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Kabukye JK, Namagembe R, Nakku J, Kiberu V, Sjölinder M, Nilsson S, Wamala-Larsson C. Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach. JMIR Hum Factors 2024; 11:e53976. [PMID: 38843515 PMCID: PMC11190627 DOI: 10.2196/53976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/01/2024] [Accepted: 05/01/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. OBJECTIVE This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. METHODS This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants' experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. RESULTS Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants' enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24×7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4%) calls stopped at the interactive voice response, 231 (64.7%) calls were answered by call agents, and 22 (6.2%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. CONCLUSIONS This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption.
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Affiliation(s)
- Johnblack K Kabukye
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
- Uganda Cancer Institute, Kampala, Uganda
| | - Rosemary Namagembe
- Hutchinson Centre Research Institute of Uganda, Uganda Cancer Institute, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - Vincent Kiberu
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Susanne Nilsson
- Unit for Integrated Product Development and Design, Department of Machine Design, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Caroline Wamala-Larsson
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
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Shi H, Du J, Jin G, Yang H, Guo H, Yuan G, Zhu Z, Xu W, Wang S, Guo H, Jiang K, Hao J, Sun Y, Su P, Zhang Z. Effectiveness of eHealth interventions for HIV prevention, testing and management: An umbrella review. Int J STD AIDS 2024:9564624241252457. [PMID: 38733263 DOI: 10.1177/09564624241252457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection has become a major contributor to the global burden of disease. Globally, the number of cases of HIV continues to increase. Electronic health (eHealth) interventions have emerged as promising tools to support disease self-management among people living with HIV. The purpose of this umbrella review is to systematically evaluate and summarize the evidence and results of published systematic reviews and meta-analyses on the effectiveness of eHealth interventions for HIV prevention, testing and management. METHODS PubMed, Embase and the Cochrane Library were searched for reviews. The methodological quality of the included studies was assessed using AMSTAR-2. RESULTS A total of 22 systematic reviews were included. The methodological quality of the reviews was low or critically low. EHealth interventions range from Internet, computer, or mobile interventions to websites, programs, applications, email, video, games, telemedicine, texting, and social media, or a combination of them. The majority of the reviews showed evidence of effectiveness (including increased participation in HIV management behaviours, successfully changed HIV testing behaviours, and reduced risk behaviours). EHealth interventions were effective in the short term. CONCLUSIONS Ehealth interventions have the potential to improve HIV prevention, HIV testing and disease management. Due to the limitations of the low methodological quality of the currently available systematic reviews, more high-quality evidence is needed to develop clear and robust recommendations.
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Affiliation(s)
- Haiyan Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Jun Du
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Guifang Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Huayu Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Haiyun Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Guojing Yuan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhihui Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Wenzhuo Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Sainan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Hao Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Kele Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Jiahu Hao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Ying Sun
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Puyu Su
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhihua Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
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Plant A, Sparks P, Creech DN, Morgan T, Klausner JD, Rietmeijer C, Montoya JA. Developing an mHealth program to improve HIV care continuum outcomes among young Black gay and bisexual men. BMC Public Health 2024; 24:1247. [PMID: 38714973 PMCID: PMC11075214 DOI: 10.1186/s12889-024-18652-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Young Black gay and bisexual men (YBGBM) in the United States face significant disparities in HIV care outcomes. Mobile health (mHealth) interventions have shown promise with improving outcomes for YBGBM across the HIV care continuum. METHODS We developed an mHealth application using human-centered design (HCD) from 2019-2021 in collaboration with YBGBM living with HIV and with HIV service providers. Our HCD process began with six focus groups with 50 YBGBM and interviews with 12 providers. These insights were used to inform rapid prototyping, which involved iterative testing and refining of program features and content, with 31 YBGBM and 12 providers. We then collected user feedback via an online survey with 200 YBGBM nationwide and usability testing of a functional prototype with 21 YBGBM. RESULTS Focus groups and interviews illuminated challenges faced by YBGBM living with HIV, including coping with an HIV diagnosis, stigma, need for social support, and a dearth of suitable information sources. YBGBM desired a holistic approach that could meet the needs of those newly diagnosed as well as those who have been living with HIV for many years. Program preferences included video-based content where users could learn from peers and experts, a range of topics, a community of people living with HIV, and tools to support their health and well-being. Providers expressed enthusiasm for an mHealth program to improve HIV care outcomes and help them serve clients. Rapid prototyping resulted in a list of content topics, resources, video characteristics, community features, and mHealth tools to support adherence, retention, goal setting, and laboratory results tracking, as well as tools to help organization staff to support clients. Online survey and usability testing confirmed the feasibility, acceptability, and usability of the content, tools, and features. CONCLUSIONS This study demonstrates the potential of a video-based mHealth program to address the unique needs of YBGBM living with HIV, offering support and comprehensive information through a user-friendly interface and videos of peers living with HIV and of experts. The HCD approach allowed for continuous improvements to the concept to maximize cultural appropriateness, utility, and potential effectiveness for both YBGBM and HIV service organizations.
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Affiliation(s)
- Aaron Plant
- Sentient Research, 231 North Walnuthaven Drive, West Covina, CA, 91790, USA.
| | - Paul Sparks
- Sentient Research, 231 North Walnuthaven Drive, West Covina, CA, 91790, USA
| | | | - Ta'Jalik Morgan
- Sentient Research, 231 North Walnuthaven Drive, West Covina, CA, 91790, USA
| | - Jeffrey D Klausner
- Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA
| | | | - Jorge A Montoya
- Sentient Research, 231 North Walnuthaven Drive, West Covina, CA, 91790, USA
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Yuan GF, Qiao S, Li X, Shen Z, Zhou Y. How Does Anticipated HIV Stigma Affect Medication Adherence? A Longitudinal Path Analysis Model. AIDS Behav 2024; 28:1684-1693. [PMID: 38340222 DOI: 10.1007/s10461-024-04293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
Prior research has documented that anticipated HIV stigma may play an important predictive role in medication adherence among people living with HIV (PLWH). However, longitudinal data on the mechanisms underlying this linkage are scarce. The current study aimed to explore the longitudinal mediation association among anticipated HIV stigma, medication adherence support, HIV self-management, and medication adherence. A four-wave sample consisting of 1,098 Chinese PLWH (Mage = 38.63, SD = 9.20; 63.9% male) with a six-month interval was used in the current study. Participants were asked to complete self-report questionnaires. A path analysis model was analyzed. Results indicate that anticipated HIV stigma at baseline was positively related to medication adherence at Time 4 (T4). Medication adherence support at Time 2 (T2) and HIV self-management at Time 3 (T3) serially mediated the anticipated HIV stigma at Time 1 (T1) and medication adherence at T4. These findings provide critical insights into the mediating roles of medication adherence support and HIV self-management in the relationship between anticipated HIV stigma and medication adherence over time. Such an understanding has important implications for the development of tailored interventions and public health strategies aimed at improving medication adherence among PLWH in the context of HIV-related stigma.
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Affiliation(s)
- Guangzhe Frank Yuan
- School of Education Science, Leshan Normal University, Leshan, Sichuan, China.
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Shan Qiao
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
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Pitpitan EV, Horvath KJ, Aldous J, Stockman JK, Patterson TL, Liang M, Barrozo C, Moore V, Penninga K, Smith LR. Peers plus mobile app for treatment in HIV (PATH): protocol for a randomized controlled trial to test a community-based integrated peer support and mHealth intervention to improve viral suppression among Hispanic and Black people living with HIV. Trials 2024; 25:212. [PMID: 38520030 PMCID: PMC10958824 DOI: 10.1186/s13063-024-08042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Significant disparities continue to exist in the HIV care continuum, whereby Hispanic and Black people living with HIV (PLWH) are less likely to achieve viral suppression compared to their White counterparts. Studies have shown that intervention approaches that involve peer navigation may play an important role in supporting patients to stay engaged in HIV care. However, implementation may be challenging in real-world settings where there are limited resources to support peer navigators. Combining a peer navigation approach with scalable mobile health (mHealth) technology may improve impact and implementation outcomes. METHODS We combined a peer navigation intervention with a mHealth application and are conducting a randomized controlled trial (RCT) to test the efficacy of this integrated "Peers plus mobile App for Treatment in HIV" (PATH) intervention to improve HIV care engagement, and ultimately sustained viral suppression, among Hispanic and Black PLWH. We will enroll up to 375 PLWH into a two-arm prospective RCT, conducting follow-up assessments every 3 months up to 12 months post-baseline. Participants randomized to the control arm will continue to receive usual care Ryan White Program case management services. Individuals randomized to receive the PATH intervention will receive usual care plus access to two main intervention components: (1) a peer navigation program and (2) a mHealth web application. The primary outcome is sustained HIV viral suppression (undetectable viral load observed at 6- and 12-month follow-up). Secondary outcomes are retention in HIV care, gaps in HIV medical visits, and self-reported ART adherence. Recruitment for the RCT began in November 2021 and will continue until June 2024. Follow-up assessments and medical chart abstractions will be conducted to collect measurements of outcome variables. DISCUSSION The efficacy trial of PATH will help to fill gaps in our scientific understanding of how a combined peer navigation and mHealth approach may produce effects on HIV care outcomes while addressing potential implementation challenges of peer navigation in Ryan White-funded clinics. TRIAL REGISTRATION The PATH trial is registered at the United States National Institutes of Health National Library of Medicine (ClinicalTrials.gov) under ID # NCT05427318 . Registered on 22 June 2022.
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Affiliation(s)
- Eileen V Pitpitan
- School of Social Work, San Diego State University, San Diego, USA.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA.
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, USA
| | | | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Megan Liang
- San Diego State University Research Foundation, San Diego, USA
| | | | | | | | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
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Liu PL. Understanding mHealth Adoption and Lifestyle Improvement: An Empirical Test of the Antecedents and Mediating Mechanisms. JOURNAL OF HEALTH COMMUNICATION 2024; 29:155-165. [PMID: 38205945 DOI: 10.1080/10810730.2024.2303641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
The potential of using mobile phones for health care service delivery has been well acknowledged. Despite that mobile health (mHealth) related research has proliferated in the past decade, mHealth is still in the fledgling stage with a low adoption rate. There is a research gap in understanding factors influencing mHealth adoption and examining the effects of mHealth use on health outcomes. The purpose of this study was thus to explore influential factors of mHealth use, and test mediation pathways through which mHealth use impacts healthy lifestyle behaviors (e.g. sleep, exercise, and social participation). Survey results from 432 online participants illustrate that performance expectancy, social influence, support conditions, and perceived reliability were significantly associated with mHealth use. However, the impact of effort expectancy on mHealth use was statistically nonsignificant. Moreover, the results indicate that mHealth use can not only contribute to the improvement of healthy lifestyle behaviors directly but also exert an impact through the mediating effect of health competence. Knowing what factors motivate people's mHealth use and how mHealth use contributes to lifestyle improvement can help trigger interventions to boost mHealth adoption and improve public health. Implications and limitations are discussed.
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Dadi TL, Wiemers AMC, Tegene Y, Medhin G, Spigt M. Experiences of people living with HIV in low- and middle-income countries and their perspectives in self-management: a meta-synthesis. AIDS Res Ther 2024; 21:7. [PMID: 38297363 PMCID: PMC10829476 DOI: 10.1186/s12981-024-00595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Availability of anti-retroviral treatment has changed HIV in to a manageable chronic disease, making effective self-management essential. However, only a few studies in low- and middle-income countries (LMICs) reported experiences of people living with HIV (PLWH) on self-management. METHODS This meta-synthesis of qualitative studies investigated perspectives of PLWH in LMICs on self-management. Various databases, including PubMed, EMBASE, EBSCO, and CINHAL, were searched through June 2022. Relevant additional articles were also included using cross-referencing of the identified papers. We used a thematic synthesis guided by the "Model of the Individual and Family Self-Management Theory" (IFSMT). RESULT PLWH in LIMICs experience a variety of challenges that restrict their options for effective self-management and compromises their quality of life. The main ones include: misconceptions about the disease, poor self-efficacy and self-management skills, negative social perceptions, and a non-patient-centered model of care that reduces the role of patients. The experiences that influenced the ability to practice self-management are summarized in context (the condition itself, physical and environmental factors, individual and family factors) and process factors (knowledge and beliefs, relationship with the health care worker, self-regulation skills and abilities, and social facilitation). Context and process greatly impacted quality of life through the self-management practices of the patients. CONCLUSION AND RECOMMENDATION PLWH encounter multiple challenges, are not empowered enough to manage their own chronic condition, and their needs beyond medical care are not addressed by service providers. Self-management practice of these patients is poor, and service providers do not follow service delivery approaches that empower patients to be at the center of their own care and to achieve an effective and sustainable outcome from treatment. These findings call for a comprehensive well thought self-management interventions.
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Affiliation(s)
- Tegene Legese Dadi
- School of Public Health, College of Medicine & Health Science, Hawassa University, Hawassa, Ethiopia.
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.
| | - Anja M C Wiemers
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Yadessa Tegene
- School of Public Health, College of Medicine & Health Science, Hawassa University, Hawassa, Ethiopia
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Mark Spigt
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsö, Norway
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Gautam K, Paudel K, Ahmed A, Dhakal M, Wickersham JA, Poudel KC, Pagoto S, Acharya B, Deuba K, Valente PK, Shrestha R. High Interest in the Use of mHealth Platform for HIV Prevention among Men Who Have Sex with Men in Nepal. J Community Health 2024:10.1007/s10900-024-01324-x. [PMID: 38281283 PMCID: PMC11283576 DOI: 10.1007/s10900-024-01324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/30/2024]
Abstract
Mobile technology growth in Nepal offers promising opportunities for using mobile health (mHealth) interventions to facilitate HIV prevention efforts. However, little is known about access and utilization of communication technology and their willingness to use mHealth for HIV prevention services in Nepal. We conducted a cross-sectional respondent-driven sampling survey of 250 MSM in Kathmandu Valley of Nepal from October to December 2022. We collected information on participant characteristics, HIV risk-related behaviors, ownership, or access to and frequency of use of communication technology (phones, tablets, laptops, and computers), and willingness to use mHealth to access HIV prevention services. Descriptive, bivariate, and multivariate linear regression analyses were performed. Almost all participants had smartphones with the internet (231/250, 92.4%) and accessed the internet daily (219/250, 87.6%) on the smartphone (236/250, 94.4%). The median score for willingness to use mHealth for HIV prevention was 10 (IQR: 3 to 17). Willingness to use mHealth was higher among those participants with a high school or above education (β = 0.223, p = < 0.001), had experienced violence (β = 0.231, p = 0.006), and had moderate to severe depressive symptoms (β = 0.223, p = < 0.001). However, monthly income above NPR 20,000 (USD 150) (β= -0.153, p = 0.008), disclosure of their sexual orientation to anyone (β= -0.159, p = < 0.007), and worry about being negatively judged by health care workers (β= -0.136, p = 0.023) were less willing to use mHealth strategies. The findings from this study suggest that there is a high willingness for utilizing mHealth interventions for HIV prevention in MSM population who are at higher risk of HIV acquisition.
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Affiliation(s)
- Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Kiran Paudel
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
- Nepal Health Frontiers, Tokha-5, Kathmandu, 44600, Nepal
| | - Ali Ahmed
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
- Department of Pharmacy Practice, Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Manisha Dhakal
- Blue Diamond Society, Dhumbarahi Marg, Kathmandu, 44600, Nepal
| | - Jeffrey A Wickersham
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, 06510, USA
| | - Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
- Institute for Global Health, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Bibhav Acharya
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, School of Medicine, 675 18th Street, San Francisco, CA, 94107, USA
- Possible, a non-profit organization, Bhim Plaza, Kathmandu, Nepal
| | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Pablo K Valente
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA.
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, 06510, USA.
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Panayi M, Charalambous GK, Jelastopulu E. Enhancing quality of life and medication adherence for people living with HIV: the impact of an information system. J Patient Rep Outcomes 2024; 8:10. [PMID: 38261120 PMCID: PMC10805742 DOI: 10.1186/s41687-023-00680-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The widespread availability of antiretroviral therapy has led to improvements in life expectancy and thus an increase in the number of people living with HIV/AIDS (PLWHA) worldwide. However, a similar increase in the number of newly-diagnosed patients in Cyprus suggests the need for solutions designed to improve monitoring, planning, and patient communication. In this study, we aimed to determine whether the use of an information system to manage PLWHA might contribute to improved quality of life and critical adherence to prescribed drug regimens and ongoing medical care. METHODS A randomized controlled trial study was conducted in Cyprus based on information that we collected using the highly valid and reliable Greek translation of the World Health Organization (WHO) Quality of Life (QOL) HIV-BREF questionnaire to assess sociodemographic variables and patient compliance. We distributed 200 questionnaires before implementing a Health Medical Care (HMC) information system at our clinic. Six months after implementing this system, 68 of the completed questionnaires were selected, including two groups of 34 participants who had been assigned at random to the intervention or the control group. Participants included PLWHA aged ≥ 18 years who had been receiving antiretroviral therapy for more than 12 months between July 15, 2020, and July 15, 2022. RESULTS The changes in baseline to six-month scores reported for the intervention group were significantly higher than in the control group in all six subscales assessed with the WHOQOL-HIV-BREF questionnaire, as well as in the assessment of compliance. Furthermore, compliance with treatment was associated with higher scores in the questionnaire subscales, including physical health, psychological health, degree of autonomy, social relationships, life circumstances, and spirituality/religious/personal beliefs. We also identified specific demographic factors and behaviors that were associated with better compliance with scheduled medical care and the prescribed drug regimen. Specifically, men exhibited better compliance than women and younger PLWHA exhibited better compliance than the elderly as did individuals who reported a higher level of educational attainment. Additionally, individuals who did not use addictive substances, consumed less alcohol, and were managed using the monitoring information system all exhibited better compliance compared to those in the control group. CONCLUSION The results of this study suggest that management of PLWHA via the use of an information system can contribute to improved QOL and drug compliance.
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Affiliation(s)
- Maria Panayi
- Ph.D. Programme Health Management, Frederick University, Nicosia, Cyprus
- Gregorios AIDS Clinic, General Hospital of Larnaca, Larnaca, Cyprus
| | - Georgios K Charalambous
- Ph.D. Programme Health Management, Frederick University, Nicosia, Cyprus
- Hippocration General Hospital, Athens, Greece
| | - Eleni Jelastopulu
- Ph.D. Programme Health Management, Frederick University, Nicosia, Cyprus.
- Department of Public Health, School of Medicine, University of Patras, Patras, Greece.
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Wang L, Yuwen W, Hua W, Chen L, Forsythe Cox V, Zheng H, Ning Z, Zhao Z, Liu Z, Jiang Y, Li X, Guo Y, Simoni JM. Enhancing Mental Health and Medication Adherence Among Men Who Have Sex With Men Recently Diagnosed With HIV With a Dialectical Behavior Therapy-Informed Intervention Incorporating mHealth, Online Skills Training, and Phone Coaching: Development Study Using Human-Centered Design Approach. JMIR Form Res 2023; 7:e47903. [PMID: 37831497 PMCID: PMC10611999 DOI: 10.2196/47903] [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: 04/04/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Mental health problems are common among men who have sex with men (MSM) living with HIV and may negatively affect medication adherence. Psychosocial interventions designed to address these urgent needs are scarce in China. Incorporating behavioral health theories into intervention development strengthens the effectiveness of these interventions. The absence of a robust theoretical basis for interventions may also present challenges to identify active intervention ingredients. OBJECTIVE This study aims to systematically describe the development of a mobile health-based intervention for MSM recently diagnosed with HIV in China, including the theoretical basis for the content and the considerations for its technological delivery. METHODS We used intervention mapping (IM) to guide overall intervention development, a behavioral intervention technology model for technological delivery design, and a human-centered design and cultural adaptation model for intervention tailoring throughout all steps of IM. RESULTS The dialectical behavior therapy (DBT)-informed intervention, Turning to Sunshine, comprised 3 components: app-based individual skills learning, group-based skills training, and on-demand phone coaching. The theoretical basis for the intervention content is based on the DBT model of emotions, which fits our conceptualization of the intervention user's mental health needs. The intervention aims to help MSM recently diagnosed with HIV (1) survive moments of high emotional intensity and strong action urges, (2) change emotional expression to regulate emotions, and (3) reduce emotional vulnerability, as well as (4) augment community resources for mental health services. Technological delivery considerations included rationale of the medium, complexity, and esthetics of information delivery; data logs; data visualization; notifications; and passive data collection. CONCLUSIONS This study laid out the steps for the development of a DBT-informed mobile health intervention that integrated app-based individual learning, group-based skills training, and phone coaching. This intervention, Turning to Sunshine, aims to improve mental health outcomes for MSM newly diagnosed with HIV in China. The IM framework informed by human-centered design principles and cultural adaptation considerations offered a systematic approach to develop the current intervention and tailor it to the target intervention users. The behavioral intervention technology model facilitated the translation of behavioral intervention strategies into technological delivery components. The systematic development and reporting of the current intervention can serve as a guide for similar intervention studies. The content of the current intervention could be adapted for a broader population with similar emotional struggles to improve their mental health outcomes.
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Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Weichao Yuwen
- School of Nursing & Healthcare Leadership, University of Washington, Tacoma, Tacoma, WA, United States
| | - Wenzhe Hua
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Lingxiao Chen
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, United States
| | - Vibh Forsythe Cox
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Huang Zheng
- Shanghai China Sex Worker & Men who have Sex with Men Center, Shanghai, China
| | - Zhen Ning
- Department of HIV/STD Control and Prevention, Shanghai Municipal Centers for Disease Control and Prevention, Shanghai, China
| | - Zhuojun Zhao
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Zhaoyu Liu
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Yunzhang Jiang
- Courant Institute of Mathematical Sciences, New York University, New York, NY, United States
| | - Xinran Li
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Yawen Guo
- Information School, University of Washington, Seattle, WA, United States
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, United States
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Adong J, Asiimwe S, Nansera D, Muyindike W, Tumuhairwe JB, Baijuka R, Tindimwebwa E, Garrison LE, Haberer JE. Electronic Antiretroviral Therapy Adherence Monitors and Associated Interventions Improve Adolescent-Caregiver Relationships and Self-Efficacy Among Adolescents and Young Adults with HIV in Uganda. AIDS Patient Care STDS 2023; 37:489-494. [PMID: 37862075 PMCID: PMC10771872 DOI: 10.1089/apc.2023.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Many adolescents and young adults with HIV (AYWH) struggle with antiretroviral therapy (ART) adherence and experience poorer outcomes than adults. Relevant factors include forgetfulness and poor self-efficacy related to their evolving neurobiology. We qualitatively explored experiences of AYWH-caregivers dyads using real-time ART adherence monitors and associated reminder functions in the home setting. As part of an implementation science-oriented study, AYWH used the Wisepill adherence monitor for 3 months. AYWH could also opt for short message service (SMS) self-reminders, a self-selected social supporter for delayed or missed doses, or an alarm reminder. We conducted in-depth interviews with randomly selected AYWH-caregiver dyads regarding their experience using the monitor. Qualitative data were analyzed using inductive content analysis. We completed 15 AYWH-caregiver dyad interviews. Of the AYWH, 67% were female, mean age was 16 years, 56% lived with their biological mother, and 86% were virologically suppressed. AYWH and their caregivers generally found the adherence monitors acceptable, though some had privacy concerns. AYWH felt the monitors helped them take charge of their medication, largely through the real-time alarm and SMS reminders; this took the burden of adherence reminders away from the caregivers, improving strained AYWH-caregiver relationships. Two adolescents reported rebound poor adherence after monitor withdrawal. ART adherence monitors and associated tools were largely acceptable to AYWH and their caregivers in home settings. The intervention helped improve AYWH self-efficacy and alleviated burden from some AYWH-caregiver relationships. Rebound poor adherence suggests the need for on-going support and/or other means to achieve intrinsic mechanisms for sustained adherence. Clinical Trial Registration number: NCT03825952.
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Affiliation(s)
- Julian Adong
- Mbarara University of Science and Technology, Departments of Pediatrics and Internal Medicine, Faculty of Medicine, Mbarara, Uganda
| | - Stephen Asiimwe
- Global Health Collaborative, Mbarara, Uganda
- Kabwohe Clinical Research Centre, Kabwohe, Uganda
| | - Denis Nansera
- Mbarara University of Science and Technology, Departments of Pediatrics and Internal Medicine, Faculty of Medicine, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Winnie Muyindike
- Mbarara University of Science and Technology, Departments of Pediatrics and Internal Medicine, Faculty of Medicine, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | | | | | | | - Lindsey E. Garrison
- Department of Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jessica E. Haberer
- Department of Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
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12
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Caldwell S, Flickinger T, Hodges J, Waldman ALD, Garofalini C, Cohn W, Dillingham R, Castel A, Ingersoll K. An mHealth Platform for People With HIV Receiving Care in Washington, District of Columbia: Qualitative Analysis of Stakeholder Feedback. JMIR Form Res 2023; 7:e48739. [PMID: 37725419 PMCID: PMC10548330 DOI: 10.2196/48739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND HIV viral suppression and retention in care continue to be challenging goals for people with HIV in Washington, District of Columbia (DC). The PositiveLinks mobile app is associated with increased retention in care and viral load suppression in nonurban settings. The app includes features such as daily medication reminders, mood and stress check-ins, an anonymized community board for peer-to-peer social support, secure messaging to care teams, and resources for general and clinic-specific information, among other features. PositiveLinks has not been tailored or tested for this distinct urban population of people with HIV. OBJECTIVE This study aimed to inform the tailoring of a mobile health app to the needs of people with HIV and their providers in Washington, DC. METHODS We conducted a 3-part formative study to guide the tailoring of PositiveLinks for patients in the DC Cohort, a longitudinal cohort of >12,000 people with HIV receiving care in Washington, DC. The study included in-depth interviews with providers (n=28) at study clinics, focus groups with people with HIV enrolled in the DC Cohort (n=32), and a focus group with members of the DC Regional Planning Commission on Health and HIV (COHAH; n=35). Qualitative analysis used a constant comparison iterative approach; thematic saturation and intercoder agreement were achieved. Emerging themes were identified and grouped to inform an adaptation of PositiveLinks tailored for patients and providers. RESULTS Emerging themes for patients, clinic providers, and COHAH providers included population needs and concerns, facilitators and barriers to engagement in care and viral suppression, technology use, anticipated benefits, questions and concerns, and suggestions. DC Cohort clinic and COHAH provider interviews generated an additional theme: clinic processes. For patients, the most commonly discussed potential benefits included improved health knowledge and literacy (mentioned n=10 times), self-monitoring (n=7 times), and connection to peers (n=6 times). For providers, the most common anticipated benefits were improved communication with the clinic team (n=21), connection to peers (n=14), and facilitation of self-monitoring (n=11). Following data review, site principal investigators selected core PositiveLinks features, including daily medication adherence, mood and stress check-ins, resources, frequently asked questions, and the community board. Principal investigators wanted English and Spanish versions depending on the site. Two additional app features (messaging and documents) were selected as optional for each clinic site. Overall, 3 features were not deployed as not all participating clinics supported them. CONCLUSIONS Patient and provider perspectives of PositiveLinks had some overlap, but some themes were unique to each group. Beta testing of the tailored app was conducted (August 2022). This formative work prepared the team for a cluster randomized controlled trial of PositiveLinks' efficacy. Randomization of clinics to PositiveLinks or usual care occurred in August 2022, and the randomized controlled trial launched in November 2022. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/37748.
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Affiliation(s)
- Sylvia Caldwell
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Science, University of Virginia, Charlottesville, VA, United States
| | - Tabor Flickinger
- Division of General Medicine, Geriatrics and Palliative Care, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Jacqueline Hodges
- Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, United States
| | - Ava Lena D Waldman
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Science, University of Virginia, Charlottesville, VA, United States
| | - Chloe Garofalini
- Milken Institute School of Public Health, George Washington University, Washingon, DC, United States
| | - Wendy Cohn
- Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Rebecca Dillingham
- Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, United States
| | - Amanda Castel
- Milken Institute School of Public Health, George Washington University, Washingon, DC, United States
| | - Karen Ingersoll
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Science, University of Virginia, Charlottesville, VA, United States
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van den Elshout MA, Hoornenborg E, Coyer L, Anderson PL, Davidovich U, de Vries HJ, Prins M, Schim van der Loeff MF. Determinants of adherence to daily PrEP measured as intracellular tenofovir diphosphate concentrations over 24 months of follow-up among men who have sex with men. Sex Transm Infect 2023; 99:303-310. [PMID: 37258273 PMCID: PMC10359585 DOI: 10.1136/sextrans-2022-055499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Adherence is key to the effectiveness of oral pre-exposure prophylaxis (PrEP) to prevent HIV. Therefore, we aimed to explore factors associated with adherence to daily PrEP (dPrEP). METHODS Men who have sex with men (MSM) using dPrEP (emtricitabine/tenofovir disoproxil) within the Amsterdam PrEP demonstration project at the Public Health Service of Amsterdam, provided dried blood spots (DBS) 12 and 24 months after PrEP initiation. From DBS, we determined intracellular tenofovir diphosphate (TFV-DP) concentrations to assess adherence; TFV-DP ≥700 fmol/punch was considered adequate. We assessed associations of sociodemographic, clinical and behavioural characteristics with TFV-DP concentrations using multivariable linear regression. RESULTS Of 263 participants who attended 12-month or 24-month study visits while on dPrEP, 257 (97.7%) provided DBS at one or both visits (492 DBS in total). Median TFV-DP concentration was 1299 (IQR 1021-1627) fmol/punch (12 months: 1332 (1087-1687); 24 months: 1248 (929-1590]). Higher TFV-DP concentrations were associated with: older age (p=0.0008), condomless anal sex with a casual partner in 6 months preceding PrEP initiation (+166 fmol/punch; 95% CI 36.5 to 296) and using a mobile application providing visualised feedback on PrEP use and sexual behaviour (+146 fmol/punch; 95% CI 28.1 to 263). Lower TFV-DP concentrations were associated with longer duration of PrEP use (24 vs 12 months; -91.5 fmol/punch; 95% CI -155 to -28.1). Time-updated number of sex partners, diagnosed STIs and chemsex were not associated with TFV-DP concentrations. CONCLUSIONS Overall, TFV-DP concentrations were high among MSM using dPrEP, indicating excellent adherence. Especially older participants, those who reported condomless anal sex with a casual partner prior to PrEP initiation and those who used an app with visualised feedback showed higher levels of adherence. As TFV-DP concentrations had decreased slightly at 2 years of PrEP use when compared with 1 year, we emphasise the importance of adherence counselling to those who continue using PrEP. TRIAL REGISTRATION NUMBER NL5413.
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Affiliation(s)
- Mark Am van den Elshout
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Liza Coyer
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Udi Davidovich
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam Faculty of Social and Behavioural Sciences, Amsterdam, The Netherlands
| | - Henry Jc de Vries
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases Research, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection & Immunity (AII), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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14
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Perinpanathan T, Maiya S, van Velthoven MHH, Nguyen AT, Free C, Smith C. Mobile phone-based interventions for improving contraception use. Cochrane Database Syst Rev 2023; 7:CD011159. [PMID: 37458240 PMCID: PMC10363274 DOI: 10.1002/14651858.cd011159.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Contraception provides significant benefits for women's and children's health, yet many women have an unmet need for contraception. Rapid expansion in the use of mobile phones in recent years has had a dramatic impact on interpersonal communication. Within the health domain text messages and smartphone applications offer means of communication between clients and healthcare providers. This review focuses on interventions delivered by mobile phone and their effect on use of contraception. OBJECTIVES To evaluate the benefits and harms of mobile phone-based interventions for improving contraception use. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was August 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) of mobile phone-based interventions to improve forms of contraception use amongst users or potential users of contraception. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. uptake of contraception, 2. uptake of a specific method of contraception, 3. adherence to contraception method, 4. safe method switching, 5. discontinuation of contraception and 6. pregnancy or abortion. Our secondary outcomes were 7. road traffic accidents, 8. any physical or psychological effect reported and 9. violence or domestic abuse. MAIN RESULTS Twenty-three RCTs (12,793 participants) from 11 countries met our inclusion criteria. Eleven studies were conducted in high-income resource settings and 12 were in low-income settings. Thirteen studies used unidirectional text messaging-based interventions, six studies used interactive text messaging, four used voice message-based interventions and two used mobile-phone apps to improve contraception use. All studies received funding from non-commercial bodies. Mobile phone-based interventions probably increase contraception use compared to the control (odds ratio (OR) 1.30, 95% confidence interval (CI) 1.06 to 1.60; 16 studies, 8972 participants; moderate-certainty evidence). There may be little or no difference in rates of unintended pregnancy with the use of mobile phone-based interventions compared to control (OR 0.82, 95% CI 0.48 to 1.38; 8 trials, 2947 participants; moderate-certainty evidence). Subgroup analysis assessing unidirectional mobile phone interventions versus interactive mobile phone interventions found evidence of a difference between the subgroups favouring interactive interventions (P = 0.003, I2 = 88.5%). Interactive interventions had an OR of 1.71 (95% CI 1.28 to 2.29; P = 0.0003, I2 = 63%; 8 trials, 3089 participants) whilst unidirectional interventions had an OR of 1.03 (95% CI 0.87 to 1.22; P = 0.72, I2 = 17%; 9 trials, 5883 participants). Subgroup analysis assessing high-income versus low-income trial settings found no difference between groups (subgroup difference test: P = 0.70, I2 = 0%). Only six trials reported on safety and unintended outcomes; one trial reported increased partner violence whilst another four trials reported no difference in physical violence rates between control and intervention groups. One trial reported no road traffic accidents with mobile phone intervention use. AUTHORS' CONCLUSIONS This review demonstrates there is evidence to support the use of mobile phone-based interventions in improving the use of contraception, with moderate-certainty evidence. Interactive mobile phone interventions appear more effective than unidirectional methods. The cost-effectiveness, cost benefits, safety and long-term effects of these interventions remain unknown, as does the evidence of this approach to support contraception use among specific populations. Future research should investigate the effectiveness and safety of mobile phone-based interventions with better quality trials to help establish the effects of interventions delivered by mobile phone on contraception use. This review is limited by the quality of the studies due to flaws in methodology, bias or imprecision of results.
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Affiliation(s)
- Tanaraj Perinpanathan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Shilpa Maiya
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, India
| | | | - Amy T Nguyen
- Department of Research, Darkness to Light, Baltimore, North Charleston, South Carolina, USA
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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15
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Healy E, O’Malley G, Mugo C, Kaggiah A, Seeh D, Muriithi A, Lopez AR, Kumar M, Guthrie B, Moreno M, John-Stewart G, Inwani I, Ronen K. "Whenever you need support, you first turn to the group": motivations and functions of WhatsApp groups for youth living with HIV. AIDS Care 2023; 35:437-446. [PMID: 35761786 PMCID: PMC9792620 DOI: 10.1080/09540121.2022.2088680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/07/2022] [Indexed: 12/30/2022]
Abstract
Social support is a critical component of achieving positive health outcomes for youth living with HIV (YLWH). Mobile health (mHealth) has significant potential for providing social support to YLWH. However, little is known about the domains of social support most needed by YLWH which mHealth interventions might address. Drawing on the spontaneous creation of WhatsApp support groups by YLWH in Nairobi, Kenya, we characterized Kenyan YLWH's social support needs and potential roles of social media groups in meeting them. We conducted interviews and focus-groups with 68 YLWH, 24 caregivers and 20 healthcare workers, and observed two YLWH-led WhatsApp groups for 6 weeks. Youth reported that existing support systems, including family and healthcare workers, already provided informational and instrumental support. However, they emphasized unmet companionship and emotional support needs, leading to isolation, hopelessness, and medication adherence challenges. Participants identified connection with other YLWH as a unique source of emotional and companionship support that allowed them to feel more secure and less isolated. Interviews and observed WhatsApp chats demonstrated that WhatsApp groups were a desirable medium for companionship support that overcame barriers to in-person connection.
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Affiliation(s)
- Elise Healy
- University of Washington, Department of Global Health, Seattle, WA, USA
| | | | - Cyrus Mugo
- University of Washington, Department of Global Health, Seattle, WA, USA
- Kenyatta National Hospital, Nairobi, Kenya
| | | | - David Seeh
- Kenyatta National Hospital, Nairobi, Kenya
| | | | - Alana R Lopez
- University of Washington, Department of Global Health, Seattle, WA, USA
| | | | - Brandon Guthrie
- University of Washington, Department of Global Health, Seattle, WA, USA
| | | | | | | | - Keshet Ronen
- University of Washington, Department of Global Health, Seattle, WA, USA
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16
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Feldman MB, Tran TT, Boucher LM, Abdelqader F, Raker AR, Hile SJ. A process and impact evaluation of a peer-led HIV self-management program. EVALUATION AND PROGRAM PLANNING 2023; 96:102175. [PMID: 36459775 DOI: 10.1016/j.evalprogplan.2022.102175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 01/24/2022] [Accepted: 10/22/2022] [Indexed: 06/17/2023]
Abstract
There is evidence that people with HIV (PWH) receive health-related benefits from having peer support and learning self-management skills. This evaluation assessed the effect of The Positive Life Workshop (TPLW)-a 7-session peer-led HIV self-management program-on psychosocial and HIV treatment outcomes. The overall sample included 1360 PWH who completed TPLW during 3/2015-2/2019. Surveys were administered before and after the program, and three months following program completion. Analyses examined changes in outcomes from pre-test to both post-test and 3-month follow-up using non-parametric tests. Subgroup analyses were conducted for 406 participants with ≥ 1 characteristic of the priority population for TPLW (i.e., recent HIV diagnosis, not taking antiretroviral therapy (ART), suboptimal ART adherence, unsuppressed viral load). In the overall sample, there were statistically significant improvements in HIV-related knowledge, social support, patient self-advocacy, and confidence in self-management between pre-test and post-test/3-month follow-up assessment. Analyses for the priority population showed significant increases from pre-test to 3-month follow-up in the proportion of participants who were ≥ 90 % adherent to ART (59-83 %, p < 0.01) and virally suppressed (42 % to 66 %, p < 0.01). The findings suggest the importance of ensuring HIV self-management interventions reach vulnerable populations of PWH who struggle with initiating and maintaining HIV-related health-promoting behaviors.
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Affiliation(s)
- Matthew B Feldman
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States.
| | - Trang T Tran
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| | - Lisa M Boucher
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent Ottawa, Ontario K1G 5Z3, Canada; C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère Street, Ottawa, Ontario K1N 5C8, Canada
| | - Faisal Abdelqader
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| | - Amanda R Raker
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
| | - Stephen J Hile
- The New York City Department of Health and Mental Hygiene, Division of Disease Control, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, 42-09 28th Street, Queens, NY 11101, United States
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17
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Sun L, Qu M, Chen B, Li C, Fan H, Zhao Y. Effectiveness of mHealth on Adherence to Antiretroviral Therapy in Patients Living With HIV: Meta-analysis of Randomized Controlled Trials. JMIR Mhealth Uhealth 2023; 11:e42799. [PMID: 36689267 PMCID: PMC9903184 DOI: 10.2196/42799] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The World Health Organization recommends that all adults with HIV adhere to antiretroviral therapy (ART). Good adherence to ART is beneficial to patients and the public. Furthermore, mHealth has shown promise in improving HIV medication adherence globally. OBJECTIVE The aim of this meta-analysis is to analyze the effectiveness of mHealth on adherence to antiretroviral therapy in patients living with HIV. METHODS Randomized controlled trials (RCTs) of the association between mHealth and adherence to ART published until December 2021 were searched in electronic databases. Odds ratios (ORs), weighted mean differences, and 95% CIs were calculated. This meta-analysis was performed using the Mantel-Haenszel method or the inverse variance test. We evaluated heterogeneity with the I2 statistic. If I2 was ≤50%, heterogeneity was absent, and a fixed effect model was used. If I2 was >50%, heterogeneity was present, and a random effects model was used. RESULTS A total of 2163 participants in 8 studies were included in this meta-analysis. All included studies were RCTs. The random effects model was used for a meta-analysis of the effects of various intervention measures compared to routine nursing; the outcome was not statistically significant (OR 1.54, 95% CI 0.99-2.38; P=.05). In the subgroups, only short messaging service (SMS)-based interventions significantly increased adherence to ART (OR 1.76, 95% CI 1.07-2.89; P=.03). Further analysis showed that only interactive or bidirectional SMS could significantly increase ART adherence (OR 1.69, 95% CI 1.22-2.34; P=.001). After combining the difference in CD4 cell count before and after the interventions, we concluded that there was no statistical heterogeneity among the studies (I2=0%; tau2=0.37; P=.95). CONCLUSIONS Interactive or bidirectional SMS can enhance intervention effects. However, whether mHealth can improve adherence to ART in patients with HIV needs further study. Owing to a lack of the required significant staff time, training, and ongoing supervision, there is still much more to do to apply mHealth to the clinical use of ART for patients living with HIV. TRIAL REGISTRATION PROSPERO CRD42022358774; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=358774.
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Affiliation(s)
- Liang Sun
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Mengbing Qu
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Bing Chen
- Sanmenxia Center for Disease Control and Prevention, Sanmenxia, China
| | - Chuancang Li
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Haohao Fan
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yang Zhao
- College of Public Health, Zhengzhou University, Zhengzhou, China
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18
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Goldhammer H, Marc LG, Psihopaidas D, Chavis NS, Massaquoi M, Cahill S, Rebchook G, Reisner S, Mayer KA, Cohen SM, Keuroghlian AS. HIV Care Continuum Interventions for Transgender Women: A Topical Review. Public Health Rep 2023; 138:19-30. [PMID: 35060802 PMCID: PMC9730173 DOI: 10.1177/00333549211065517] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Transgender women experience a disproportionate prevalence of HIV and barriers to linkage to care, retention in care, medication adherence, and viral suppression. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature from January 1, 2010, through June 1, 2020, for English-language articles on interventions designed to improve at least 1 HIV care continuum outcome or address 1 barrier to achieving HIV care continuum outcomes among transgender women diagnosed with HIV in the United States. To be included, articles needed to identify transgender women as a priority population for the intervention. We found 22 interventions, of which 15 reported quantitative or qualitative outcomes and 7 reported study protocols. Recent interventions have incorporated a range of strategies that show promise for addressing pervasive structural and individual barriers rooted in societal and cultural stigma and discrimination against transgender people. Cross-cutting themes found among the interventions included meaningful community participation in the design and implementation of the interventions; culturally affirming programs that serve as a gateway to HIV care and combine gender-affirming care and social services with HIV care; interventions to improve behavioral health outcomes; peer-led counseling, education, and navigation; and technology-based interventions to increase access to care management and online social support. Ongoing studies will further elucidate the efficacy and effectiveness of these interventions, with the goal of reducing disparities in the HIV care continuum and bringing us closer to ending the HIV epidemic among transgender women in the United States.
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Affiliation(s)
| | - Linda G. Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Nicole S. Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
- Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Greg Rebchook
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Sari Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kenneth A. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M. Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S. Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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19
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Polhemus A, Simblett S, Dawe Lane E, Elliott B, Jilka S, Negbenose E, Burke P, Weyer J, Novak J, Dockendorf MF, Temesi G, Wykes T. Experiences of health tracking in mobile apps for multiple sclerosis: A qualitative content analysis of user reviews. Mult Scler Relat Disord 2023; 69:104435. [PMID: 36493561 DOI: 10.1016/j.msard.2022.104435] [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: 01/04/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mobile health applications (apps) are promising condition self-management tools for people living with multiple sclerosis (MS). However, most existing apps do not include health tracking features. This gap has been raised as a priority research topic, but the development of new self-management apps will require designers to understand the context and needs of those living with MS. Our aim was to conduct a content analysis of publicly available user reviews of existing MS self-management apps to understand desired features and guide the design of future apps. METHODS We systematically reviewed MS self-management apps which were publicly available in English on the Google Play and iOS app stores. We then conducted sentiment and content analysis of recent user reviews which referenced health tracking and data visualization to understand self-reported experiences and feedback. RESULTS Searches identified 75 unique apps, of which six met eligibility criteria and had reviews. One hundred and thirty-seven user reviews of these apps were eligible, though most were associated with a single app (n=108). Overall, ratings and sentiment scores skewed highly positive (Median [IQR]: Ratings - 5 [4-5], Sentiment scores - 0.70 [0.44-0.86]), though scores of individual apps varied. Content analysis revealed five themes: reasons for app usage, simple user experience, customization and flexibility, feature requests, and technical issues. Reviewers suggested that app customization, interconnectivity, and consolidated access to desired features should be considered in the design of future apps. User ratings weakly correlated with review sentiment scores (ρ = 0.27 [0.11-0.42]). CONCLUSIONS Self-tracking options in MS apps are currently limited, though the apps that offer these functions are considered useful by individuals with MS. Additional qualitative research is required to understand how specific app features and opportunities for personalization should be incorporated into new self-management tools for this population.
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Affiliation(s)
- Ashley Polhemus
- Merck Research Labs Information Technology, Merck Sharp, & Dohme, Kenilworth, NJ, USA; Epidemiology Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland.
| | - Sara Simblett
- Institute of Psychiatry, King's College London, London, UK
| | - Erin Dawe Lane
- Institute of Psychiatry, King's College London, London, UK
| | | | - Sagar Jilka
- Institute of Psychiatry, King's College London, London, UK
| | | | - Patrick Burke
- RADAR-CNS Patient Advisory Board, King's College London, London, UK
| | - Janice Weyer
- RADAR-CNS Patient Advisory Board, King's College London, London, UK
| | - Jan Novak
- Merck Research Labs Information Technology, Merck Sharp, & Dohme, Kenilworth, NJ, USA
| | - Marissa F Dockendorf
- Merck Research Labs Information Technology, Merck Sharp, & Dohme, Kenilworth, NJ, USA
| | - Gergely Temesi
- Merck Research Labs Information Technology, Merck Sharp, & Dohme, Kenilworth, NJ, USA
| | - Til Wykes
- Institute of Psychiatry, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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- The RADAR-CNS Consortium (www.radar-cns.org)
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20
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Kruse CS, Pacheco GJ, Rosenthal N, Kopp CJ, Omorotionmwan O, Cruz JE. Leveraging mHealth for the Treatment and Management of PLHIV. Risk Manag Healthc Policy 2023; 16:677-697. [PMID: 37077534 PMCID: PMC10106311 DOI: 10.2147/rmhp.s403946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/25/2023] [Indexed: 04/21/2023] Open
Abstract
Objective The objective of this systematic review was to analyze published literature from the last five years to assess facilitators and barriers to the adoption of mHealth as interventions to treat and manage HIV for PLHIV (people living with HIV). The primary outcomes were physical and mental conditions. The secondary outcomes were behavior based (substance use, care engagement, and healthy habits). Methods Four databases (PubMed, CINAHL, Web of Science, and ScienceDirect) were queried on 9/2/2022 for peer-reviewed studies on the treatment and management of PLHIV with mHealth as the intervention. The review was conducted in accordance with the Kruse Protocol and reported in accordance with PRISMA 2020. Results Five mHealth interventions were identified across 32 studies that resulted in improvements in physical health, mental health, care engagement, and behavior change. mHealth interventions offer both convenience and privacy, meet a digital preference, increase health knowledge, decrease healthcare utilization, and increase quality of life. Barriers are cost of technology and incentives, training of staff, security concerns, digital literacy gap, distribution of technology, technical issues, usability, and visual cues are not available over the phone. Conclusion mHealth offers interventions to improve physical health, mental health, care engagement, and behavior for PLHIV. There are many advantages to this intervention and very few barriers to its adoption. The barriers are strong, however, and should be addressed through policy. Further research should focus on specific apps for younger versus older PLHIV, based on preferences and the digital literacy gap.
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Affiliation(s)
- Clemens Scott Kruse
- Texas State University, School of Health Administration, 601 University Drive, San Marcos, TX, 78666, USA
- Correspondence: Clemens Scott Kruse, Email
| | - Gerardo J Pacheco
- Texas State University, School of Health Administration, 601 University Drive, San Marcos, TX, 78666, USA
| | - Noah Rosenthal
- Texas State University, School of Health Administration, 601 University Drive, San Marcos, TX, 78666, USA
| | - Caris J Kopp
- Texas State University, School of Health Administration, 601 University Drive, San Marcos, TX, 78666, USA
| | - Omosigho Omorotionmwan
- Texas State University, School of Health Administration, 601 University Drive, San Marcos, TX, 78666, USA
| | - John E Cruz
- Texas State University, School of Health Administration, 601 University Drive, San Marcos, TX, 78666, USA
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21
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Beck EJ, Mandalia S, Yfantopoulos P, Leon A, Merino MJ, Garcia F, Wittevogel M, Apers L, Benkovic I, Zekan S, Begovac J, Cunha AS, Teofilo E, Rodrigues G, Borges MDF, Fatz D, Vera J, Whetham J. Efficiency of the EmERGE Pathway of Care in Five European HIV Centres. PHARMACOECONOMICS 2022; 40:1235-1246. [PMID: 36227463 DOI: 10.1007/s40273-022-01193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We aimed to calculate the efficiency of the EmERGE Pathway of Care in five European HIV clinics, developed and implemented for medically stable people living with HIV. METHODS Participants were followed up for 1 year before and after implementation of EmERGE, between April 2016 and October 2019. Micro-costing studies were performed in the outpatient services of the clinics. Unit costs for outpatient services were calculated in national currencies and converted to US$ 2018 OECD purchasing parity prices to enable between clinic comparisons in terms of outcomes and costs. Unit costs were linked to the mean use of services for medically stable people living with HIV, before and after implementation of EmERGE. Primary outcome measures were CD4 count and viral load; secondary outcomes were patient activation (PAM13) and quality of life (PROQOL-HIV). Out-of-pocket expenditure data were collected. RESULTS There were 2251 participants: 87-93% were male, mean age at entry was 41-47 years. Medically stable people living with HIV had outpatient visits in four sites which decreased by 9-31% and costs by 5-33%; visits and costs increased by 8% in one site, which had to revert back to face-to-face visits. Antiretroviral drugs comprised 83-91% of annual costs: the Portuguese site had the highest antiretroviral drug costs in US$ purchasing parity prices. Primary and secondary outcome measures of participants did not change during the study. CONCLUSIONS EmERGE is acceptable and provided cost savings in different socio-economic settings. Antiretroviral drug costs remain the main cost drivers in medically stable people living with HIV. While antiretroviral drug prices in local currencies did not differ that much between countries, conversion to US$ purchasing parity prices revealed antiretroviral drugs were more expensive in the least wealthy countries. This needs to be taken into consideration when countries negotiate drug prices with pharmaceutical vendors. Greater efficiencies can be anticipated by extending the use of the EmERGE Pathway to people with complex HIV infection or other chronic diseases. Extending such use should be systematically monitored, implementation should be evaluated and funding should be provided to monitor and evaluate future changes in service provision.
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Affiliation(s)
- Eduard J Beck
- NPMS-HHC CIC, 21 Bedford Square, London, WC1B 3HH, UK.
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - Agathe Leon
- Infectious Diseases Department, Hospital Clínic-IDIBAPS (HC-IDIBAPS), University of HC-IDIBAPS, Barcelona, Spain
| | - Marie J Merino
- Infectious Diseases Department, Hospital Clínic-IDIBAPS (HC-IDIBAPS), University of HC-IDIBAPS, Barcelona, Spain
| | - Felipe Garcia
- Infectious Diseases Department, Hospital Clínic-IDIBAPS (HC-IDIBAPS), University of HC-IDIBAPS, Barcelona, Spain
| | | | - Ludwig Apers
- Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Ivana Benkovic
- University Hospital for Infectious Diseases (UHID), Zagreb, Croatia
| | - Sime Zekan
- University Hospital for Infectious Diseases (UHID), Zagreb, Croatia
| | - Josip Begovac
- University Hospital for Infectious Diseases (UHID), Zagreb, Croatia
| | - Ana S Cunha
- Hospital Capuchos, Centro Hospitalar De Lisboa Central, EPE (HC-CHLC), Lisbon, Portugal
| | - Eugenio Teofilo
- Hospital Capuchos, Centro Hospitalar De Lisboa Central, EPE (HC-CHLC), Lisbon, Portugal
| | - Goncalo Rodrigues
- Hospital Capuchos, Centro Hospitalar De Lisboa Central, EPE (HC-CHLC), Lisbon, Portugal
| | - Margarida D F Borges
- Hospital Capuchos, Centro Hospitalar De Lisboa Central, EPE (HC-CHLC), Lisbon, Portugal
| | - Duncan Fatz
- Brighton and Sussex University Hospitals NHS Trust (BSUHT), Brighton, UK
| | - Jamie Vera
- Brighton and Sussex University Hospitals NHS Trust (BSUHT), Brighton, UK
| | - Jennifer Whetham
- Brighton and Sussex University Hospitals NHS Trust (BSUHT), Brighton, UK
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22
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Peng ML, Wickersham JA, Altice FL, Shrestha R, Azwa I, Zhou X, Halim MAA, Ikhtiaruddin WM, Tee V, Kamarulzaman A, Ni Z. Formative Evaluation of the Acceptance of HIV Prevention Artificial Intelligence Chatbots By Men Who Have Sex With Men in Malaysia: Focus Group Study. JMIR Form Res 2022; 6:e42055. [PMID: 36201390 PMCID: PMC9585446 DOI: 10.2196/42055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Mobile technologies are being increasingly developed to support the practice of medicine, nursing, and public health, including HIV testing and prevention. Chatbots using artificial intelligence (AI) are novel mobile health strategies that can promote HIV testing and prevention among men who have sex with men (MSM) in Malaysia, a hard-to-reach population at elevated risk of HIV, yet little is known about the features that are important to this key population. OBJECTIVE The aim of this study was to identify the barriers to and facilitators of Malaysian MSM's acceptance of an AI chatbot designed to assist in HIV testing and prevention in relation to its perceived benefits, limitations, and preferred features among potential users. METHODS We conducted 5 structured web-based focus group interviews with 31 MSM in Malaysia between July 2021 and September 2021. The interviews were first recorded, transcribed, coded, and thematically analyzed using NVivo (version 9; QSR International). Subsequently, the unified theory of acceptance and use of technology was used to guide data analysis to map emerging themes related to the barriers to and facilitators of chatbot acceptance onto its 4 domains: performance expectancy, effort expectancy, facilitating conditions, and social influence. RESULTS Multiple barriers and facilitators influencing MSM's acceptance of an AI chatbot were identified for each domain. Performance expectancy (ie, the perceived usefulness of the AI chatbot) was influenced by MSM's concerns about the AI chatbot's ability to deliver accurate information, its effectiveness in information dissemination and problem-solving, and its ability to provide emotional support and raise health awareness. Convenience, cost, and technical errors influenced the AI chatbot's effort expectancy (ie, the perceived ease of use). Efficient linkage to health care professionals and HIV self-testing was reported as a facilitating condition of MSM's receptiveness to using an AI chatbot to access HIV testing. Participants stated that social influence (ie, sociopolitical climate) factors influencing the acceptance of mobile technology that addressed HIV in Malaysia included privacy concerns, pervasive stigma against homosexuality, and the criminalization of same-sex sexual behaviors. Key design strategies that could enhance MSM's acceptance of an HIV prevention AI chatbot included an anonymous user setting; embedding the chatbot in MSM-friendly web-based platforms; and providing user-guiding questions and options related to HIV testing, prevention, and treatment. CONCLUSIONS This study provides important insights into key features and potential implementation strategies central to designing an AI chatbot as a culturally sensitive digital health tool to prevent stigmatized health conditions in vulnerable and systematically marginalized populations. Such features not only are crucial to designing effective user-centered and culturally situated mobile health interventions for MSM in Malaysia but also illuminate the importance of incorporating social stigma considerations into health technology implementation strategies.
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Affiliation(s)
- Mary L Peng
- Social and Behavioral Sciences Department, Yale School of Public Health, New Haven, CT, United States
| | - Jeffrey A Wickersham
- Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Roman Shrestha
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Iskandar Azwa
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Infectious Disease Unit, Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Xin Zhou
- Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Mohd Akbar Ab Halim
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Mohd Ikhtiaruddin
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vincent Tee
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Section of Infectious Disease, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Infectious Disease Unit, Faculty of Medicine, Kuala Lumpur, Malaysia
| | - Zhao Ni
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, United States
- School of Nursing, Yale University, New Haven, CT, United States
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23
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The efficiency of the EmERGE platform for medically stable people living with HIV in Portugal. Porto Biomed J 2022; 7:e191. [DOI: 10.1097/j.pbj.0000000000000191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/27/2022] [Indexed: 11/22/2022] Open
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Costa-Cordella S, Grasso-Cladera A, Rossi A, Duarte J, Guiñazu F, Cortes CP. Internet-based peer support interventions for people living with HIV: A scoping review. PLoS One 2022; 17:e0269332. [PMID: 36040950 PMCID: PMC9426879 DOI: 10.1371/journal.pone.0269332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Peer support interventions for people living with HIV and AIDS (PLWHA) are effective, but their associated time and material costs for the recipient and the health system make them reachable for only a small proportion of PLWHA. Internet-based interventions are an effective alternative for delivering psychosocial interventions for PLWHA as they are more accessible. Currently, no reviews are focusing on internet-based interventions with peer support components. This scoping review aims to map the existing literature on psychosocial interventions for PLWHA based on peer support and delivered through the internet. We conducted a systematic scoping review of academic literature following methodological guidelines for scoping reviews, and 28 articles met our criteria. We summarized the main characteristics of the digital peer support interventions for PLWHA and how they implemented peer support in a virtual environment. Overall the reported outcomes appeared promising, but more robust evidence is needed.
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Affiliation(s)
- Stefanella Costa-Cordella
- Centro de Estudios en Psicología Clínica y Psicoterapia (CEPPS), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Instituto Milenio Depresión y Personalidad (MIDAP), Santiago, Chile
- Centro de Estudios en Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Aitana Grasso-Cladera
- Centro de Estudios en Psicología Clínica y Psicoterapia (CEPPS), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Centro de Estudios en Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Alejandra Rossi
- Centro de Estudios en Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Javiera Duarte
- Centro de Estudios en Psicología Clínica y Psicoterapia (CEPPS), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Instituto Milenio Depresión y Personalidad (MIDAP), Santiago, Chile
| | - Flavia Guiñazu
- Web Intelligence Centre, Facultad de Ingeniería Industrial, Universidad de Chile, Santiago, Chile
| | - Claudia P. Cortes
- Hospital Clínico San Borja Arriarán & Fundación Arriarán, Santiago, Chile
- Departamento de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- * E-mail:
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25
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Beck EJ, Mandalia S, Yfantopoulos P, Jones CI, Bremner S, Whetham J, Etcheverry F, Moreno L, Gonzalez E, Merino MJ, Leon A, Garcia F. Efficiency of the EmERGE Pathway to provide continuity of care for Spanish people living with medically stable HIV. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:388-395. [PMID: 35906033 DOI: 10.1016/j.eimce.2020.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/23/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Calculate the efficiency of the EmERGE Pathway of Care for medically stable people living with HIV at the Hospital Clínic-IDIBAPS, Barcelona, Spain. METHODS 546 study participants were followed between 1st July 2016 and 30th October 2019 across three HIV outpatient clinics, but the virtual clinic was closed during the second year. Unit costs were calculated, linked to mean use outpatient services per patient year, one-year before and after the implementation of EmERGE. Costs were combined with primary and secondary outcomes. RESULTS Annual costs across HIV-outpatient services increased by 8%: €1073 (95%CI €999-€1157) to €1158 (95%CI €1084-€1238). Annual cost of ARVs was €7,557; total annual costs increased by 1% from €8430 (95%CI €8356-8514) to €8515 (95%CI €8441-8595). Annual cost for 433 participants managed in face-to-face (F2F) clinics decreased by 5% from €958 (95%CI 905-1018) to €904 (95%CI 863-945); participants transferred from virtual to F2F outpatient clinics (V2F) increased their annual cost by a factor of 2.2, from €115 (95%CI 94-139) to €251 (95%CI 219-290). No substantive changes were observed in primary and secondary outcomes. CONCLUSION EmERGE Pathway is an efficient and acceptable intervention. Increases in costs were caused by internal structural changes. The cost reduction observed in F2F clinics were off-set by the transfer of participants from the virtual to the F2F clinics due to the closure of the virtual clinic during the second year of the Study. Greater efficiencies are likely to be achieved by extending the use of the Pathway to other PLHIV.
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Affiliation(s)
- E J Beck
- NPMS-HHC CIC, London, UK; Department of Health Services Research and Policy, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - C I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - S Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - J Whetham
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - F Etcheverry
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - L Moreno
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - E Gonzalez
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - M J Merino
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - A Leon
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - F Garcia
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
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Glick JL, Jivapong B, Russo R, Pelaez D, Piser R, Footer K, Sherman SG. Cultivating PEARL (Promoting Empowerment and Risk Reduction): Formative Research for a PrEP Intervention Among Female Sex Workers in Baltimore, Maryland. AIDS Behav 2022; 26:2664-2675. [PMID: 35124751 PMCID: PMC9885761 DOI: 10.1007/s10461-022-03600-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 02/01/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a vital component of comprehensive HIV prevention among female sex workers (FSW). There are limited PrEP interventions targeting FSW in the U.S., who have high HIV risk. Formative research was conducted to inform PEARL (Promoting Empowerment And Risk Reduction), a PrEP intervention for FSW in Baltimore, MD, including a community forum, key informant interviews with providers, and focus group discussions with FSW. FSW and providers acknowledged challenges to building rapport and establishing continuity in care settings. FSW reported low PrEP awareness, with high interest once aware. FSW and providers reported uptake barriers including perceived financial issues, lack of PrEP awareness, and mistrust of the pharmaceutical industry. Concerns were raised about substance use and daily PrEP adherence. Developing a tailored PrEP intervention for FSW necessitates multiple perspectives (e.g. FSW, service providers). Resumen La profilaxis preexposición (PrEP) es un componente vital de la prevención integral del VIH para las trabajadoras sexuales (TSF). En los Estados Unidos, hay pocas intervenciones de PrEP dirigidas a las TSF, quienes experiencian un riesgo elevado de contraer el VIH. Se realizó una investigación formativa para informar a PEARL (Promoción del empoderamiento y la reducción de riesgos), una intervención de PrEP para TSF en Baltimore, MD-la cual incluyó un foro comunitario, entrevistas con proveedores de servicios a las TSF y discusiones entre grupos focales de TSF. TSF y proveedores de servicio reconocieron los retos de mantener buenas relaciones y establecer continuidad en los servicios de salud. TSF exhibieron conocimiento limitado sobre la PrEP, pero expresaron gran interés en la PrEP después de estar informadas. TSF y los proveedores de servicios hablaron de barreras aceptando a la PrEP, incluyendo problemas financieros percibidos, falta de conocimiento sobre la PrEP y desconfianza en la industria farmacéutica. Se expresaron preocupaciones sobre el uso de sustancias y la adherencia diaria a la PrEP. El desarrollo de una intervención de PrEP personalizada para TSF requiere varias perspectivas (por ejemplo, TSF, proveedores de servicios).
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Affiliation(s)
- Jennifer L Glick
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Belinda Jivapong
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rienna Russo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Rebecca Piser
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Katherine Footer
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Self-Management Frameworks for Youth Living with Human Immunodeficiency Virus. Pediatr Clin North Am 2022; 69:759-777. [PMID: 35934498 DOI: 10.1016/j.pcl.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
HIV is now a chronic condition that can be managed. Adolescents and emerging adults represent a large proportion of new diagnoses, but struggle with many aspects of HIV-related self-management. Self-management of HIV is critical to maintaining health and involves retention in HIV care, medication adherence to achieve viral suppression, managing substance use, and sexual and general health-related behaviors. This article describes theoretic frameworks for HIV self-management as adapted for youth and reviews self-management interventions developed to improve health outcomes in youth living with HIV identified from a recent systematic review.
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Shrestha R, Maviglia F, Altice FL, DiDomizio E, Khati A, Mistler C, Azwa I, Kamarulzaman A, Halim MAA, Wickersham JA. Mobile Health Technology Use and the Acceptability of an mHealth Platform for HIV Prevention Among Men Who Have Sex With Men in Malaysia: Cross-sectional Respondent-Driven Sampling Survey. J Med Internet Res 2022; 24:e36917. [PMID: 35877172 PMCID: PMC9361153 DOI: 10.2196/36917] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/14/2022] [Accepted: 05/08/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The growth in mobile technology access, utilization, and services holds great promise in facilitating HIV prevention efforts through mobile health (mHealth) interventions in Malaysia. Despite these promising trends, there is a dearth of evidence on the use of mHealth platforms that addresses HIV prevention among Malaysian men who have sex with men. OBJECTIVE The goal of this study was to gain insight into (1) access and utilization of communication technology (eg, landline phone, internet, mobile phone), (2) acceptability of mHealth-based interventions for HIV prevention services, and (3) preferences regarding the format and frequency of mHealth interventions among Malaysian men who have sex with men. METHODS We conducted a cross-sectional survey with Malaysian men who have sex with men between July 2018 and March 2020. Participants were recruited using respondent-driven sampling in the Greater Kuala Lumpur region of Malaysia. We collected information on demographic characteristics, HIV risk-related behaviors, access to and the frequency of use of communication technology, and acceptability of using mHealth for HIV prevention using a self-administered questionnaire with a 5-point scale (1, never; 2, rarely; 3, sometimes; 4, often; 5, all the time). RESULTS A total of 376 men participated in the survey. Almost all respondents owned or had access to a smartphone with internet access (368/376, 97.9%) and accessed the internet daily (373/376, 99.2%), mainly on a smartphone (334/376, 88.8%). Participants on average used smartphones primarily for social networking (mean 4.5, SD 0.8), followed by sending or receiving emails (mean 4.0, SD 1.0), and searching for health-related information (mean 3.5, SD 0.9). There was high acceptance of the use of mHealth for HIV prevention (mean 4.1, SD 1.5), including for receiving HIV prevention information (345/376, 91.8%), receiving medication reminders (336/376, 89.4%), screening and monitoring sexual activity (306/376, 81.4%) or illicit drug use (281/376, 74.7%), and monitoring drug cravings (280/376, 74.5%). Participants overwhelmingly preferred a smartphone app over other modalities (eg, text, phone call, email) for engaging in mHealth HIV prevention tools. Preference for app notifications ranged from 186/336 (53.9%), for receiving HIV prevention information, to 212/336 (69.3%), for screening and monitoring sexual activity. Acceptance of mHealth was higher for those who were university graduates (P=.003), living in a relationship with a partner (P=.04), engaged in sexualized drug use (P=.01), and engaged in receptive anal sex (P=.006). CONCLUSIONS Findings from this study provide support for developing and deploying mHealth strategies for HIV prevention using a smartphone app in men who have sex with men-a key population with suboptimal engagement in HIV prevention and treatment.
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Affiliation(s)
- Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Francesca Maviglia
- Section of Infectious Diseases, Yale University, New Haven, CT, United States
| | - Frederick L Altice
- Section of Infectious Diseases, Yale University, New Haven, CT, United States
| | - Elizabeth DiDomizio
- Section of Infectious Diseases, Yale University, New Haven, CT, United States
| | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Colleen Mistler
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Iskandar Azwa
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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29
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Skeen SJ, Jones SS, Cruse CM, Horvath KJ. Integrating Natural Language Processing and Interpretive Thematic Analyses to Gain Human-Centered Design Insights on HIV Mobile Health: Proof-of-Concept Analysis. JMIR Hum Factors 2022; 9:e37350. [PMID: 35862171 PMCID: PMC9353680 DOI: 10.2196/37350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND HIV mobile health (mHealth) interventions often incorporate interactive peer-to-peer features. The user-generated content (UGC) created by these features can offer valuable design insights by revealing what topics and life events are most salient for participants, which can serve as targets for subsequent interventions. However, unstructured, textual UGC can be difficult to analyze. Interpretive thematic analyses can preserve rich narratives and latent themes but are labor-intensive and therefore scale poorly. Natural language processing (NLP) methods scale more readily but often produce only coarse descriptive results. Recent calls to advance the field have emphasized the untapped potential of combined NLP and qualitative analyses toward advancing user attunement in next-generation mHealth. OBJECTIVE In this proof-of-concept analysis, we gain human-centered design insights by applying hybrid consecutive NLP-qualitative methods to UGC from an HIV mHealth forum. METHODS UGC was extracted from Thrive With Me, a web app intervention for men living with HIV that includes an unstructured peer-to-peer support forum. In Python, topics were modeled by latent Dirichlet allocation. Rule-based sentiment analysis scored interactions by emotional valence. Using a novel ranking standard, the experientially richest and most emotionally polarized segments of UGC were condensed and then analyzed thematically in Dedoose. Design insights were then distilled from these themes. RESULTS The refined topic model detected K=3 topics: A: disease coping; B: social adversities; C: salutations and check-ins. Strong intratopic themes included HIV medication adherence, survivorship, and relationship challenges. Negative UGC often involved strong negative reactions to external media events. Positive UGC often focused on gratitude for survival, well-being, and fellow users' support. CONCLUSIONS With routinization, hybrid NLP-qualitative methods may be viable to rapidly characterize UGC in mHealth environments. Design principles point toward opportunities to align mHealth intervention features with the organically occurring uses captured in these analyses, for example, by foregrounding inspiring personal narratives and expressions of gratitude, or de-emphasizing anger-inducing media.
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Affiliation(s)
- Simone J Skeen
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States.,Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Stephen Scott Jones
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Carolyn Marie Cruse
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States
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Velen K, Nguyen VN, Nguyen BH, Dang T, Nguyen HA, Vu DH, Do TT, Pham Duc C, Nguyen HL, Pham HT, Marais BJ, Johnston J, Britton W, Beardsley J, Negin J, Wiseman V, Marks GB, Nguyen TA, Fox GJ. Harnessing new mHealth technologies to Strengthen the Management of Multidrug-Resistant Tuberculosis in Vietnam (V-SMART trial): a protocol for a randomised controlled trial. BMJ Open 2022; 12:e052633. [PMID: 35732397 PMCID: PMC9226862 DOI: 10.1136/bmjopen-2021-052633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem globally. Long, complex treatment regimens coupled with frequent adverse events have resulted in poor treatment adherence and patient outcomes. Smartphone-based mobile health (mHealth) technologies offer national TB programmes an appealing platform to improve patient care and management; however, clinical trial evidence to support their use is lacking. This trial will test the hypothesis that an mHealth intervention can improve treatment success among patients with MDR-TB and is cost-effective compared with standard practice. METHODS AND ANALYSIS A community-based, open-label, parallel-group randomised controlled trial will be conducted among patients treated for MDR-TB in seven provinces of Vietnam. Patients commencing therapy for microbiologically confirmed rifampicin-resistant or multidrug-resistant tuberculosis within the past 30 days will be recruited to the study. Participants will be individually randomised to an intervention arm, comprising use of an mHealth application for treatment support, or a 'standard care' arm. In both arms, patients will be managed by the national TB programme according to current national treatment guidelines. The primary outcome measure of effectiveness will be the proportion of patients with treatment success (defined as treatment completion and/or bacteriological cure) after 24 months. A marginal Poisson regression model estimated via a generalised estimating equation will be used to test the effect of the intervention on treatment success. A prospective microcosting of the intervention and within-trial cost-effectiveness analysis will also be undertaken from a societal perspective. Cost-effectiveness will be presented as an incremental cost per patient successfully treated and an incremental cost per quality-adjusted life-year gained. ETHICS Ethical approval for the study was granted by The University of Sydney Human Research Ethics Committee (2019/676). DISSEMINATION Study findings will be disseminated to participants and published in peer-reviewed journals and conference proceedings. TRIAL REGISTRATION NUMBER ACTRN12620000681954.
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Affiliation(s)
- Kavindhran Velen
- Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Tho Dang
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | - Hoang Anh Nguyen
- National Drug Information and Adverse Drug Reaction Monitoring Centre, Hanoi, Vietnam
| | - Dinh Hoa Vu
- National Drug Information and Adverse Drug Reaction Monitoring Centre, Hanoi, Vietnam
| | | | - Cuong Pham Duc
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
| | | | | | - Ben J Marais
- Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - James Johnston
- BCCDC, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Warwick Britton
- Centenary Institute of Cancer Medicine and Cell Biology, The University of Sydney, Sydney, New South Wales, Australia
- Department of Clinical Immunology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Justin Beardsley
- Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Joel Negin
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Virginia Wiseman
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Health Economics, LSHTM, London, UK
| | | | | | - Greg J Fox
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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31
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Fee C, Fuller J, Guss CE, Woods ER, Cooper ER, Bhaumik U, Graham D, Burchett S, Dumont O, Marty E, Narvaez M, Haberer JE, Swendeman D, Mulvaney SA, Kumar VS, Jackson JL, Ho YX. A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study (Preprint). JMIR Form Res 2022; 6:e39357. [DOI: 10.2196/39357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/24/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
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Patel P, Kerzner M, Reed JB, Sullivan P, El-Sadr WM. Public health implications of adapting HIV pre-exposure prophylaxis programs for virtual service delivery in the context of the COVID-19 pandemic: a systematic review. JMIR Public Health Surveill 2022; 8:e37479. [PMID: 35486813 PMCID: PMC9177169 DOI: 10.2196/37479] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/06/2022] [Accepted: 04/27/2022] [Indexed: 12/13/2022] Open
Abstract
Background The novel coronavirus disease COVID-19 caused by SARS-CoV-2 threatens to disrupt global progress toward HIV epidemic control. Opportunities exist to leverage ongoing public health responses to mitigate the impacts of COVID-19 on HIV services, and novel approaches to care provision might help address both epidemics. Objective As the COVID-19 pandemic continues, novel approaches to maintain comprehensive HIV prevention service delivery are needed. The aim of this study was to summarize the related literature to highlight adaptations that could address potential COVID-19–related service interruptions. Methods We performed a systematic review and searched six databases, OVID/Medline, Scopus, Cochrane Library, CINAHL, PsycINFO, and Embase, for studies published between January 1, 2010, and October 26, 2021, related to recent technology-based interventions for virtual service delivery. Search terms included “telemedicine,” “telehealth,” “mobile health,” “eHealth,” “mHealth,” “telecommunication,” “social media,” “mobile device,” and “internet,” among others. Of the 6685 abstracts identified, 1259 focused on HIV virtual service delivery, 120 of which were relevant for HIV prevention efforts; 48 pertained to pre-exposure prophylaxis (PrEP) and 19 of these focused on evaluations of interventions for the virtual service delivery of PrEP. Of the 16 systematic reviews identified, three were specific to PrEP. All 35 papers were reviewed for outcomes of efficacy, feasibility, and/or acceptability. Limitations included heterogeneity of the studies’ methodological approaches and outcomes; thus, a meta-analysis was not performed. We considered the evidence-based interventions found in our review and developed a virtual service delivery model for HIV prevention interventions. We also considered how this platform could be leveraged for COVID-19 prevention and care. Results We summarize 19 studies of virtual service delivery of PrEP and 16 relevant reviews. Examples of technology-based interventions that were effective, feasible, and/or acceptable for PrEP service delivery include: use of SMS, internet, and smartphone apps such as iText (50% [95% CI 16%-71%] reduction in discontinuation of PrEP) and PrEPmate (OR 2.62, 95% CI 1.24-5.5.4); telehealth and eHealth platforms for virtual visits such as PrEPTECH and IowaTelePrEP; and platforms for training of health care workers such as Extension for Community Healthcare Outcomes (ECHO). We suggest a virtual service delivery model for PrEP that can be leveraged for COVID-19 using the internet and social media for demand creation, community-based self-testing, telehealth platforms for risk assessment and follow-up, applications for support groups and adherence/appointment reminders, and applications for monitoring. Conclusions Innovations in the virtual service provision of PrEP occurred before COVID-19 but have new relevance during the COVID-19 pandemic. The innovations we describe might strengthen HIV prevention service delivery during the COVID-19 pandemic and in the long run by engaging traditionally hard-to-reach populations, reducing stigma, and creating a more accessible health care platform. These virtual service delivery platforms can mitigate the impacts of the COVID-19 pandemic on HIV services, which can be leveraged to facilitate COVID-19 pandemic control now and for future responses.
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Affiliation(s)
- Pragna Patel
- Centers for Disease Control and Prevention, CDC COVID-19 Response, 1600 Clifton Road, Atlanta, US
| | - Michael Kerzner
- Centers for Disease Control and Prevention, CDC COVID-19 Response, 1600 Clifton Road, Atlanta, US
| | | | | | - Wafaa M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, US
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Beck EJ, Mandalia S, Yfantopoulos P, Jones CI, Bremner S, Fatz D, Vera J, Whetham J. The efficiency of the EmERGE pathway of care for people living with HIV in England. AIDS Care 2022; 35:899-908. [PMID: 35348411 DOI: 10.1080/09540121.2022.2040723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study estimated the efficiency of implementing the EmERGE Pathway of Care for people living with medically stable HIV in Brighton, UK; an App enables individuals to communicate with caregivers via their smart-phone. Individual data on the use of HIV outpatient services were collected one-year pre- and post-implementation of EmERGE. Unit costs of HIV outpatient services were calculated and linked with mean use of services per patient year. Primary outcomes were CD4 count and viral load; patient activation and quality-of-life measures were secondary outcomes. 565 participants were followed up April 2017 - October 2018: 93% men, mean age at recruitment 47.0 years (95%CI:46.2-47.8). Outpatient visits decreased by 9% from 5.6 (95%CI:5.4-5.8) to 5.1 (95%CI:4.9-5.3). Face-to-face visits decreased and virtual visits increased. Annual costs decreased by 9% from £751 (95%CI: £722-£780) to £678 (95%CI: £653-£705). Including anti-retroviral drugs, total annual cost decreased from £7,343 (95%CI: £7,314-7,372) to £7,270 (95%CI: £7,245-7,297): ARVs costs comprised 90%. EmERGE was a cost-saving intervention, patients remained engaged and clinically stable. Annual costs were reduced, but ARVs continue to dominate costs. Extension of EmERGE to other people with chronic conditions, could produce greater efficiencies but these needs to be evaluated and monitored over time.
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Affiliation(s)
- E J Beck
- NPMS-HHC CIC, London, UK.,Department of Health Services Research and Policy, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - C I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - S Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - D Fatz
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - J Vera
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - J Whetham
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Hodges J, Caldwell S, Cohn W, Flickinger T, Waldman AL, Dillingham R, Castel A, Ingersoll K. Evaluation of the implementation and effectiveness of a mobile health intervention to improve outcomes for people with HIV in the DC Cohort: a study protocol for a cluster randomized controlled trial. JMIR Res Protoc 2022; 11:e37748. [PMID: 35349466 PMCID: PMC9077495 DOI: 10.2196/37748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 12/01/2022] Open
Abstract
Background Gaps remain in achieving retention in care and durable HIV viral load suppression for people with HIV in Washington, DC (hereafter DC). Although people with HIV seeking care in DC have access to a range of supportive services, innovative strategies are needed to enhance patient engagement in this setting. Mobile health (mHealth) interventions have shown promise in reaching previously underengaged groups and improving HIV-related outcomes in various settings. Objective This study will evaluate the implementation and effectiveness of a clinic-deployed, multifeature mHealth intervention called PositiveLinks (PL) among people with HIV enrolled in the DC Cohort, a longitudinal cohort of people with HIV receiving care in DC. A cluster randomized controlled trial will be conducted using a hybrid effectiveness-implementation design and will compare HIV-related outcomes between clinics randomized to PL versus usual care. Methods The study aims are threefold: (1) We will perform a formative evaluation of PL in the context of DC Cohort clinics to test the feasibility, acceptability, and usability of PL and tailor the platform for use in this context. (2) We will conduct a cluster randomized controlled trial with 12 DC Cohort clinics randomized to PL or usual care (n=6 [50%] per arm) and measure the effectiveness of PL by the primary outcomes of patient visit constancy, retention in care, and HIV viral load suppression. We aim to enroll a total of 482 participants from DC Cohort clinic sites, specifically including people with HIV who show evidence of inconsistent retention in care or lack of viral suppression. (3) We will use the Consolidated Framework for Implementation Research (CFIR) and the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to measure implementation success and identify site, patient, provider, and system factors associated with successful implementation. Evaluation activities will occur pre-, mid-, and postimplementation. Results Formative data collection was completed between April 2021 and January 2022. Preliminary mHealth platform modifications have been performed, and the first round of user testing has been completed. A preimplementation evaluation was performed to identify relevant implementation outcomes and design a suite of instruments to guide data collection for evaluation of PL implementation throughout the trial period. Instruments include those already developed to support DC Cohort Study activities and PL implementation in other cohorts, which required modification for use in the study, as well as novel instruments designed to complete data collection, as guided by the CFIR and RE-AIM frameworks. Conclusions Formative and preimplementation evaluations will be completed in spring 2022 when the trial is planned to launch. Specifically, comprehensive formative data analysis will be completed following data collection, coding, preliminary review, and synthesis. Corresponding platform modifications are ready for beta testing within the DC Cohort. Finalization of the platform for use in the trial will follow beta testing. Trial Registration ClinicalTrials.gov NCT04998019; https://clinicaltrials.gov/ct2/show/NCT04998019 International Registered Report Identifier (IRRID) PRR1-10.2196/37748
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Affiliation(s)
- Jacqueline Hodges
- Division of Infectious Diseases and International Health, University of Virginia, 1215 Lee St, Charlottesville, US
| | - Sylvia Caldwell
- Division of Infectious Diseases and International Health, University of Virginia, 1215 Lee St, Charlottesville, US
| | - Wendy Cohn
- Public Health Sciences, University of Virginia, Charlottesville, US
| | - Tabor Flickinger
- Department of Medicine, University of Virginia, Charlottesville, US
| | - Ava Lena Waldman
- Division of Infectious Diseases and International Health, University of Virginia, 1215 Lee St, Charlottesville, US
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, 1215 Lee St, Charlottesville, US
| | - Amanda Castel
- Milken Institute School of Public Health, George Washington University, Washington, US
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, US
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Hodges J, Waldman AL, Koshkina O, Suzdalnitsky A, Schwendinger J, Vitko S, Plenskey A, Plotnikova Y, Moiseeva E, Koshcheyev M, Sebekin S, Zhdanova S, Ogarkov O, Heysell S, Dillingham R. Process evaluation for the adaptation, testing and dissemination of a mobile health platform to support people with HIV and tuberculosis in Irkutsk, Siberia. BMJ Open 2022; 12:e054867. [PMID: 35351714 PMCID: PMC8966533 DOI: 10.1136/bmjopen-2021-054867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We developed and tested a mobile health-based programme to enhance integration of HIV and tuberculosis (TB) care and to promote a patient-centred approach in a region of high coinfection burden. Phases of programme development included planning, stakeholder interviews and platform re-build, testing and iteration. SETTING In Irkutsk, Siberia, HIV/TB coinfection prevalence is high relative to the rest of the Russian Federation. PARTICIPANTS Pilot testing occurred for a cohort of 60 people with HIV and TB. RESULTS Key steps emerged to ensure the mobile health-based programme could be operational and adequately adapted for the context, including platform language adaptation, optimisation of server management, iteration of platform features, and organisational practice integration. Pilot testing of the platform rebuild yielded favourable patient perceptions of usability and acceptability at 6 months (n=47 surveyed), with 18 of 20 items showing scores above 4 (on a scale from 1 to 5) on average. Development of this mobile health-based programme for integrated care of infections highlighted the importance of several considerations for tailoring these interventions contextually, including language adaptation and technological capacity, but also, importantly, contextualised patient preferences related to privacy and communication with peers and/or providers, existing regional capacity for care coordination of different comorbidities, and infection severity and treatment requirements. CONCLUSIONS Our experience demonstrated that integration of care for TB and HIV can be well served by using multimodal mobile health-based programmes, which can enhance communication and streamline workflow between providers across multiple collaborating institutions and improve continuity between inpatient and outpatient care settings. Further study of programme impact on contextual disease-related stigma and social isolation as well as evaluation of implementation on a broader scale for HIV care is currently under way. TRIAL REGISTRATION NUMBER NCT03819374.
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Affiliation(s)
- Jacqueline Hodges
- Division of Infectious Diseases & International Health, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ava Lena Waldman
- Division of Infectious Diseases & International Health, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Olga Koshkina
- Irkutsk Regional Tuberculosis Referral Hospital, Irkutsk, Russian Federation
| | - Alexey Suzdalnitsky
- Irkutsk Regional Tuberculosis Referral Hospital, Irkutsk, Russian Federation
| | - Jason Schwendinger
- Division of Infectious Diseases & International Health, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Serhiy Vitko
- Division of Infectious Diseases & International Health, University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | - Elena Moiseeva
- Irkutsk Regional Tuberculosis Referral Hospital, Irkutsk, Russian Federation
| | - Mikhail Koshcheyev
- Irkutsk Regional Tuberculosis Referral Hospital, Irkutsk, Russian Federation
| | - Sergey Sebekin
- Irkutsk Regional AIDS Centre, Irkutsk, Russian Federation
| | - Svetlana Zhdanova
- Department of Epidemiology and Microbiology, Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation
| | - Oleg Ogarkov
- Department of Epidemiology and Microbiology, Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation
| | - Scott Heysell
- Division of Infectious Diseases & International Health, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Rebecca Dillingham
- Division of Infectious Diseases & International Health, University of Virginia Health System, Charlottesville, Virginia, USA
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Okpechi IG, Muneer S, Ye F, Zaidi D, Ghimire A, Tinwala MM, Saad S, Osman MA, Lunyera J, Tonelli M, Caskey F, George C, Kengne AP, Malik C, Damster S, Levin A, Johnson D, Jha V, Bello AK. Global eHealth capacity: secondary analysis of WHO data on eHealth and implications for kidney care delivery in low-resource settings. BMJ Open 2022; 12:e055658. [PMID: 35321893 PMCID: PMC8943769 DOI: 10.1136/bmjopen-2021-055658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe the use of electronic health (eHealth) in support of health coverage for kidney care across International Society of Nephrology (ISN) regions. DESIGN Secondary analysis of WHO survey on eHealth as well as use of data from the World Bank, and Internet World Stats on global eHealth services. SETTING A web-based survey on the use of eHealth in support of universal health coverage. PARTICIPANTS 125 WHO member states provided response. PRIMARY OUTCOME MEASURES Availability of eHealth services (eg, electronic health records, telehealth, etc) and governance frameworks (policies) for kidney care across ISN regions. RESULTS The survey conducted by the WHO received responses from 125 (64.4%) member states, representing 4.4 billion people globally. The number of mobile cellular subscriptions was <100% of the population in Africa, South Asia, North America and North East Asia; the percentage of internet users increased from 2015 to 2020 in all regions. Western Europe had the highest percentage of internet users in all the periods: 2015 (82.0%), 2019 (90.7%) and 2020 (93.9%); Africa had the least: 9.8%, 21.8% and 31.4%, respectively. The North East Asia region had the highest availability of national electronic health record system (75%) and electronic learning access in medical schools (100%), with the lowest in Africa (27% and 39%, respectively). Policies concerning governance aspects of eHealth (eg, privacy, liability, data sharing) were more widely available in high-income countries (55%-93%) than in low-income countries (0%-47%), while access to mobile health for treatment adherence was more available in low-income countries (21%) than in high-income countries (7%). CONCLUSION The penetration of eHealth services across ISN regions is suboptimal, particularly in low-income countries. Increasing utilisation of internet communication technologies provides an opportunity to improve access to kidney education and care globally, especially in low-income countries.
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Affiliation(s)
- Ikechi G Okpechi
- Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Shezel Muneer
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Anukul Ghimire
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed M Tinwala
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Syed Saad
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohamed A Osman
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Lunyera
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Marcello Tonelli
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Fergus Caskey
- Department of Medicine, University of Bristol Faculty of Medicine and Dentistry, Bristol, UK
| | - Cindy George
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Charu Malik
- Administration, International Society of Nephrology, Brussels, Belgium
| | - Sandrine Damster
- Administration, International Society of Nephrology, Brussels, Belgium
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Johnson
- Department of Medicine, The University of Queensland Faculty of Medicine and Biomedical Sciences, Herston, Queensland, Australia
| | - Vivekanand Jha
- Department of Medicine, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Effectiveness of eHealth Interventions for HIV Prevention and Management in Sub-Saharan Africa: Systematic Review and Meta-analyses. AIDS Behav 2022; 26:457-469. [PMID: 34427813 PMCID: PMC8813706 DOI: 10.1007/s10461-021-03402-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 12/19/2022]
Abstract
HIV is still the leading cause of death in Sub-Saharan Africa (SSA), despite medical advances. eHealth interventions are effective for HIV prevention and management, but it is unclear whether this can be generalised to resource-poor settings. This systematic review aimed to establish the effectiveness of eHealth interventions in SSA. Six electronic databases were screened to identify randomised controlled trials (RCTs) published between 2000 and 2020. Meta-analyses were performed, following Cochrane methodology, to assess the impact of eHealth interventions on HIV-related behaviours and biological outcomes. 25 RCTs were included in the review. Meta-analyses show that eHealth interventions significantly improved HIV management behaviours (OR 1.21; 95% CI 1.05-1.40; Z = 2.67; p = 0.008), but not HIV prevention behaviours (OR 1.02; 95% CI 0.78-1.34; Z = 0.17; p = 0.86) or biological outcomes (OR 1.17; 95% CI 0.89-1.54; Z = 1.10; p = 0.27) compared with minimal intervention control groups. It is a hugely important finding that eHealth interventions can improve HIV management behaviours as this is a low-cost way of improving HIV outcomes and reducing the spread of HIV in SSA. PROSPERO registration number: CRD42020186025.
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Shrestha R, Fisher C, Wickersham JA, Khati A, Kim R, Azwa I, Mistler C, Goldsamt L. Privacy and Confidentiality Concerns Related to the Use of mHealth Apps for HIV Prevention Efforts Among Malaysian Men Who Have Sex With Men: Cross-sectional Survey Study. JMIR Form Res 2021; 5:e28311. [PMID: 34924355 PMCID: PMC8726055 DOI: 10.2196/28311] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/19/2021] [Accepted: 11/21/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of mobile health (mHealth), including smartphone apps, can improve the HIV prevention cascade for key populations such as men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, the mHealth platform has the potential to open new frontiers for HIV prevention efforts. However, little guidance is available to inform researchers about privacy and confidentiality concerns unique to the development and implementation of app-based HIV prevention programs. OBJECTIVE Given the lack of empirical data in this area, we aim to understand the privacy and confidentiality concerns associated with participation in a hypothetical app-based research study for HIV prevention efforts. METHODS A cross-sectional, web-based survey was conducted between June and July 2020 among 355 Malaysian MSM. The survey included demographic and sexual health questions and a series of short videos describing a hypothetical app-based HIV prevention program, followed by questions related to privacy and confidentiality concerns in each step of the app-based program (ie, recruitment, clinical interaction, risk assessment, and weekly reminder). Multivariable logistic regression models were used to identify the correlates of willingness to use such an app-based program. RESULTS Most of the participants (266/355, 74.9%) indicated their willingness to participate in a hypothetical mHealth app-based HIV prevention program. Participants expressed concerns about privacy, confidentiality, data security, and risks and benefits of participating in all stages of the app-based HIV research process. Multivariate analyses indicated that participants who had a higher degree of perceived participation benefits (adjusted odds ratio [aOR] 1.873; 95% CI 1.274-2.755; P=.001) were more willing to participate. In contrast, participants who had increased concerns about app-based clinical interaction and e-prescription (aOR 0.610; 95% CI 0.445-0.838; P=.002) and those who had a higher degree of perceived risks of participating (aOR 0.731; 95% CI 0.594-0.899; P=.003) were less willing to participate. CONCLUSIONS Overall, our results indicate that mHealth app-based HIV prevention programs are acceptable for future research on Malaysian MSM. The findings further highlighted the role of privacy and confidentiality, as well as the associated risks and benefits associated with participation in such a program. Given the ever-evolving nature of such technological platforms and the complex ethical-legal landscape, such platforms must be safe and secure to ensure widespread public trust and uptake.
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Affiliation(s)
- Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Celia Fisher
- Center for Ethics Education, Fordham University, New York, NY, United States
| | | | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Rayne Kim
- Department of Internal Medicine, Yale University, New Haven, CT, United States
| | - Iskandar Azwa
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Colleen Mistler
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Lloyd Goldsamt
- Rory Meyers School of Nursing, New York University, New York, NY, United States
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Bezabih AM, Gerling K, Abebe W, Abeele VV. Behavioral Theories and Motivational Features Underlying eHealth Interventions for Adolescent Antiretroviral Adherence: Systematic Review. JMIR Mhealth Uhealth 2021; 9:e25129. [PMID: 34890353 PMCID: PMC8709919 DOI: 10.2196/25129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/06/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background eHealth systems provide new opportunities for the delivery of antiretroviral therapy (ART) adherence interventions for adolescents. They may be more effective if grounded in health behavior theories and behavior change techniques (BCTs). Prior reviews have examined the effectiveness, feasibility, and acceptability of these eHealth systems. However, studies have not systematically explored the use of health behavior theories and BCTs in the design of these applications. Objective The purpose of this review was to explore whether health behavior theories and BCTs were considered to ground designs of eHealth systems supporting adolescents’ (10-24 years) ART adherence. More specifically, we examined which specific theories and BCTs were applied, and how these BCTs were implemented as design features. Additionally, we investigated the quality and effect of eHealth systems. Methods A systematic search was performed on IEEE Xplore, ACM, ScienceDirect, PubMed, Scopus, and Web of Science databases from 2000 to 2020. Theory use and BCTs were coded using the Theory Coding Scheme and the Behavior Change Technique Taxonomy version 1 (BCTTv1), respectively. Design features were identified using the lenses of motivational design for mobile health (mHealth). The number of BCTs and design features for each eHealth system and their prevalence across all systems were assessed. Results This review identified 16 eHealth systems aiming to support ART adherence among adolescents. System types include SMS text message reminders (n=6), phone call reminders (n=3), combined SMS text message and phone call reminders (n=1), electronic adherence monitoring devices (n=3), smartphone apps (n=1), smartphone serious games (n=1), gamified smartphone apps (n=1), leveraging existing social media (n=2), web-based applications (n=1), videoconferencing (n=1), and desktop applications (n=1). Nine were grounded in theory, of which 3 used theories extensively. The impact of adolescent developmental changes on ART adherence was not made explicit. A total of 42 different BCTs and 24 motivational design features were used across systems. Ten systems reported positive effects on 1 or more outcomes; however, of these ten systems, only 3 reported exclusively positive effects on all the outcomes they measured. As much as 6 out of 16 reported purely no effect in all the outcomes measured. Conclusions Basic applications (SMS text messaging and phone calls) were most frequent, although more advanced systems such as mobile apps and games are also emerging. This review indicated gaps in the use of theory and BCTs, and particularly the impact of developmental changes on ART adherence was not adequately considered. Together with adopting a developmental orientation, future eHealth systems should effectively leverage health theories and consider developing more advanced systems that open the door to using BCTs more comprehensively. Overall, the impact of eHealth systems on adolescent ART adherence and its mediators is promising, but conclusive evidence on effect still needs to be provided.
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Affiliation(s)
- Alemitu Mequanint Bezabih
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kathrin Gerling
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Vero Vanden Abeele
- Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
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Stonbraker S, Liu J, Sanabria G, George M, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Halpern M, Rowell-Cunsolo T, Bakken S, Schnall R. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav 2021; 25:4061-4073. [PMID: 34129143 PMCID: PMC8602767 DOI: 10.1007/s10461-021-03331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 02/05/2023]
Abstract
We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.
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Affiliation(s)
- Samantha Stonbraker
- Anschutz Medical Campus, University of Colorado College of Nursing, 13120 E. 19th Ave, Aurora, CO, 80045, USA.
- Clínica de Familia La Romana, La Romana, Dominican Republic.
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | | | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
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Beck EJ, Mandalia S, Yfantopoulos P, Jones CI, Bremner S, Whetham J, Wittevrongel M, Apers L. The efficiency of the EmERGE pathway to provide continuity of care for medically stable people living with HIV in Belgium. Acta Clin Belg 2021; 77:915-924. [PMID: 34802399 DOI: 10.1080/17843286.2021.2004697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Li Y, Guo Y, Hong YA, Zeng C, Zeng Y, Zhang H, Zhu M, Qiao J, Cai W, Li L, Liu C. Mediating Effects of Stigma and Depressive Symptoms in a Social Media-Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial. J Med Internet Res 2021; 23:e27897. [PMID: 34751654 PMCID: PMC8663519 DOI: 10.2196/27897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/09/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions have been shown to effectively improve the quality of life (QOL) among people living with HIV. However, little is known about the long-term effects of mHealth interventions. OBJECTIVE This study aims to explore the intervention mechanisms of a social media-based intervention, Run4Love, on the QOL of people with HIV over across a 9-month follow-up period. METHODS We recruited people living with HIV who were concurrently experiencing elevated depressive symptoms from an HIV outpatient clinic in South China. A total of 300 eligible participants were randomized either to the intervention group or the control group in a 1:1 ratio after they provided informed consent and completed a baseline survey. The intervention group received a 3-month WeChat-based intervention, comprising cognitive-behavioral stress management (CBSM) courses and physical activity promotion. The control group received a printed brochure on nutrition guidelines in addition to the usual care for HIV treatment. Neither participants nor the research staff were blinded to group assignment. All patients were followed at 3, 6, and 9 months. The primary outcome was depressive symptoms. Structural equation model (SEM) with longitudinal data was conducted to examine the sequential mediating effects of HIV-related stigma and depressive symptoms on the long-term intervention effects on participants' QOL. RESULTS About 91.3% (274/300), 88.3% (265/300), and 86.7% (260/300) of all participants completed follow-up surveys at 3, 6, and 9 months, respectively. Results showed that the intervention had significantly improved participants' QOL at 9 months, via complete mediating effects of reduced HIV-related stigma at 3 months and decreased depressive symptoms at 6 months. No adverse events were reported. CONCLUSIONS These findings underscore the critical roles of HIV-related stigma and depressive symptoms in an mHealth intervention with long-term effects on QOL improvements. We call for targeted mHealth interventions to improve QOL among people living with HIV, especially social media-based interventions that can address HIV-related stigma and alleviate depressive symptoms. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019.
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Affiliation(s)
- Yiran Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan Guo
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Center for Global Health, Guangzhou, China
| | - Y Alicia Hong
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Yu Zeng
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hanxi Zhang
- National Center of AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mengting Zhu
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jiaying Qiao
- Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Weiping Cai
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Linghua Li
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Cong Liu
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
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Gibbs A, Gumede D, Luthuli M, Xulu Z, Washington L, Sikweyiya Y, Adeagbo O, Shahmanesh M. Opportunities for technologically driven dialogical health communication for participatory interventions: Perspectives from male peer navigators in rural South Africa. Soc Sci Med 2021; 292:114539. [PMID: 34776288 PMCID: PMC8783050 DOI: 10.1016/j.socscimed.2021.114539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/15/2021] [Accepted: 11/04/2021] [Indexed: 01/30/2023]
Abstract
There is increasing interest in the potential to deliver participatory dialogical HIV and intimate partner violence (IPV) prevention interventions via digital platforms, though the majority of mHealth interventions have been didactic in approach. We undertook 10 in-depth interviews with male Peer Navigators (PNs) who had been extensively trained and working on a larger intervention promoting young people's sexual and reproductive rights, in rural KwaZulu-Natal. Interviews focused on their, and their peers', use of technology in their everyday lives. Data were transcribed and translated, and subjected to thematic analysis. PNs described structural barriers to the use of technology, including poor connectivity, high data costs, and erratic electricity. They primarily used Facebook and WhatsApp for communication and highlighted how reading messages asynchronously was important to overcome connectivity challenges. PNs shared how groups were primarily for information sharing, they also discussed ‘sensitive’ issues online. Privacy was a concern, especially for conversations, and there was recognition of how confidentiality could be breached. It was also felt that WhatsApp could potentially support greater openness in discussions. We reflect on the potential for online interventions to support dialogical health communication, highlighting how dialogical health communication may be enabled through information provision, the asynchronous communication enhancing the potential for reflection, and greater participation in discussion by those who are shyer. Despite this potential there remain important risks around privacy of discussions and how to implement these approaches online. Qualitative research with young men showed high levels of cellphone usage. Emphasizes the importance of sharing information and personal discussions online. Suggests potential opportunities for discussion and reflection via WhatsApp. Recognises limitations of WhatsApp communication for health communication.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, South Africa.
| | - Dumsani Gumede
- African Health Research Institute (AHRI), Durban, South Africa
| | - Manono Luthuli
- African Health Research Institute (AHRI), Durban, South Africa
| | - Zakhele Xulu
- African Health Research Institute (AHRI), Durban, South Africa
| | | | - Yandisa Sikweyiya
- Gender and Health Research Unit, South African Medical Research Council, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Oluwafemi Adeagbo
- African Health Research Institute (AHRI), Durban, South Africa; Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, USA; Department of Sociology, University of Johannesburg, South Africa
| | - Maryam Shahmanesh
- School of Nursing and Public Health, University of KwaZulu-Natal, South Africa; African Health Research Institute (AHRI), Durban, South Africa; Institute for Global Health, University College London, London, UK
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Ramsey SE, Ames EG, Uber J, Habib S, Clark S, Waldrop D. A Preliminary Test of an mHealth Facilitated Health Coaching Intervention to Improve Medication Adherence among Persons Living with HIV. AIDS Behav 2021; 25:3782-3797. [PMID: 34117965 PMCID: PMC8563378 DOI: 10.1007/s10461-021-03342-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
This study examined feasibility, acceptability, and preliminary efficacy of an mHealth facilitated health coaching antiretroviral therapy (ART) adherence intervention. Persons living with HIV (n = 53) were randomized to an in-person adherence session and 12 months of app access and health coaching via the app (Fitbit Plus) versus single adherence session (SOC). At baseline and 1, 3, 6, and 12 months, we measured ART adherence, substance use, and depressive symptoms. We also conducted individual qualitative interviews. The intervention was found to be largely feasible and highly acceptable, with the health coach spending an average of 2.4 min per month with a participant and 76.5% of Fitbit Plus participants using the app regularly at 12 months. While most comparisons were not significant, the pattern of results was consistent with better adherence in the Fitbit Plus compared to SOC condition. Substance use was significantly associated with poorer ART adherence while depressive symptoms were not.ClinicalTrials.gov Identifier: NCT02676128; Registered: 2/8/2016.
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Affiliation(s)
- Susan E Ramsey
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Evan G Ames
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Julia Uber
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Samia Habib
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Seth Clark
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Division of General Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Chong MS, Sit JWH, Karthikesu K, Chair SY. Effectiveness of technology-assisted cardiac rehabilitation: A systematic review and meta-analysis. Int J Nurs Stud 2021; 124:104087. [PMID: 34562846 DOI: 10.1016/j.ijnurstu.2021.104087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/06/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objectives of this review were to identify different technology-assisted interventions in cardiac rehabilitation, to explore and examine the effectiveness of technology-assisted cardiac rehabilitation. DESIGN A systematic review and meta-analysis. METHODS A systematic search was performed on six electronic databases: CINALH Complete, Cochrane Library, PubMed, MEDLINE via OvidSP, British Nursing Index and PsycINFO to identify randomised controlled trials from 2010 to 2020. Selection of studies was performed by screening the titles, abstracts and full texts, and two reviewers independently and critically appraised the included studies using the revised Cochrane risk of bias tool for randomized trials (RoB 2). RESULTS Nine randomised controlled trials met the inclusion criteria; five studies with some bias concerns related to allocation concealment (n = 2) and measurement of outcome (n = 4), and four studies were of low risk of bias. The pooled effect size showed comparable effectiveness between technology-assisted cardiac rehabilitation and conventional/centre-based cardiac rehabilitation on modifiable coronary risk factors (systolic and diastolic blood pressure, total cholesterol, p>0.05), psychological outcomes (anxiety: SMD 0.25, 95% CI -0.11 to 0.62, p = 0.17 and depression: SMD 0.09, 95% CI -0.16 to 0.35, p = 0.47). Narrative synthesis was performed for adherence to prescribed exercise sessions in cardiac rehabilitation. No significant adverse events occurred. The adverse events that did occur were self-reported, mostly unrelated to the interventions with technology and the number of events was comparable between both groups. Inconsistent results were found across the studies. This review revealed lack of self-efficacy and behaviour change theories/strategies, and educational emphasis among studies. CONCLUSIONS The results in the meta-analysis have indicated that technology-assisted cardiac rehabilitation demonstrated comparable results to conventional/centre-based cardiac rehabilitation. Technology-assisted cardiac rehabilitation is a potential alternative not only to remove cardiac rehabilitation barriers but also in the midst of current prolonged pandemic. Future studies on technology-assisted cardiac rehabilitation with the emphasis behavior change theories/strategies and education are required.
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Affiliation(s)
- Mei Sin Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR.
| | - Janet Wing Hung Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Karthijekan Karthikesu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
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Canan CE, Flickinger TE, Waselewski M, Tabackman A, Baker L, Eger S, Waldman ALD, Ingersoll K, Dillingham R. Toward understanding the impact of mHealth features for people with HIV: a latent class analysis of PositiveLinks usage. Transl Behav Med 2021; 11:172-181. [PMID: 31816017 PMCID: PMC7877298 DOI: 10.1093/tbm/ibz180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PositiveLinks (PL) is a multi-feature smartphone-based platform to improve engagement-in-care and viral suppression (VS) among clinic patients living with HIV. Features include medication reminders, mood/stress check-ins, a community board, and secure provider messaging. Our goal was to examine how PL users interact with the app and determine whether usage patterns correlate with clinical outcomes. Patients (N = 83) at a university-based Ryan White clinic enrolled in PL from June 2016 to March 2017 and were followed for up to 12 months. A subset (N = 49) completed interviews after 3 weeks of enrollment to explore their experiences with and opinions of PL. We differentiated PL members based on 6-month usage of app features using latent class analysis. We explored characteristics associated with class membership, compared reported needs and preferences by class, and examined association between class and VS. The sample of 83 PL members fell into four classes. "Maximizers" used all app features frequently (27%); "Check-in Users" tended to interact only with daily queries (22%); "Moderate All-Feature Users" used all features occasionally (33%); and "As-Needed Communicators" interacted with the app minimally (19%). VS improved or remained high among all classes after 6 months. VS remained high at 12 months among Maximizers (baseline and 12-month VS: 100%, 94%), Check-in Users (82%, 100%), and Moderate All-Feature Users (73%, 94%) but not among As-Needed Communicators (69%, 60%). This mixed-methods study identified four classes based on PL usage patterns that were distinct in characteristics and clinical outcomes. Identifying and characterizing mHealth user classes offers opportunities to tailor interventions appropriately based on patient needs and preferences as well as to provide targeted alternative support to achieve clinical goals.
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Affiliation(s)
- Chelsea E Canan
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Tabor E Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Marika Waselewski
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Alexa Tabackman
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Logan Baker
- University of Virginia's College at Wise, Wise, VA, USA
| | - Samuel Eger
- University of Virginia's College at Wise, Wise, VA, USA
| | - Ava Lena D Waldman
- Department of Medicine, 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
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Hewitt C, Lloyd KC, Tariq S, Durrant A, Claisse C, Kasadha B, Gibbs J. Patient-generated data in the management of HIV: a scoping review. BMJ Open 2021; 11:e046393. [PMID: 34011598 PMCID: PMC8137219 DOI: 10.1136/bmjopen-2020-046393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Patient-generated data (PGData) are an emergent research area and may improve HIV care. The objectives of this scoping review were to synthesise, evaluate and make recommendations based on the available literature regarding PGData use in HIV care. DESIGN Scoping review. DATA SOURCES Embase, Medline, CINAHL Plus, Web of Science, Scopus, PsycINFO and Emcare databases. ELIGIBILITY CRITERIA Studies involving PGData use within HIV care for people living with HIV and/or healthcare professionals (HCPs) published before February 2021. DATA EXTRACTION AND SYNTHESIS Data were extracted using a table and the Mixed Methods Appraisal Tool was used to assess empirical rigour. We used thematic analysis to evaluate content. RESULTS 11 articles met the eligibility criteria. Studies were observational, predominantly concerned hypothetical or novel digital platforms, mainly conducted in high-income settings, and had small sample sizes (range=10-160). There were multiple definitions of PGData. In the majority of studies (n=9), participants were people living with HIV, with a few studies including HCPs, informatics specialists or mixed participant groups. Participants living with HIV were aged 23-78 years, mostly men, of diverse ethnicities, and had low educational, health literacy and income levels.We identified four key themes: (1) Perceptions of PGData and associated digital platforms; (2) Opportunities; (3) Anticipated barriers and (4) Potential impact on patient-HCP relationships. CONCLUSIONS Use of PGData within HIV care warrants further study, especially with regard to digital inequalities, data privacy and security. There is a need for longitudinal data on use within HIV in a variety of settings with a broad range of users, including impact on clinical outcomes. This will allow greater understanding of the role of PGData use in improving the health and well-being of people living with HIV, which is increasingly pertinent as digital healthcare becomes more widespread as a result of COVID-19.
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Affiliation(s)
- Clara Hewitt
- Institute for Global Health, University College London, London, UK
| | - Karen C Lloyd
- Institute for Global Health, University College London, London, UK
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
| | - Abigail Durrant
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Claisse
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
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Crowley T, Rohwer A. Self-management interventions for adolescents living with HIV: a systematic review. BMC Infect Dis 2021; 21:431. [PMID: 33962558 PMCID: PMC8105944 DOI: 10.1186/s12879-021-06072-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/09/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Self-management interventions aim to enable people living with chronic conditions to increase control over their condition in order to achieve optimal health and may be pertinent for young people with chronic illnesses such as HIV. Our aim was to evaluate the effectiveness of self-management interventions for improving health-related outcomes of adolescents living with HIV (ALHIV) and identify the components that are most effective, particularly in low-resource settings with a high HIV burden. METHODS We considered randomised controlled trials (RCTs), cluster RCTs, non-randomised controlled trials (non-RCTs) and controlled before-after (CBA) studies. We did a comprehensive search up to 1 August 2019. Two authors independently screened titles, abstracts and full texts, extracted data and assessed the risk of bias. We synthesised results in a meta-analysis where studies were sufficiently homogenous. In case of substantial heterogeneity, we synthesised results narratively. We assessed the certainty of evidence using GRADE and presented our findings as summaries in tabulated form. RESULTS We included 14 studies, comprising 12 RCTs and two non-RCTs. Most studies were conducted in the United States, one in Thailand and four in Africa. Interventions were diverse, addressing a variety of self-management domains and including a combination of individual, group, face-to-face, cell phone or information communication technology mediated approaches. Delivery agents varied from trained counsellors to healthcare workers and peers. Self-management interventions compared to usual care for ALHIV made little to no difference to most health-related outcomes, but the evidence is very uncertain. Self-management interventions may increase adherence and decrease HIV viral load, but the evidence is very uncertain. We could not identify any particular components of interventions that were more effective for improving certain outcomes. CONCLUSION Existing evidence on the effectiveness of self-management interventions for improving health-related outcomes of ALHIV is very uncertain. Self-management interventions for ALHIV should take into account the individual, social and health system contexts. Intervention components need to be aligned to the desired outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019126313.
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Affiliation(s)
- Talitha Crowley
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anke Rohwer
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Cohn WF, Canan CE, Knight S, Waldman AL, Dillingham R, Ingersoll K, Schexnayder J, Flickinger TE. An Implementation Strategy to Expand Mobile Health Use in HIV Care Settings: Rapid Evaluation Study Using the Consolidated Framework for Implementation Research. JMIR Mhealth Uhealth 2021; 9:e19163. [PMID: 33908893 PMCID: PMC8116995 DOI: 10.2196/19163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/25/2020] [Accepted: 03/23/2021] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps can provide support to people living with a chronic disease by offering resources for communication, self-management, and social support. PositiveLinks (PL) is a clinic-deployed mHealth app designed to improve the health of people with HIV. In a pilot study, PL users experienced considerable improvements in care engagement and viral load suppression. To promote its expansion to other HIV clinics, we developed an implementation strategy consisting of training resources and on-demand program support. Objective The objective of our study was to conduct an interim analysis of the barriers and facilitators to PL implementation at early adopting sites to guide optimization of our implementation strategy. Methods Semistructured interviews with stakeholders at PL expansion sites were conducted. Analysis of interviews identified facilitators and barriers that were mapped to 22 constructs of the Consolidated Framework for Implementation Research (CFIR). The purpose of the analysis was to identify the facilitators and barriers to PL implementation in order to adapt the PL implementation strategy. Four Ryan White HIV clinics were included. Interviews were conducted with one health care provider, two clinic managers, and five individuals who coordinated site PL activities. Results Ten common facilitators and eight common barriers were identified. Facilitators to PL implementation included PL’s fit with patient and clinic needs, PL training resources, and sites’ early engagement with their information technology personnel. Most barriers were specific to mHealth, including access to Wi-Fi networks, maintaining patient smartphone access, patient privacy concerns, and lack of clarity on how to obtain approvals for mHealth use. Conclusions The CFIR is a useful framework for evaluating mHealth interventions. Although PL training resources were viewed favorably, we identified important barriers to PL implementation in a sample of Ryan White clinics. This enabled our team to expand guidance on identifying information technology stakeholders and procuring and managing mobile resources. Ongoing evaluation results continue to inform improvements to the PL implementation strategy, facilitating PL access for future expansion sites.
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Affiliation(s)
- Wendy F Cohn
- Department of Public Health Sciences, University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, United States
| | - Chelsea E Canan
- Division of Infectious Diseases, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Sarah Knight
- Division of Infectious Diseases, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Ava Lena Waldman
- Division of Infectious Diseases, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Rebecca Dillingham
- Division of Infectious Diseases, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
| | - Julie Schexnayder
- Division of Infectious Diseases, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Tabor E Flickinger
- Division of General, Geriatric, Palliative and Hospital Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, United States
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Gárate FJ, Chausa P, Whetham J, Jones CI, García F, Cáceres C, Sánchez-González P, Wallitt E, Gómez EJ. EmERGE mHealth Platform: Implementation and Technical Evaluation of a Digital Supported Pathway of Care for Medically Stable HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063156. [PMID: 33803821 PMCID: PMC8003226 DOI: 10.3390/ijerph18063156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/21/2022]
Abstract
In this article, we described a new mobile-Health (mHealth) supported clinical pathway of care for people living with medically stable HIV in terms of platform acceptability, usability and technical feasibility. The EmERGE mHealth platform was codesigned with clinicians and the community, developed using Scrum agile methodology, integrated with hospital information systems and validated in a large prospective cohort study of 2251 participants. The evaluation of this new paradigm of care was conducted using a tailored Health Technology Assessment: the Model for Assessment of Telemedicine Applications. Usability and acceptability were assessed through the System Usability Score and a Patient Reported Experience Measure. The EmERGE platform was successfully deployed across diverse care settings in five European countries and used by 2251 patients and more than 20 clinicians for up to 30 months. Results from the formal evaluation demonstrated that the EmERGE platform is feasible and acceptable, with a high level of usability (median System Usability Score (SUS) 85.0%) and very positive patient-reported experiences (94.2% would recommend to a friend). The EmERGE platform is a secure and General Data Protection Regulation (GDPR)-compliant system with a complete set of functionalities that could be easily adapted to other clinical conditions, clinical sites and health systems thanks to its modular technical architecture.
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Affiliation(s)
- Francisco J. Gárate
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Correspondence: (F.J.G.); (P.C.)
| | - Paloma Chausa
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Correspondence: (F.J.G.); (P.C.)
| | - Jennifer Whetham
- Department of Sexual Health and HIV Medicine, Brighton and Sussex University Hospitals NHS Trust, BN2 5BE Brighton, UK;
| | | | - Felipe García
- Infectious Diseases Department, Fundacio Privada Clinic per a la Recerca Biomedica—IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - César Cáceres
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Computer Science Department, Universidad Rey Juan Carlos, 28933 Madrid, Spain
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Centro de Investigación Biomédica en Red, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | | | - Enrique J. Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Centro de Investigación Biomédica en Red, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
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