Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Oct 30, 2018
Date Accepted: Jan 3, 2019
Do smartphones increase linkage to and retention in care in newly diagnosed HIV-positive patients in Johannesburg, South Africa: A multisite randomised controlled trial
ABSTRACT
Background:
South Africa provides free antiretroviral therapy (ART) for almost 5 million people living with HIV, but only 71% of eligible people are on treatment, representing a shortfall in the care cascade, especially among men and youth. Many developing countries have expanded access to smart phones; success in health applications (apps) raises the possibility of improving this cascade.
Objective:
SmartLink, 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 smart phone owners.
Methods:
This study was a multi-site randomised controlled trial in Johannesburg. The intervention arm received the app (along with referral to a treatment site) and the control arm received standard of care (referral alone). Linkage to care was confirmed by a HIV-related blood test reported on the National Health Laboratory Service database between two weeks and eight months after initiation.
Results:
345 participants were recruited into the study, 64.9% were female and 44.1% were under 30 years of age. 46.7% were employed full-time, 95.9% had at least secondary school education, and just over one third (35.9%) were from Zimbabwe. Linkage to care between two weeks and eight months was 48.6% in the intervention arm versus 45.1% in the control (P= 0.52) and increased to 64.1% and 61.0% (P =0.55), respectively, after the initial eight-month period. 18-30 years old showed a statistically significant 20% increase in linkage to care for the intervention group.
Conclusions:
Youth under 30 years of age have been historically difficult to reach with traditional interventions, and the SmartLink app provides a proof of concept that this population reacts to mHealth interventions that engage patients in HIV care. Clinical Trial: ClinicalTrials.gov NCT02756949; https://clinicaltrials.gov/ct2/show/NCT02756949 (Archived by WebCite at http://www.webcitation.org/6z1GTJCNW)
Citation
