JMIR Publications

ABSTRACT

Background:

For people living with HIV (PLWH), antiretroviral therapy (ART) adherence is crucial to attain better health outcomes. While research has leveraged consumer health information technologies to enhance ART adherence, no study has evaluated feasibility and clinical outcomes associated with usage of a commercially available, regularly updated mHealth app for improving ART adherence among PLWH.

Objective:

We sought to assess the feasibility acceptability and clinical outcomes of Care4Today, an existing, free, biprogramatic, mHealth app for improving ART adherence among PLWH.

Methods:

The Florida Mobile Health Application Adherence Project (FL-mAPP) was a 90-day longitudinal pilot study conducted in three public HIV clinics in Florida, United States. After obtaining informed consent, 132 participants completed a survey and then were given the option to try an existing mHealth app to help with ART adherence. Of these, 33.3% declined, 31.1% agreed but never used the app, and 35.6% used the app. All were asked to complete follow-up surveys at 30-days and 90-days after enrollment. Usage data was used to assess feasibility. Clinical outcomes of self-reported ART adherence and chart-obtained HIV viral load and CD4+ T-cell counts were compared among those who used the platform (users) vs. those who did not(non-users). Participants and HIV care providers also provided responses to open-ended questions about what they liked and did not like about the app; comments were analyzed using thematic analysis.

Results:

Of 132 participants, 47 (35.6%) and 85 (64.4%) were categorized as users and non-users, respectively. Among users, a Kaplan Meier plot showed 25 persons (53%) continued using the app after the 90-day follow-up. At 30-day follow-up, 13 (81.3% ) of those who used the mHealth app reported ≥95% ART adherence, compared to 17 (58.6%) of non-users (p = 0.12). Overall, 39 (82%) users liked or somewhat liked using the platform. Participants’ favorite features were medication reminders, ability to create custom reminders, and adherence reports.

Conclusions:

This longitudinal study found that a commercially available medication adherence mHealth application was a feasible and acceptable intervention to improve ART adherence among PLWH and engaged in clinical care across three public HIV clinics in the state of Florida. Overall, participants liked the Care4Today app and thought the medication reminders were their favorite feature. Generally, self-reports of ART adherence were better among users than non-users, both at 30- and 90-day follow-ups. Further clinical research needs to address user fatigue for improving app usage.