Attitudes, Beliefs, and Willingness Toward the Use of mHealth Tools for Medication Adherence in the Florida mHealth Adherence Project for People Living With HIV (FL-mAPP): Pilot Questionnaire Study.

Jamie P Morano,Michael Ruppal,Irene K Chen,David Kirk,Willie M Carter,César G Escobar-Viera,Kevin Clauson,Zhi Zhou,Robert L Cook,Spencer Lieb

doi:10.2196/12900

Abstract

BackgroundAntiretroviral (ART) adherence among people living with HIV (PLWH) continues to be a challenge despite advances in HIV prevention and treatment. Mobile health (mHealth) interventions are increasingly deployed as tools for ART adherence. However, little is known about the uptake and attitudes toward commercially available, biprogrammatic mobile apps (ie, designed for both smartphone and short message service [SMS] messaging) among demographically diverse PLWH.ObjectivesThe Florida mHealth Adherence Project for PLWH (FL-mAPP) is an innovative pilot study that aimed to determine the acceptability of a commercially available, biprogrammatic mHealth intervention platform to ensure medication adherence and gauge the current attitudes of PLWH toward current and future mHealth apps.MethodsA predeveloped, commercially available, biprogrammatic mHealth platform (Care4Today Mobile Health Manager, Johnson & Johnson, New Brunswick, NJ) was deployed, with self-reported ART adherence recorded in the app and paper survey at both short term (30-day) or long-term (90-day) follow-ups. Consented participants completed baseline surveys on sociodemographics and attitudes, beliefs, and willingness toward the use of mHealth interventions for HIV care using a 5-point Likert scale. Chi-square tests and multivariate logistic regression analyses identified correlations with successful uptake of the mHealth platform.ResultsAmong 132 PLWH, 66% (n=87) initially agreed to use the mHealth platform, of which 54% (n=47) successfully connected to the platform. Of the 87 agreeing to use the mHealth platform, we found an approximate 2:1 ratio of persons agreeing to try the smartphone app (n=59) versus the SMS text messages (n=28). Factors correlating with mHealth uptake were above high school level education (adjusted odds ratio 2.65; P=.05), confidence that a clinical staff member would assist with mHealth app use (adjusted odds ratio 2.92, P=.048), belief that PLWH would use such an mHealth app (adjusted odds ratio 2.89; P=.02), and ownership of a smartphone in contrast to a “flip-phone” model (adjusted odds ratio 2.80; P=.05). Of the sample, 70.2% (n=92) reported daily interest in receiving medication adherence reminders via an app (80.4% users versus 64.7% nonusers), although not significantly different among the user groups (P=.06). In addition, 34.8% (n=16) of mHealth users reported a theoretical “daily” interest and 68.2% (n=58) of non-mHealth users reported no interest in using an mHealth app for potentially tracking alcohol or drug intake (P=.002).ConclusionsThis commercially available, biprogrammatic mHealth platform showed feasibility and efficacy for enhanced ART and medication adherence within public health clinics and successfully included older age groups. Successful use of the platform among demographically diverse PLWH is important for HIV implementation science and promising for uptake on a larger scale.

Highlights

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Ending the AIDS epidemic is more than a historic obligation to the 39 million people who have died of the disease
In December 2013, the UNAIDS Programme Coordinating Board called on UNAIDS to support country- and region-led efforts to establish new targets for HIV treatment scale-up beyond 2015

Summary

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The global consultation on adolescent treatment access generated numerous recommendations for action with respect to new treatment targets These include enhanced age-disaggregated data collection and reporting, as well as development of robust surveillance strategies to monitor trends and outcomes for children and adolescents. 29% of malnourished children in sub-Saharan Africa are living with HIV, making nutritional services an ideal venue for case-finding and linkage to care.[27] Likewise, 22% of children with TB in South Africa are living with HIV28, highlighting the need to leverage TB service systems to promote HIV testing for children For those children who receive a timely diagnosis of HIV infection, a limited array of treatment options is available.

90-90-90 CAN HAPPEN

Findings

Samji H et al Closing the Gap