Abstract
BackgroundSouth Africa provides free antiretroviral therapy for almost 5 million people living with HIV, but only 71% of the eligible people are on treatment, representing a shortfall in the care cascade, especially among men and youth. Many developing countries have expanded access to smartphones; success in health apps raises the possibility of improving this cascade.ObjectiveSmartLink is a health app for Android smartphones providing HIV-related laboratory results, information, support, and appointment reminders to engage and link patients to care. This study aimed to evaluate the ability of SmartLink to improve linkage to care for HIV-positive smartphone owners.MethodsThis study was a multisite randomized controlled trial in Johannesburg. The intervention arm received the app (along with referral to a treatment site) and the control arm received the standard of care (referral alone). Linkage to care was confirmed by an HIV-related blood test reported on the National Health Laboratory Service database between 2 weeks and 8 months after initiation.ResultsA total of 345 participants were recruited into the study; 64.9% (224/345) of the participants were female and 44.1% (152/345) were aged less than 30 years. In addition, 46.7% (161/345) were employed full time, 95.9% (331/345) had at least secondary school education, and 35.9% (124/345) were from Zimbabwe. Linkage to care between 2 weeks and 8 months was 48.6% (88/181) in the intervention arm versus 45.1% (74/164) in the control (P=.52) and increased to 64.1% (116/181) and 61.0% (100/164) (P=.55), respectively, after the initial 8-month period. Moreover, youth aged 18 to 30-years showed a statistically significant 20% increase in linkage to care for the intervention group.ConclusionsYouth aged less than 30 years have been historically difficult to reach with traditional interventions, and the SmartLink app provides a proof of concept that this population reacts to mobile health interventions that engage patients in HIV care.Trial RegistrationClinicalTrials.gov NCT02756949; https://clinicaltrials.gov/ct2/show/NCT02756949 (Archived by WebCite at http://www.webcitation.org/6z1GTJCNW)
Highlights
BackgroundSouth Africa has the largest antiretroviral therapy (ART) program in the world, which provides free ART to approximately 4.4 million people living with HIV [1], and since its introduction in 2004, AIDS-related deaths and new HIV infections have been reduced by 58% and 46%, respectively [1]
Youth aged less than 30 years have been historically difficult to reach with traditional interventions, and the SmartLink app provides a proof of concept that this population reacts to mobile health interventions that engage patients in HIV care
The high smartphone ownership coupled with our evidence of increased linkage in care strongly suggests that mobile health (mHealth) apps for engagement in care should be considered for this age group
Summary
BackgroundSouth Africa has the largest antiretroviral therapy (ART) program in the world, which provides free ART to approximately 4.4 million people living with HIV [1], and since its introduction in 2004, AIDS-related deaths and new HIV infections have been reduced by 58% and 46%, respectively [1]. It is well documented that patients, especially young people aged less than 30 years and men, are being lost to follow-up along the entire HIV care cascade, but the most significant attrition is found during the stage from HIV diagnosis to the start of treatment [7,8,9]. Improving this deficit is needed to ensure that patients are initiated on ART early as patients lost during linkage to care often return as late presenters when they become seriously ill. Many developing countries have expanded access to smartphones; success in health apps raises the possibility of improving this cascade
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