Experience of Using a Mobile App to Improve Adherence to Treatment in Patients with TB/HIV Coinfection

Abstract

The objective of the study: to summarize experience of using a mobile technology to improve adherence in patients with tuberculosis and HIV infection (TB/HIV) who are psychoactive substance users.Subjects and Methods. A smartphone app was used, it included daily patient inquiries about mood, stress levels, and medication intake; periodic reminders about outpatient appointments; and anonymous chats with the coordinating physician and other patients. Treatment results were evaluated in Group 1 (n = 54) and Group 2 (n = 50), where this technology was used and not used, respectively.Results. The number of patients cured of tuberculosis was not significantly different between Groups 1 and 2 (32/51 vs. 27/48; χ2 = 0.61, p = 0.48). Patients from Group 2 died significantly more often during the follow-up period (14/48 vs. 3/51; χ2 = 7.86, p = 0.006) associated with antiretroviral therapy interruption or withdrawal. Increased CD4 count by 6 months of follow-up was found in both groups, most pronounced among those who started ART (W = 6.0, p = 0.004 – in Group 1 and W = 15.0, p = 0.004 – in Group 2). The total number of patients with viral suppression was greater in Group 1 than in Group 2 (34/47 vs. 20/39; χ2 = 4.05, p = 0.04).Conclusion. The mobile app used is suitable for supporting the outpatient management of patients with TB/HIV coinfection but its direct impact was reflected only in the formation of ART adherence and lower number of deaths.