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Currently accepted at: JMIR mHealth and uHealth

Date Submitted: Jul 7, 2017
Date Accepted: Apr 8, 2018
(closed for review but you can still tweet)

This paper has been accepted and is currently in production.

It will appear shortly on 10.2196/mhealth.8376

The final accepted version (not copyedited yet) is in this tab.

The final, peer-reviewed published version of this preprint can be found here:

Improving Linkage to HIV Care Through Mobile Phone Apps: Randomized Controlled Trial

Venter W, Coleman J, Chan VL, Shubber Z, Phatsoane M, Gorgens M, Stewart-Isherwood L, Carmona S, Fraser-Hurt N

Improving Linkage to HIV Care Through Mobile Phone Apps: Randomized Controlled Trial

JMIR Mhealth Uhealth 2018;6(7):e155

DOI: 10.2196/mhealth.8376

PMID: 30021706

PMCID: 6068383

Improving Linkage to HIV Care Through Mobile Phone Apps: Randomized Controlled Trial

  • Willem Venter; 
  • Jesse Coleman; 
  • Vincent Lau Chan; 
  • Zara Shubber; 
  • Mothepane Phatsoane; 
  • Marelize Gorgens; 
  • Lynsey Stewart-Isherwood; 
  • Sergio Carmona; 
  • Nicole Fraser-Hurt

ABSTRACT

Background:

In HIV treatment program, gaps in the “cascade of care” where patients are lost between diagnosis, laboratory evaluation, treatment initiation, and retention in HIV care, is a well-described challenge. Growing access to internet-enabled mobile phones has led to an interest in using the technology to improve patient engagement with health care.

Objective:

The objectives of this trial were: (1) to assess whether a mobile phone–enabled app could provide HIV patients with laboratory test results, (2) to better understand the implementation of such an intervention, and (3) to determine app effectiveness in improving linkage to HIV care after diagnosis.

Methods:

We developed and tested an app through a randomized controlled trial carried out in several primary health care facilities in Johannesburg. Newly diagnosed HIV-positive patients were screened, recruited, and randomized into the trial as they were giving a blood sample for initial CD4 staging. Trial eligibility included ownership of a phone compatible with the app and access to the internet. Trial participants were followed for a minimum of eight months to determine linkage to HIV care indicated by an HIV-related laboratory test result.

Results:

The trial outcome results are being prepared for publication, but here we describe the significant operational and technological lessons provided by the implementation. Android was identified as the most suitable operating system for the app, due to Android functionality and communication characteristics. Android also had the most significant market share of all smartphone operating systems in South Africa. The app was successfully developed with laboratory results sent to personal smartphones. However, given the trial requirements and the app itself, only 10% of screened HIV patients successfully enrolled. We report on issues such as patient eligibility, app testing in a dynamic phone market, software installation and compatibility, safe identification of patients, linkage of laboratory results to patients lacking unique identifiers, and present lessons and potential solutions.

Conclusions:

The implementation challenges and lessons of this trial may assist future similar mHealth interventions to avoid some of the pitfalls. Ensuring sufficient expertise and understanding of the programmatic needs by the software developer, as well as in the implementation team, with adequate and rapid piloting within the target groups, could have led to better trial recruitment. However, the majority of screened patients were interested in the study, and the app was installed successfully in patients with suitable smartphones, suggesting that this may be a way to engage patients with their health care data in future. Trial Registration: ClinicalTrials.gov NCT02756949; https://clinicaltrials.gov/ct2/show/NCT02756949 (Archived by WebCite at http://www.webcitation.org/6z1GTJCNW)


 Citation

Please cite as:

Venter W, Coleman J, Chan VL, Shubber Z, Phatsoane M, Gorgens M, Stewart-Isherwood L, Carmona S, Fraser-Hurt N

Improving Linkage to HIV Care Through Mobile Phone Apps: Randomized Controlled Trial

JMIR mHealth and uHealth. (forthcoming/in press)

DOI: 10.2196/mhealth.8376

URL: https://preprints.jmir.org/preprint/8376

PMID: 30021706

PMCID: 6068383

Per the author's request the PDF is not available.