlled Trials), and Scopus. Key findings were synthesized using a narrative and thematic approach. Results A total of 22 papers met the inclusion criteria from an initial pool of 3332 abstracts. These papers included 23% (5/22) quantitative studies, 9% (2/22) mixed methods studies, and 68% (15/22) qualitative studies published between 2007 and 2019. Cross-sectional evidence suggests that engagement with HIV and AIDS–related online support groups is empowering for members and may lead to a range of psychosocial benefits. Furthermore, qualitative evidence suggests that these groups provide an opportunity to connect with similar people and share experiences. This can help improve self-worth, reduce stigma, facilitate improved illness management, and gain greater confidence when interacting with health professionals. However, online support groups are not without their limitations as qualitative evidence suggests that users may encounter examples of interpersonal conflict between members as well as be exposed to challenging content. Finally, HIV and AIDS–related online support groups are avenues through which individuals can solicit support, most commonly informational or emotional. Conclusions HIV and AIDS–related online support groups may have some benefits for members, particularly in terms of providing social support. There is a need for a systematic review of this literature that includes an assessment of the methodological quality of the available evidence.
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Affiliation(s)
- Neil S Coulson
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Heather Buchanan
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
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Flickinger TE, Waselewski M, Tabackman A, Huynh J, Hodges J, Otero K, Schorling K, Ingersoll K, Tiouririne NAD, Dillingham R. Communication between patients, peers, and care providers through a mobile health intervention supporting medication-assisted treatment for opioid use disorder. PATIENT EDUCATION AND COUNSELING 2022; 105:2110-2115. [PMID: 35260260 PMCID: PMC10112280 DOI: 10.1016/j.pec.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Our team developed the HOPE app as a clinic-based platform to support patients receiving medication assisted treatment (MAT) for opioid use disorder. We investigated the app's two communication features: an anonymous community message board (CMB) and secure messaging between patients and their clinic team. METHODS The HOPE (Heal Overcome Persist Endure) app was piloted with patients and MAT providers. Text from the CMB and messaging were downloaded and de-identified. Content analysis was performed using iteratively developed codebooks with team consensus. RESULTS The pilot study enrolled 28 participants; 25 were "members" (patients) and 3 were providers (physician, nurse, social worker). Of member-generated CMB posts, 45% described the poster's state of mind, including positive and negative emotions, 47% conveyed support and 8% asked for support. Members' secure messages to the team included 52% medical, 45% app-related, and 8% social topics. Provider's messages contained information exchange (90%) and relationship-building (36%). DISCUSSION Through the CMB, members shared emotions and social support with their peers. Through secure messaging, members addressed medical and social needs with their care team, used primarily for information exchange but also relationship-building. PRACTICE IMPLICATIONS The HOPE app addresses communication needs for patients in MAT and can support them in recovery.
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Affiliation(s)
- Tabor E Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Marika Waselewski
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alexa Tabackman
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Jacqueline Hodges
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kori Otero
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kelly Schorling
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Nassima Ait-Daoud Tiouririne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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Cramer RJ, Wright S, Wilsey CN, Kaniuka AR, Bowling J, Crocker T, Langhinrichsen-Rohling J, Montanaro E, Mennicke A, Heron KE. Alternative sexuality, sexual orientation and mobile technology: findings from the National Coalition for Sexual Freedom technology and health enhancement feasibility study. PSYCHOLOGY & SEXUALITY 2022. [DOI: 10.1080/19419899.2020.1777188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Robert J. Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Susan Wright
- National Coalition for Sexual Freedom, Baltimore, MD, USA
| | - Corrine N. Wilsey
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | - Andrea R. Kaniuka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Tianca Crocker
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Erika Montanaro
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Annelise Mennicke
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Kristin E. Heron
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
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PositiveLinks and the COVID-19 Response: Importance of Low-Barrier Messaging for PLWH in Non-urban Virginia in a Crisis. AIDS Behav 2021; 25:3519-3527. [PMID: 33974168 PMCID: PMC8111858 DOI: 10.1007/s10461-021-03294-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/05/2022]
Abstract
PositiveLinks (PL) is an evidence-based mobile health intervention promoting engagement in care for people living with HIV. PL offers secure, in-app patient-provider messaging. We investigated messaging during the early COVID-19 pandemic, comparing messages exchanged between 01/13/2020 and 03/01/2020 (“Pre-COVID”) to messages exchanged between 03/02/2020 and 04/19/2020 (“early COVID”) using Poisson regression. We performed qualitative analysis on a subset of messages exchanged between 02/01/2020 and 03/31/2020. Between “Pre-COVID” and “early COVID” periods, weekly member and provider messaging rates increased significantly. Of the messages analyzed qualitatively, most (53.3%) addressed medical topics, and more than a fifth (21.3%) addressed social issues. COVID-related messages often focused on care coordination and risk information; half of COVID messages contained rapport-building. PL patients (“members”) and providers used in-app secure messaging to reach out to one another, identifying needs, organizing receipt of healthcare resources, and strengthening patient-care team relationships. These findings underscore the importance of low-barrier messaging during a crisis.
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Nouri SS, Adler-Milstein J, Thao C, Acharya P, Barr-Walker J, Sarkar U, Lyles C. Patient characteristics associated with objective measures of digital health tool use in the United States: A literature review. J Am Med Inform Assoc 2021; 27:834-841. [PMID: 32364238 DOI: 10.1093/jamia/ocaa024] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/09/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The study sought to determine which patient characteristics are associated with the use of patient-facing digital health tools in the United States. MATERIALS AND METHODS We conducted a literature review of studies of patient-facing digital health tools that objectively evaluated use (eg, system/platform data representing frequency of use) by patient characteristics (eg, age, race or ethnicity, income, digital literacy). We included any type of patient-facing digital health tool except patient portals. We reran results using the subset of studies identified as having robust methodology to detect differences in patient characteristics. RESULTS We included 29 studies; 13 had robust methodology. Most studies examined smartphone apps and text messaging programs for chronic disease management and evaluated only 1-3 patient characteristics, primarily age and gender. Overall, the majority of studies found no association between patient characteristics and use. Among the subset with robust methodology, white race and poor health status appeared to be associated with higher use. DISCUSSION Given the substantial investment in digital health tools, it is surprising how little is known about the types of patients who use them. Strategies that engage diverse populations in digital health tool use appear to be needed. CONCLUSION Few studies evaluate objective measures of digital health tool use by patient characteristics, and those that do include a narrow range of characteristics. Evidence suggests that resources and need drive use.
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Affiliation(s)
- Sarah S Nouri
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Crishyashi Thao
- Center for Clinical Informatics and Improvement Research, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Prasad Acharya
- Chronic Disease Control Branch, Center for Healthy Communities, California Department of Public Health, Sacramento, California, USA
| | - Jill Barr-Walker
- Zuckerberg San Francisco General Hospital Library, University of California, San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Courtney Lyles
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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Marhefka SL, Lockhart E, Turner D, Wang W, Dolcini MM, Baldwin JA, Roig-Romero RM, Lescano CM, Glueckauf RL. Social Determinants of Potential eHealth Engagement Among People Living with HIV Receiving Ryan White Case Management: Health Equity Implications from Project TECH. AIDS Behav 2020; 24:1463-1475. [PMID: 31828450 DOI: 10.1007/s10461-019-02723-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Evaluate the relationships between social characteristics of Floridian persons living with HIV (PLWH) and both use of digital technologies and willingness to use eHealth for HIV-related information. METHODS Ryan White case managers (N = 155) from 55 agencies in 47 Florida counties administered a survey to PLWH (N = 1268) from June 2016-April 2017. Multilevel logistic regression models were used to identify correlates of technology use and willingness. RESULTS Use of mobile phones with text messaging was high (89%). Older (vs. younger) adults and non-Hispanic blacks (vs. whites) were less likely to use most technologies. These groups, along with Hispanics (vs. whites) were less likely to express willingness to use technologies for HIV-related information in models adjusting for use. CONCLUSIONS Among PLWH in Florida, eHealth-related inequities exist. Willingness to engage in HIV-related eHealth is affected by social determinants, even when considering technology access. Although eHealth may reduce some healthcare inequities, it may exacerbate others.
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Affiliation(s)
- Stephanie L Marhefka
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612, USA.
| | - Elizabeth Lockhart
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612, USA
| | - DeAnne Turner
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612, USA
| | - Wei Wang
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612, USA
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - M Margaret Dolcini
- Hallie E. Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Julie A Baldwin
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Regina Maria Roig-Romero
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612, USA
| | - Celia M Lescano
- Department of Mental Health Law & Policy, College of Behavioral & Community Sciences, University of South Florida, Tampa, FL, 33612, USA
| | - Robert L Glueckauf
- Department of Behavioral Sciences & Social Medicine, College of Medicine Florida State University, Florida State University, Tallahassee, FL, USA
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Canan CE, Waselewski ME, Waldman ALD, Reynolds G, Flickinger TE, Cohn WF, Ingersoll K, Dillingham R. Long term impact of PositiveLinks: Clinic-deployed mobile technology to improve engagement with HIV care. PLoS One 2020; 15:e0226870. [PMID: 31905209 PMCID: PMC6944340 DOI: 10.1371/journal.pone.0226870] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/07/2019] [Indexed: 01/23/2023] Open
Abstract
Background PositiveLinks (PL) is a smartphone-based platform designed in partnership with people living with HIV (PLWH) to improve engagement in care. PL provides daily medication reminders, check-ins about mood and stress, educational resources, a community message board, and an ability to message providers. The objective of this study was to evaluate the impact of up to 24 months of PL use on HIV viral suppression and engagement in care and to examine whether greater PL use was associated with improved outcomes. Setting This study occurred between September 2013 and March 2017 at a university-based Ryan White HIV clinic. Methods We assessed engagement in care and viral suppression from study baseline to the 6-, 12-, 18- and 24-month follow-up time periods and compared trends among high vs. low PL users. We compared time to viral suppression, proportion of days virally suppressed, and time to engagement in care in patients with high vs. low PL use. Results 127 patients enrolled in PL. Engagement in care and viral suppression improved significantly after 6 months of PL use and remained significantly improved after 24 months. Patients with high PL use were 2.09 (95% CI 0.64–6.88) times more likely to achieve viral suppression and 1.52 (95% CI 0.89–2.57) times more likely to become engaged in care compared to those with low PL use. Conclusion Mobile technology, such as PL, can improve engagement in care and clinical outcomes for PLWH. This study demonstrates long-term acceptability of PL over two years and provides evidence for long-term improvement in engagement in care and viral suppression associated with PL use.
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Affiliation(s)
- Chelsea E. Canan
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Marika E. Waselewski
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Ava Lena D. Waldman
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - George Reynolds
- Health Decision Technologies, Oakland, CA, United States of America
| | - Tabor E. Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Wendy F. Cohn
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
- * E-mail:
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Maloney KM, Bratcher A, Wilkerson R, Sullivan PS. Electronic and other new media technology interventions for HIV care and prevention: a systematic review. J Int AIDS Soc 2020; 23:e25439. [PMID: 31909896 PMCID: PMC6945883 DOI: 10.1002/jia2.25439] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 11/04/2019] [Accepted: 12/04/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Electronic and other new media technologies (eHealth) can facilitate large-scale dissemination of information and effective delivery of interventions for HIV care and prevention. There is a need to both monitor a rapidly changing pipeline of technology-based care and prevention methods and to assess whether the interventions are appropriately diversified. We systematically review and critically appraise the research pipeline of eHealth interventions for HIV care and prevention, including published studies and other funded projects. METHODS Two peer-reviewed literature databases were searched for studies describing the development, trial testing or implementation of new technology interventions, published from September 2014 to September 2018. The National Institutes of Health database of grants was searched for interventions still in development. Interventions were included if eHealth was utilized and an outcome directly related to HIV treatment or prevention was targeted. We summarized each intervention including the stage of development, eHealth mode of delivery, target population and stage of the HIV care and prevention continua targeted. RESULTS AND DISCUSSION Of 2178 articles in the published literature, 113 were included with 84 unique interventions described. The interventions utilize a variety of eHealth technologies and target various points on the prevention and care continua, with greater emphasis on education, behaviour change and testing than linkage to medical care. There were a variety of interventions for HIV care support but none for PrEP care. Most interventions were developed for populations in high income countries. An additional 62 interventions with funding were found in the development pipeline, with greater emphasis on managing HIV and PrEP care. CONCLUSIONS Our systematic review found a robust collection of eHealth interventions in the published literature as well as unpublished interventions still in development. In the published literature, there is an imbalance of interventions favouring education and behaviour change over linkage to care, retention in care, and adherence, especially for PrEP. The next generation of interventions already in the pipeline might address these neglected areas of care and prevention, but the development process is slow. Researchers need new methods for more efficient and expedited intervention development so that current and future needs are addressed.
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Affiliation(s)
| | - Anna Bratcher
- Department of EpidemiologyUniversity of CaliforniaLos AngelesCAUSA
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Bond KT, Ramos SR. Utilization of an Animated Electronic Health Video to Increase Knowledge of Post- and Pre-Exposure Prophylaxis for HIV Among African American Women: Nationwide Cross-Sectional Survey. JMIR Form Res 2019; 3:e9995. [PMID: 31144667 PMCID: PMC6658301 DOI: 10.2196/formative.9995] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/30/2018] [Accepted: 04/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background Despite renewed focus on biomedical prevention strategies since the publication of several clinical trials highlighting the efficacy of pre-exposure prophylaxis (PrEP), knowledge of postexposure prophylaxis (PEP) and PrEP continues to remain scarce among women, especially among African American women who are disproportionally affected by HIV. In an effort to address this barrier and encourage uptake of PEP and PrEP, an electronic health (eHealth) video was created using an entertainment-education format. Objective The study aimed to explore the feasibility, acceptability, and preference of an avatar-led, eHealth video, PEP and PrEP for Women, to increase awareness and knowledge of PEP and PrEP for HIV in a sample of African American women. Methods A cross-sectional, Web-based study was conducted with 116 African American women aged 18 to 61 years to measure participants’ perceived acceptability of the video on a 5-point scale: poor, fair, good, very good, and excellent. Backward stepwise regression was used to the find the outcome variable of a higher rating of the PEP and PrEP for Women video. Thematic analysis was conducted to explore the reasons for recommending the video to others after watching the eHealth video. Results Overall, 89% of the participants rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (beta=−.814; P=.004), not having unprotected sex in the last 3 months (beta=−.488; P=.03), higher income (beta=.149; P=.03), lower level of education (beta=−.267; P=.005), and lower exposure to sexual assault since the age of 18 years (beta=−.313; P=.004). After watching the eHealth video, reasons for recommending the video included the video being educational, entertaining, and suitable for women. Conclusions Utilization of an avatar-led eHealth video fostered education about PEP and PrEP among African American women who have experienced insufficient outreach for biomedical HIV strategies. This approach can be leveraged to increase awareness and usage among African American women.
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Affiliation(s)
- Keosha T Bond
- Department of Public Health, New York Medical College, Valhalla, NY, United States
| | - S Raquel Ramos
- Rory Meyers College of Nursing, New York University, New York, NY, United States
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Flickinger TE, Ingersoll K, Swoger S, Grabowski M, Dillingham R. Secure Messaging Through PositiveLinks: Examination of Electronic Communication in a Clinic-Affiliated Smartphone App for Patients Living with HIV. Telemed J E Health 2019; 26:359-364. [PMID: 30900961 PMCID: PMC7071062 DOI: 10.1089/tmj.2018.0261] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose: Secure messaging between patients and their health care team can facilitate chronic care management. PositiveLinks® (PL) is a clinic-affiliated smartphone application designed for patients living with HIV that includes a secure messaging feature for patients, PL staff, and clinic providers to communicate. Our aim was to examine the content and function of messaging within PL. Methodology: We examined messages exchanged through PL from November 2017 through January 2018. Qualitative analysis included categorization of topics as: related to the app, medical care, or social needs. Messaging functions were categorized as information exchange or rapport building. Results: Of the 1,474 PL messages analyzed, 44% were sent by PL staff, 38% by patients, and 18% by providers, whereas 61% were received by patients, 22% by providers, and 17% by PL staff. Message topics included app-related (57.6%), medical care (34.3%), and social concerns (12.4%). App-related messages addressed technical difficulties, software updates, or coordinating phone payments. Medical messages included medical information, medications, appointments, outreach, and care coordination for physical and mental health. Social messages related to insurance, transportation, housing, food, utilities, disability, finances, and work absences. Message function coding showed that 87.3% of messages contained information exchange and 33.8% contained rapport building. Messages sent by providers were most likely to contain rapport building at 54.8%. Conclusion: PL messaging was used to handle medical and social needs with potential impact on patients' health and offers an opportunity to strengthen patient–provider relationships through responsiveness and rapport building. Secure messaging through a clinic-affiliated smartphone app could enhance patient-centered care between clinical visits.
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Affiliation(s)
- Tabor E Flickinger
- Department of Medicine and University of Virginia School of Medicine, Charlottesville, Virginia
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sabrina Swoger
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Marika Grabowski
- Department of Medicine and University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rebecca Dillingham
- Department of Medicine and University of Virginia School of Medicine, Charlottesville, Virginia
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Laurence C, Wispelwey E, Flickinger TE, Grabowski M, Waldman AL, Plews-Ogan E, Debolt C, Reynolds G, Cohn W, Ingersoll K, Dillingham R. Development of PositiveLinks: A Mobile Phone App to Promote Linkage and Retention in Care for People With HIV. JMIR Form Res 2019; 3:e11578. [PMID: 30892269 PMCID: PMC6446157 DOI: 10.2196/11578] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/01/2018] [Accepted: 12/31/2018] [Indexed: 12/31/2022] Open
Abstract
Background Linkage to and retention in HIV care are challenging, especially in the Southeastern United States. The rise in mobile phone app use and the potential for an app to deliver just in time messaging provides a new opportunity to improve linkage and retention among people living with HIV (PLWH). Objective This study aimed to develop an app to engage, link, and retain people in care. We evaluated the acceptability, feasibility, and impact of the app among users. Methods App development was informed by principles of chronic disease self-management and formative interviews with PLWH. Once developed, the app was distributed among participants, and usability feedback was incorporated in subsequent iterations. We interviewed app users after 3 weeks to identify usability issues, need for training on the phone or app, and to assess acceptability. We tracked and analyzed usage of app features for the cohort over 2 years. Results A total of 77 participants used the app during the pilot study. The query response rate for the first 2 years was 47.7%. Query response declined at a rate of 0.67% per month. The community message board was the most popular feature, and 77.9% (60/77) of users posted on the board at least once during the 2 years. Conclusions The PositiveLinks app was feasible and acceptable among nonurban PLWH. High participation on the community message board suggests that social support from peers is important for people recently diagnosed with or returning to care for HIV.
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Affiliation(s)
- Colleen Laurence
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Erin Wispelwey
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Tabor E Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Marika Grabowski
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Ava Lena Waldman
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Erin Plews-Ogan
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Claire Debolt
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Wendy Cohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
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14
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Flickinger TE, DeBolt C, Xie A, Kosmacki A, Grabowski M, Waldman AL, Reynolds G, Conaway M, Cohn WF, Ingersoll K, Dillingham R. Addressing Stigma Through a Virtual Community for People Living with HIV: A Mixed Methods Study of the PositiveLinks Mobile Health Intervention. AIDS Behav 2018; 22:3395-3406. [PMID: 29882048 PMCID: PMC6153974 DOI: 10.1007/s10461-018-2174-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Stigma has negative consequences for quality of life and HIV care outcomes. PositiveLinks is a mobile health intervention that includes a secure anonymous community message board (CMB). We investigated discussion of stigma and changes in stigma scores. Of 77 participants in our pilot, 63% were male, 49% Black, and 72% had incomes below the federal poverty level. Twenty-one percent of CMB posts (394/1834) contained stigma-related content including negative (experiencing stigma) and positive (overcoming stigma) posts addressing intrapersonal and interpersonal stigma. Higher baseline stigma was positively correlated with stress and negatively correlated with HIV care self-efficacy. 12-month data showed a trend toward more improved stigma scores for posters on the CMB versus non-posters (- 4.5 vs - 0.63) and for posters of stigma-related content versus other content (- 5.1 vs - 3.3). Preliminary evidence suggests that a supportive virtual community, accessed through a clinic-affiliated smartphone app, can help people living with HIV to address stigma.
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Affiliation(s)
- Tabor E Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Claire DeBolt
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Alice Xie
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Alison Kosmacki
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Marika Grabowski
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ava Lena Waldman
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Mark Conaway
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
- UVA Center for Global Health, P.O. Box 801379, Charlottesville, VA, 22908, USA.
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Dillingham R, Ingersoll K, Flickinger TE, Waldman AL, Grabowski M, Laurence C, Wispelwey E, Reynolds G, Conaway M, Cohn WF. PositiveLinks: A Mobile Health Intervention for Retention in HIV Care and Clinical Outcomes with 12-Month Follow-Up. AIDS Patient Care STDS 2018; 32:241-250. [PMID: 29851504 PMCID: PMC5982157 DOI: 10.1089/apc.2017.0303] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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.
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Affiliation(s)
- Rebecca Dillingham
- 1Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Tabor E. Flickinger
- 1Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Ava Lena Waldman
- 1Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Marika Grabowski
- 1Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Colleen Laurence
- 1Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Erin Wispelwey
- 1Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | | | - Mark Conaway
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Wendy F. Cohn
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
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Bond K, Ramos SR. Utilization of an Animated eHealth Video to Increase Knowledge of HIV Post- and Pre-exposure Prophylaxis among African American Women (Preprint). JMIR Res Protoc 2018. [DOI: 10.2196/resprot.9995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Schafer KR, Albrecht H, Dillingham R, Hogg RS, Jaworsky D, Kasper K, Loutfy M, MacKenzie LJ, McManus KA, Oursler KAK, Rhodes SD, Samji H, Skinner S, Sun CJ, Weissman S, Ohl ME. The Continuum of HIV Care in Rural Communities in the United States and Canada: What Is Known and Future Research Directions. J Acquir Immune Defic Syndr 2017; 75:35-44. [PMID: 28225437 PMCID: PMC6169533 DOI: 10.1097/qai.0000000000001329] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The nature of the HIV epidemic in the United States and Canada has changed with a shift toward rural areas. Socioeconomic factors, geography, cultural context, and evolving epidemics of injection drug use are coalescing to move the epidemic into locations where populations are dispersed and health care resources are limited. Rural-urban differences along the care continuum demonstrate the implications of this sociogeographic shift. Greater attention is needed to build a more comprehensive understanding of the rural HIV epidemic in the United States and Canada, including research efforts, innovative approaches to care delivery, and greater community engagement in prevention and care.
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Affiliation(s)
- Katherine R Schafer
- *Section on Infectious Diseases, Wake Forest University Health Sciences, Winston-Salem, NC; †Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine; ‡Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA; §Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; ‖BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; ¶Clinician Investigator Program, University of British Columbia, Vancouver, BC, Canada; #Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada; **Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada; ††CIHR Canadian HIV Trials Network, Vancouver, BC, Canada; ‡‡Clinician Investigator Program, University of Manitoba, Winnipeg, MB, Canada; §§Carver College of Medicine, University of Iowa, Iowa City, IA; ‖‖Salem Veterans Affairs Medical Center, Virginia Tech Carilion School of Medicine, Salem, VA; ¶¶Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC; ##British Columbia Centre for Disease Control, Vancouver, BC, Canada; ***University of Saskatchewan, Saskatoon, SK, Canada; and †††Oregon Health & Science University-Portland State University School of Public Health, Portland, OR
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