Acceptability of a mobile health intervention to enhance HIV care coordination for patients with substance use disorders

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Abstract

Background

Persons living with HIV and substance use disorders face barriers to sustained engagement in medical care, leading to suboptimal antiretroviral treatment outcomes. Innovative mobile technology tools such as customizable smartphone applications have the potential to enhance existing care coordination programs, but have not been rigorously studied.

Methods

We developed and implemented a two-component intervention consisting of peer health navigation supported by a smartphone application conducting ecologic momentary assessment (EMA) of barriers to care and medication adherence. Patients with a history of antiretroviral treatment failure and substance use were recruited to participate in the 9-month pilot intervention. Three peer health navigators were trained to provide social and logistical support while participants re-engaged in HIV care. We assessed the acceptability of the intervention components using qualitative analysis of in-depth interviews conducted with study participants and peer navigators.

Results

Of 19 patients enrolled in the study, 17 participated for at least 2 months and 15 completed the entire 9-month study protocol. The acceptability of the peer navigation intervention was rated favorably by all participants interviewed, who felt that peer support was instrumental in helping them re-engage in HIV care. Participants also responded favorably to the smartphone application, but described its usefulness mostly as providing reminders to take medications and attend appointments, rather than as a facilitator of patient navigation.

Conclusions

Peer health navigation and smartphone-based EMA are acceptable approaches to facilitating engagement in HIV care for drug using populations. Future studies to evaluate the efficacy of this approach for improving long-term retention in care and antiretroviral treatment outcomes are warranted.

ClinicalTrials.gov Identifier NCT01941108; registered on September 4, 2013

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Most cited references 19

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Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population.

M Holodniy, L Sheiner, Melissa A. Moss … (2000)

To examine the relationship between adherence, viral suppression and antiretroviral resistance in HIV-infected homeless and marginally housed people on protease inhibitor (PI) therapy. A cross-sectional analysis of subjects in an observational prospective cohort systematically sampled from free meal lines, homeless shelters and low-income, single-room occupancy (SRO) hotels. Thirty-four HIV-infected people with a median of 12 months of PI therapy. Adherence measured by periodic unannounced pill counts, electronic medication monitoring, and self-report; HIV RNA viral load; and HIV-1 genotypic changes associated with drug resistance. Median adherence was 89, 73, and 67% by self-report, pill count, and electronic medication monitor, respectively. Thirty-eight per cent of the population had over 90% adherence by pill count. Depending on the measure, adherence explained 36-65% of the variation in concurrent HIV RNA levels. The three adherence measures were closely related. Of 20 genotyped patients who received a new reverse transcriptase inhibitor (RTI) when starting a PI, three had primary protease gene substitutions. Of 12 genotyped patients who received a PI without a new RTI, six had primary protease gene substitutions (P < 0.03). A substantial proportion of homeless and marginally housed individuals had good adherence to PI therapy. A strong relationship was found between independent methods of measuring adherence and concurrent viral suppression. PI resistance was more closely related to the failure to change RTI when starting a PI than to the level of adherence.

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HIV System Navigation: an emerging model to improve HIV care access.

Sharon Coleman, William A. Cunningham, B Bradford (2006)

Little is known about the effectiveness of outreach interventions to engage and retain underserved populations living with HIV in stable, primary medical care. This study provided an opportunity to adapt a patient navigation model first developed for cancer care to assess its effectiveness with HIV-infected disadvantaged populations. Four grantees from the Health Resources and Services Administration (HRSA)-funded Outreach Initiative developed and successfully implemented navigation-like interventions. We examined the effectiveness of these interventions in decreasing barriers to HIV primary medical care and improving health outcomes. The conceptual framework laid out in the 1993 Institute of Medicine report Access to Health Care in America provided a valuable heuristic for guiding the analysis, and we used the model to select measures for the study. A reduction in barriers, improvement in mediators, and improved health outcomes were observed over the 12-month intervention period. Structural barriers to HIV care and provider engagement were significantly associated with health outcomes. Based on study results, we propose that an adapted navigation approach referred to as "HIV System Navigation" has promise for improving access to HIV care and warrants further development.

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Does Food Insecurity Undermine Adherence to Antiretroviral Therapy? A Systematic Review.

Amanda W Singer, Sheri D Weiser, Sandra I McCoy (2015)

A growing body of research has identified food insecurity as a barrier to antiretroviral therapy (ART) adherence. We systematically reviewed and summarized the quantitative literature on food insecurity or food assistance and ART adherence. We identified nineteen analyses from eighteen distinct studies examining food insecurity and ART adherence. Of the thirteen studies that presented an adjusted effect estimate for the relationship between food insecurity and ART adherence, nine found a statistically significant association between food insecurity and sub-optimal ART adherence. Four studies examined the association between food assistance and ART adherence, and three found that ART adherence was significantly better among food assistance recipients than non-recipients. Across diverse populations, food insecurity is an important barrier to ART adherence, and food assistance appears to be a promising intervention strategy to improve ART adherence among persons living with HIV. Additional research is needed to determine the effectiveness and cost-effectiveness of food assistance in improving ART adherence and other clinical outcomes among people living with HIV in the era of widespread and long-term treatment.

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Author and article information

Contributors

Ryan P. Westergaard:

ORCID: http://orcid.org/0000-0001-5701-4516

608-265-7927 , rpw@medicine.wisc.edu

Andrew Genz: agenz3@jhsph.edu

Kristen Panico: Kristen.panico@gmail.com

Pamela J. Surkan: psurkan@jhu.edu

Jeanne Keruly: jkeruly@jhmi.edu

Heidi E. Hutton: hhutton@jhmi.edu

Larry W. Chang: lchang8@jhmi.edu

Gregory D. Kirk: gdk@jhu.edu

Journal

Journal ID (nlm-ta): Addict Sci Clin Pract

Journal ID (iso-abbrev): Addict Sci Clin Pract

Title: Addiction Science & Clinical Practice

Publisher: BioMed Central (London )

ISSN (Print): 1940-0632

ISSN (Electronic): 1940-0640

Publication date (Electronic): 26 April 2017

Publication date PMC-release: 26 April 2017

Publication date (Print): 2017

Volume: 12

Electronic Location Identifier: 11

Affiliations

[1 ]ISNI 0000 0001 2167 3675, GRID grid.14003.36, Department of Medicine, , University of Wisconsin School of Medicine and Public Health, ; Madison, WI USA

[2 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of Epidemiology, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, MD USA

[3 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of Population, Family and Reproductive Health, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, MD USA

[4 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of International Health, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, MD USA

[5 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of Medicine, , Johns Hopkins School of Medicine, ; Baltimore, MD USA

[6 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of Psychiatry and Behavioral Sciences, , Johns Hopkins School of Medicine, ; Baltimore, MD USA

[7 ]ISNI 0000 0001 2167 3675, GRID grid.14003.36, , University of Wisconsin-Madison, ; 1685 Highland Ave, MFCB 5223, Madison, WI 53705-2281 USA

Author information

Ryan P. Westergaard http://orcid.org/0000-0001-5701-4516

Article

Publisher ID: 76

DOI: 10.1186/s13722-017-0076-y

PMC ID: 5405459

PubMed ID: 28441962

SO-VID: 3fe2d784-1cee-40cc-a456-a8bfabc7ab9b

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 13 October 2016

Date accepted : 30 March 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;

Award ID: R34DA033181

Award ID: K23DA032306

Award ID: U01DA036297

Award Recipient : Ryan P. Westergaard Gregory D. Kirk

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ScienceOpen disciplines: Health & Social care

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Acceptability of a mobile health intervention to enhance HIV care coordination for patients with substance use disorders

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Tobacco Prevention & Cessation

Most cited references 19

Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population.

HIV System Navigation: an emerging model to improve HIV care access.

Does Food Insecurity Undermine Adherence to Antiretroviral Therapy? A Systematic Review.

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