HIV App Boosts Patient Adherence, Viral Suppression

Rebecca Dillingham, MD, MPH, an associate professor of medicine at UVA

Rebecca Dillingham, MD, MPH

Patients with HIV who used a specially designed smartphone app had significantly higher rates of regular clinic visits and viral suppression, according to a new study.

Researchers at the University of Virginia developed an app called PositiveLinks to test out whether interactive smartphone functions and reminders could have a real-world impact on the health of HIV-positive patients. To test it, they enrolled 77 recently diagnosed patients who had sought treatment at the Ryan White Clinic in central Virginia.

At the start of the trial, 51% of the patients reported regular visits to the clinic. After 6 months of using the app, 88% reported regular visits, while after 12 months, the number was 81%.

Meanwhile, 47% of study enrollees, all of whom had been diagnosed within the previous 90 days before the start of the study, suppressed their virus by the time they started using the app. At 6 months, the viral suppression rate increased to 87%, and held at 79% within 12 months.

The app provides several features to benefit patients, including appointment reminders and daily check-ins, in which the app asks users about their stress levels and medication adherence.

Lead author Rebecca Dillingham, MD, MPH, an associate professor of medicine at UVA, said it didn’t seem to matter that the reminders were coming from a piece of software.

“In our early studies with texting, we were initially surprised that our patients found automated text messages comforting and even motivating,” she said. “We built on that observation with the app.”

However, the app also helps create a community, she said, by allowing users to communicate with other users, thereby acting as a sort of virtual support group.

“They can offer and receive tips about living with HIV, about the rest of life, and about how to interact with the clinical services available,” she said. “They can have all of this interaction without having to reveal their identity or their disease status which is important in many contexts but particularly for some of our patients who live in rural communities where stigma levels associated with HIV infection remain very high.”

Physicians and clinic staff can also use the messaging features, allowing for asynchronous communication and eliminating the annoyance of office phone trees or long waits on hold.

“Also, the ‘texting’-like format of the messaging is more in line with the way many people communicate today,” she said. “We hear over and over again that it is harder and harder to reach people with a phone call, sometimes especially one that comes from a number associated with a health care organization.”

The success of the app is also demonstrated in the usage data. Participants accessed the app an average of 188 times at the 6-month mark, and 312 times at the 1-year mark. After 12 months, 40% of users were still answering the daily check-in questions.

The version of the app used in the trial was built around self-monitoring, Dillingham said. She and her team, however, have been working on ways to facilitate physician access to the valuable data collected by the app based on requests from users.

“There is now a provider-directed app that allows providers to message with patients and to view their self-reported data,” she said.

She said there’s no method for immediate physician access at this time, but such a feature is in the works. In the meantime, PositiveLinks staff analyze the data on a weekly basis and alert patients and/or physicians if they see significant changes. This monitoring has already made a difference in enabling faster intervention when patients experience a hurdle such as a loss of work or were in need of a referral to mental health care.

“Previously, we also wouldn’t know about issues until a follow-up visit which may occur at 3- or 6-month intervals, largely sufficient time for negative health consequences to ensue,” she said.

The study is titled “PositiveLinks: A Mobile Health Intervention for Retention in HIV Care and Clinical Outcomes with 12-Month Follow-Up. It was published June 1 in AIDS Patient Care and STDs.