mHealth App Feasible and Acceptable for Improving ART Adherence in HIV

A mobile health (mHealth) app has demonstrated acceptability and feasibility for improving antiretroviral therapy (ART) adherence among people living with HIV in Florida, according to results of a study published in JMIR mHealth and uHealth.

Previous research has demonstrated that approximately 85% of people living with HIV (PLWHIV) report 95% adherence to their ART. Three meta-analyses have shown text message reminders are effective in improving adherence rates, however these were modest and declined over time. No studies have been conducted to investigate the long-term feasibility and acceptable of a commercially available, free ad regularly update mHealth app on the rate of ART adherence.

Therefore, researchers conducted a longitudinal study via 3 public HIV clinics in Florida that included 132 participants, all of whom were being treated with ART for HIV, who were aged >18 years, and who could provide a confirmed viral load test. Participants completed a survey with an option to receive SMS reminders or a full mHealth app to improve ART adherence, and all participants were asked to complete surveys at days 30 and 90 following enrollment.

The study researchers collected demographic variables including age, gender, race/ethnicity, education, and marital status. Researchers assessed feasibility through usage data, and self-reported ART adherence was measured by asking how many medication doses they had forgotten or missed in the past 30 days. HIV viral load and CD4+ T-cell count were also collected and compared between users and nonusers. Investigators also collected information from both clinicians who provide HIV care and participants on what they liked and disliked about the app.

Among the study’s 132 participants, 35.6% (n=47) used the app at least once; 64.4% (n=85) did not use the app. Among those who used the app, 6% (n=3) used it for less than 30 days, whereas the majority (53%; n=25) used it for at least 90 days. The difference in ≥95% ART adherence between app users and nonusers did not achieve statistical significance (P =.12).

At day 30, of the 47 app users, 82% (n=39) reported liking or somewhat liking the app, whereas 2% (n=1) reported not liking it. In terms of favorite features, participants listed medication reminders (n=25), the ability to set a custom reminder (n=5), access to adherence reports (n=5), and multiple features (n=4). The majority (80%; n=36) reported intent to continue using the app.

Limitations of this study included a lack of generalizability to other states’ health departments, a lack of data on nonparticipants, and a lack of subgroup analysis due to small sample sizes.

The study researchers concluded that the mobile health manager app was, “… feasible and acceptable for improving ART adherence among [people living with HIV] during a 3-month longitudinal study.” However, they further noted that clinical studies are needed “to address user fatigue to improve platform usage.”

Reference

Escobar-Viera C, Zhou Z, Morano JP, et al. The Florida Mobile Health Adherence Project for People Living With HIV (FL-mAPP): longitudinal assessment of feasibility, acceptability, and clinical outcomes [published online January 8, 2020]. JMIR Mhealth Uhealth. doi_: _10.2196/14557