A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study

Connie Fee, Julia Fuller, Carly E Guss, Elizabeth R Woods, Ellen R Cooper, Urmi Bhaumik, Dionne Graham, Sandra K Burchett, Olivia Dumont, Emily B Martey, Maria Narvaez, Jessica E Haberer, Dallas Swendeman, Shelagh A Mulvaney, Vikram S Kumar, Jonathan L Jackson, Y Xian Ho, Connie Fee, Julia Fuller, Carly E Guss, Elizabeth R Woods, Ellen R Cooper, Urmi Bhaumik, Dionne Graham, Sandra K Burchett, Olivia Dumont, Emily B Martey, Maria Narvaez, Jessica E Haberer, Dallas Swendeman, Shelagh A Mulvaney, Vikram S Kumar, Jonathan L Jackson, Y Xian Ho

Abstract

Background: Advances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today.

Objective: The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages).

Methods: We conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively.

Results: The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study.

Conclusions: Although perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life.

Trial registration: ClinicalTrials.gov NCT03758066; https://ichgcp.net/clinical-trials-registry/NCT03758066.

Keywords: HIV; case management; digital health; mHealth; mobile health; mobile phone; young adult; youth.

Conflict of interest statement

Conflicts of Interest: JF, YXH, JLJ, and VSK are employed by the organization (Dimagi, Inc) whose revenue is derived from the open-source platform on which the digital app described here was built and studied. JEH has served as a paid consultant for Merck.

©Connie Fee, Julia Fuller, Carly E Guss, Elizabeth R Woods, Ellen R Cooper, Urmi Bhaumik, Dionne Graham, Sandra K Burchett, Olivia Dumont, Emily B Martey, Maria Narvaez, Jessica E Haberer, Dallas Swendeman, Shelagh A Mulvaney, Vikram S Kumar, Jonathan L Jackson, Y Xian Ho. Originally published in JMIR Formative Research (https://formative.jmir.org), 21.11.2022.

Figures

Figure 1
Figure 1
PlusCare dashboard for patient (left) as viewed on a smartphone and case manager as viewed in a web application on a laptop computer (right).
Figure 2
Figure 2
Frequency of patient and case manager app use by feature over week from participant enrollment date (top and bottom, respectively).
Figure 3
Figure 3
Average (95% CIs) ratings of self-efficacy in chronic disease management (1=not at all confident to 10=totally confident) and health-related quality of life (1=poor to 5=excellent) among youth living with HIV (top and bottom, respectively). Dashed line represents change between baseline and 12-month time points, solid lines represent comparisons between baseline and 6-month and 6- and 12-month time points. Significant increases in self-efficacy were found from baseline to 12 months (P=.02) and from 6 to 12 months (P=.02). Self-rated general health at 12 months was significantly higher than that at baseline (P=.03). Significant increases in ratings between time points are indicated (*).

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