Effectiveness of a Web-Based Intervention to Support Medication Adherence Among People Living With HIV: Web-Based Randomized Controlled Trial

José Côté, Geneviève Rouleau, Maria Pilar Ramirez-Garcia, Patricia Auger, Réjean Thomas, Judith Leblanc, José Côté, Geneviève Rouleau, Maria Pilar Ramirez-Garcia, Patricia Auger, Réjean Thomas, Judith Leblanc

Abstract

Background: Taking antiretroviral therapy (ART) is part of the daily life of people living with HIV. Different electronic health (eHealth) initiatives adjunctive to usual care have been proposed to support optimal medication adherence. A web-based intervention called HIV Treatment, Virtual Nursing Assistance, and Education or VIH-TAVIE (from its French version Virus de l'immunodéficience humaine-Traitement assistance virtuelle infirmière et enseignement) was developed to empower people living with HIV to manage their ART and symptoms optimally.

Objective: We aimed to evaluate the effectiveness of VIH-TAVIE in a web-based randomized controlled trial (RCT).

Methods: This RCT was entirely web-based, including recruitment, consent granting, questionnaire completion, and intervention exposure (consultation with VIH-TAVIE [experimental group] or websites [control group]). To be eligible for the study, people living with HIV had to be 18 years or older, be on ART for at least 6 months, have internet access, and have internet literacy. Participants were randomly assigned to either the experimental group (n=45) or control group (n=43). The primary outcome was ART adherence. The secondary outcomes included self-efficacy regarding medication intake, symptom-related discomfort, skills and strategies, and social support. All outcomes were measured with a self-administered web-based questionnaire at the following three time points: baseline and 3 and 6 months later. A generalized linear mixed model was built to assess the evolution of ART adherence over time in both groups.

Results: The sample included 88 participants, and of these, 73 (83%) were men. The median age of the participants was 42 years. Participants had been diagnosed with HIV a median of 7 years earlier (IQR 3-17) and had been on ART for a median of 5 years (IQR 2-12). The proportion of treatment-adherent participants at baseline was high in both groups (34/41, 83% in the experimental group and 30/39, 77% in the control group). Participants also reported high treatment adherence, high self-efficacy, and high skills; perceived good social support; and experienced low discomfort from symptoms. Analyses revealed no intergroup difference regarding ART adherence (OR 1.9, 95% CI 0.6-6.4).

Conclusions: This study highlights the challenges and lessons learned from conducting an entirely web-based RCT among people living with HIV. The challenges were related to the engagement of people living with HIV on the following three levels: starting the web-based study (recruitment), completing the web-based intervention (engagement), and continuing the study (retention). The results contribute to the existing body of knowledge regarding how to conduct web-based evaluation studies of eHealth interventions aimed at developing and strengthening personal skills and abilities.

Trial registration: ClinicalTrials.gov NCT01510340; https://ichgcp.net/clinical-trials-registry/NCT01510340.

Keywords: antiretroviral therapy; medication adherence; nursing; people living with HIV; self-management; web-based intervention; web-based randomized controlled trial.

Conflict of interest statement

Conflicts of Interest: JC and MPRG declare granting of licensing options for marketing VIH-TAVIE. The remaining authors declare no conflict of interest.

©José Côté, Geneviève Rouleau, Maria Pilar Ramirez-Garcia, Patricia Auger, Réjean Thomas, Judith Leblanc. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 20.04.2020.

Figures

Figure 1
Figure 1
Flow diagram. The measurement time points are baseline (T0) and 3 months (T3) and 6 months later (T6).
Figure 2
Figure 2
Adherence over time. The solid bars represent the estimated proportion of treatment-adherent participants, and the error bars (lines) indicate the corresponding 95% CIs from the generalized linear mixed model. The measurement time points are baseline (T0) and 3 months (T3) and 6 months later (T6).

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