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Schaaf J, Weber T, von Wagner M, Stephan C, Carney J, Köhler SM, Voigt A, Noll R, Storf H, Müller A. Interviews with HIV Experts for Development of a Mobile Health Application in HIV Care-A Qualitative Study. Healthcare (Basel) 2023; 11:2180. [PMID: 37570423 PMCID: PMC10418895 DOI: 10.3390/healthcare11152180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The Communication and Tracing App HIV (COMTRAC-HIV) project aims to develop a mobile health application for integrated care of HIV patients due to the low availability of those apps in Germany. This study addressed organizational conditions and necessary app functionalities, especially for the care of late diagnosed individuals (late presenters) and those using pre-exposure prophylaxis. We followed a human-centered design approach and interviewed HIV experts in Germany to describe the context of use of the app. The interviews were paraphrased and analyzed with a qualitative content analysis. To define the context of use, user group profiles were defined and tasks derived, which will represent the functionalities of the app. A total of eight experts were included in the study. The results show that the app should include a symptom diary for entering symptoms, side effects, and their intensity. It offers chat/video call functionality for communication with an HIV expert, appointment organization, and sharing findings. The app should also provide medication overview and reminders for medications and appointments. This qualitative study is a first step towards the development of an app for HIV individuals in Germany. Further research includes involving patients in the initial app design and test design usability.
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Affiliation(s)
- Jannik Schaaf
- Institute of Medical Informatics, Goethe University Frankfurt, University Hospital, 60590 Frankfurt, Germany (R.N.)
| | - Timm Weber
- Department of Medical Information Systems and Digitalization, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Michael von Wagner
- Department of Medical Information Systems and Digitalization, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Christoph Stephan
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, 60596 Frankfurt, Germany
| | - Jonathan Carney
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, 60596 Frankfurt, Germany
| | - Susanne Maria Köhler
- Institute of General Practice, Goethe University Frankfurt, 60596 Frankfurt, Germany (A.M.)
| | - Alexander Voigt
- Institute of Medical Informatics, Goethe University Frankfurt, University Hospital, 60590 Frankfurt, Germany (R.N.)
| | - Richard Noll
- Institute of Medical Informatics, Goethe University Frankfurt, University Hospital, 60590 Frankfurt, Germany (R.N.)
| | - Holger Storf
- Institute of Medical Informatics, Goethe University Frankfurt, University Hospital, 60590 Frankfurt, Germany (R.N.)
| | - Angelina Müller
- Institute of General Practice, Goethe University Frankfurt, 60596 Frankfurt, Germany (A.M.)
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Schaab BL, Remor E. Development, feasibility testing and perceived benefits of a new app to help with adherence to antiretroviral therapy in people living with HIV in Brazil. Pilot Feasibility Stud 2023; 9:130. [PMID: 37496084 PMCID: PMC10369752 DOI: 10.1186/s40814-023-01370-7] [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: 03/30/2022] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Despite the availability of antiretroviral therapy (ART) in many countries, people living with HIV still experience difficulties with treatment. We propose a new smartphone mobile application to assist in adherence to ART. This study aimed to describe this new mobile application's development (content construction and usability), feasibility testing (recruitment, retention rates [attendance], satisfaction) and primary perceived benefits. METHODS Two consecutive studies were conducted. First, people living with HIV, health care workers and experts in information technology provided feedback to improve the content and usability of the app. After changes in the app were implemented according to the feedback, a second study was performed to assess the feasibility and perceived benefits. Effects on self-reported adherence and perceived well-being were also assessed. RESULTS Scores of participants (N = 11) showed differences in adherence (effect size .43) and well-being (effect size .45) after using the app. However, the differences did not reach statistical significance. Observing scores individually, six out of 11 participants improved their overall adherence scores, and seven out of 11 participants improved their perceived well-being scores. Recruitment was 95%, and attendance at sessions was 62.5%. In general, the participants were satisfied with the intervention and viewed the app as an informative tool. CONCLUSION The results are promising and allow us to recommend further studies with the app.
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Affiliation(s)
- Bruno Luis Schaab
- Institute of Psychology, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, 2600, Porto Alegre, RS. 90035003, Brazil
| | - Eduardo Remor
- Institute of Psychology, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, 2600, Porto Alegre, RS. 90035003, Brazil.
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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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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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Zimmerman RS, Mehrotra P, Madden T, Paul R. The Value of Assessing Self-Reported and Biological Indicators of Outcomes in Evaluating HIV Programs. Curr HIV/AIDS Rep 2021; 18:365-376. [PMID: 33993397 DOI: 10.1007/s11904-021-00560-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW In this manuscript, we present recent findings concerning concordance and discrepancy between biological measures and self-reports of these three outcomes of HIV programs: HIV status, adherence to antiretroviral medications (ARVs) and use of and adherence to pre-exposure prophylaxis medication (PrEP), and condom use/unprotected sex. RECENT FINDINGS Recent studies suggest that three successive rapid HIV tests (for those whose first test in positive) might be reasonably inexpensive and valid biological data to collect to combine with self-reports of HIV status, dried blood spots sufficiently affordable to combine with self-reports of adherence to ARVs and use of or adherence to PrEP, and that the discrepancy between self-reports of condom use and biomarkers of unprotected sex may be relatively small in high-income countries. Additional work on assessment of incorrect condom usage and breakage, standardized self-report measures of condom use, and more private data collection methodologies in low-income settings might reduce the recent observed discrepancies even further. Concordance between self-reports of HIV and biomarkers indicating HIV positive status has varied considerably, with much lower rates in low-income countries, where the stigma of HIV is still very high. Recommendation is for combining self-report data with the results of three successive rapid tests for those testing positive. For adherence, again agreement between self-reports and a variety of more objective and/or biological measures is only moderate. Dried blood spots (DBS) may be sufficiently inexpensive in low-resource settings that this may be the best biological method to combine with self-reports. In publications over the last 8 years, the discrepancy between self-reports of condom use and biomarkers for unprotected sex may be even lower than 20% after controlling for other features of the study, particularly in high-income countries. Our results suggest that more careful assessment of incorrect condom use and breakage as reasons other than intentional misreporting should be investigated more carefully and that more private data collection methods such as audio, computer-assisted self-interviewing (ACASI) might be employed more often in low-resource settings to reduce this discrepancy in those settings further. In addition, further analysis of the discrepancy between self-reports of condom use and biomarkers should be conducted of published studies using the correct calculation methods to be more certain of these findings.
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Affiliation(s)
- Rick S Zimmerman
- College of Nursing, Wayne State University, 5557 Cass Ave., 319 Cohn Bldg, Detroit, MI, 48202, USA.
| | - Purnima Mehrotra
- Centre for Social and Behaviour Change, Ashoka University, Rajiv Gandhi Education City, Sonipat, Haryana, India
| | - Tessa Madden
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel Paul
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
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