Accepted for/Published in: JMIR Formative Research
Date Submitted: May 9, 2023
Open Peer Review Period: May 4, 2023 - Jun 29, 2023
Date Accepted: Aug 2, 2023
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Formative studies to customize a mobile health platform to meet the needs of people with HIV living in the District of Columbia
ABSTRACT
Background:
Achieving HIV viral suppression and retention in HIV care continue to be challenging for people with HIV (PWH) in the Washington, D.C. area. The PositiveLinks (PL) mobile application has been associated with an increase in retention in care and in viral load suppression rates among rural and suburban people. However, PL has not been tailored or tested for the unique needs of urban PWH.
Objective:
To conduct and analysis formative work to tailor a mHealth application for people living with HIV and their clinic providers in the District of Columbia.
Methods:
We conducted a three-part formative study to guide tailoring of PL for patients in the D.C. Cohort, a longitudinal cohort of over 11,800 PWH receiving care from HIV clinics in Washington, D.C. Studies included in-depth interviews with providers (n=28) at D.C. Cohort study clinics, focus groups with PWH enrolled in the D.C. Cohort (n=32), and a focus group with members of the D.C. Planning Commission on Health and HIV (COHAH) (n=35). Qualitative analysis used a constant comparison iterative approach. Emerging themes were identified and grouped together to inform an adaptation of the PL platform tailored for patients and providers in the D.C. Cohort.
Results:
Emerging themes for patient, D.C. Cohort clinic providers, and COHAH providers included: population needs and concerns, facilitators and barriers of engagement and viral suppression, technology use, anticipated benefits and questions/concerns, and suggestions. D.C. Cohort clinic and COHAH providers had an additional theme, clinic processes. Themes from all groups were reviewed and discussed with the D.C. Cohort study site principal investigators (site PIs). After reviewing the data, site PIs selected core PositiveLinks app features including: daily medication adherence, mood and stress Check-ins, Resources, FAQs, and the Community board. Additionally, PIs wanted both English and Spanish versions depending on site. Two additional app features (Messaging and Documents) were selected as optional for each clinical site. Three features (Labs, Appointments, and Telehealth) were not included for PL in the DC Cohort.
Conclusions:
Patient and provider perspectives of the PL app had some overlap, but some themes were unique to the view of providers and patients, respectively. Beta testing of the app with DC Cohort-selected features was conducted (August 2022). This formative work prepared investigators and sites for a cluster randomized trial of PL efficacy. Randomization of the clinics to PositiveLinks or Usual Care was completed in August 2022 and the RCT launched in December 2022. Clinical Trial: https://clinicaltrials.gov/ct2/show/NCT04998019
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