JMIR Publications

ABSTRACT

Background:

Antiretroviral (ART) adherence among persons living with HIV (PLWH) continues to be a challenge despite gains in HIV prevention and treatment, and mHealth interventions are increasingly deployed as tools for ART adherence. However, little is known about uptake and attitudes towards biprogrammatic mobile applications (i.e., smart phone and SMS messaging).

Objective:

The Florida mHealth Adherence Project for PLWH (FL-mAPP) is an innovative, interventional clinical pilot study to determine acceptability and uptake among mobile phone users in both smart phone and SMS messaging formats among PLWH in public health HIV care clinics.

Methods:

A biprogrammatic smartphone / SMS mHealth platform was deployed with uptake and ART adherence recorded at both short term (30- day) or long term (90-day) follow-up periods. Consented participants were surveyed on socio-demographics and attitudes, beliefs, and willingness to use mHealth interventions for HIV care using a 5-point Likert scale. Baseline and follow-up HIV viral load level and CD4+ T-cell count were recorded to confirm mobile application adherence data. Chi-square tests and a multivariable logistic regression analysis were conducted to identify independent factors associated with successful use of the mHealth platform.

Results:

Among 132 PLWH, 66% (n=87) initially agreed to use the mHealth platform, of whom 54% (n=47) successfully connected. 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) vs. the SMS text messages (n=28). Factors correlating with mHealth use were having more than a high school education (AOR 2.65; p=.05), having confidence that a clinical staff member would assist with mHealth app use (AOR 2.92, p=.048), belief that they would use such an mHealth app (AOR 2.89; p=0.02), and owning a smart phone in contrast to a “flip-phone” model (AOR 2.80; p=0.05). A mHealth app for potentially tracking alcohol or drug use received the most attention with 34.8% (n=16) of mHealth users reporting a theoretical "daily" interest and 68.2% (n=58) of non-mHealth users reporting no interest in such an application (p<0.002). Overall, 18.3% (n=24) of the study sample expressed occasional interest. Of the sample, 70.2% (n=92) reported daily interest in receiving medication adherence reminders via app (80.4% vs 64.7%), though not significantly different among the user groups (p=.06).

Conclusions:

Positive attitudes were reported by both mHealth users and non-users for acceptability of this mHealth app to help promote ART and broader medication adherence. Further, the majority of PLWH engaged with this mHealth platform for the duration of the study. An inclusive mHealth platform allowing for both smartphone and feature phone owners and featuring bi-directional and biprogrammatic medication reminders may enhance retention in programmatic initiatives seeking to improve ART adherence in PLWH. Clinical Trial: No Trial Registration.