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

Ryan P Westergaard, Andrew Genz, Kristen Panico, Pamela J Surkan, Jeanne Keruly, Heidi E Hutton, Larry W Chang, Gregory D Kirk, Ryan P Westergaard, Andrew Genz, Kristen Panico, Pamela J Surkan, Jeanne Keruly, Heidi E Hutton, Larry W Chang, Gregory D Kirk

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.

Figures

Fig. 1
Fig. 1
Conceptual framework for mPeer2Peer based on the sIMB model
Fig. 2
Fig. 2
Framework and components the mHealth application

References

    1. UNAIDS: UNAIDS fact sheet 2015. In Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS); . Archived at on 01/21/16; 2015.
    1. Bangsberg DR, Hecht FM, Charlebois ED, Zolopa AR, Holodniy M, Sheiner L, Bamberger JD, Chesney MA, Moss A. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000;14(4):357–366. doi: 10.1097/00002030-200003100-00008.
    1. Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, Wagener MM, Singh N. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30. doi: 10.7326/0003-4819-133-1-200007040-00004.
    1. Huang YF, Kuo HS, Lew-Ting CY, Tian F, Yang CH, Tsai TI, Gange SJ, Nelson KE. Mortality among a cohort of drug users after their release from prison: an evaluation of the effectiveness of a harm reduction program in Taiwan. Addiction. 2011;106(8):1437–1445. doi: 10.1111/j.1360-0443.2011.03443.x.
    1. Nakimuli-Mpungu E, Bass JK, Alexandre P, Mills EJ, Musisi S, Ram M, Katabira E, Nachega JB. Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: a systematic review. AIDS Behav. 2012;16(8):2101–2118. doi: 10.1007/s10461-011-0087-8.
    1. Rachlis BS, Mills EJ, Cole DC. Livelihood security and adherence to antiretroviral therapy in low and middle income settings: a systematic review. PLoS One. 2011;6(5):e18948. doi: 10.1371/journal.pone.0018948.
    1. Leaver CA, Bargh G, Dunn JR, Hwang SW. The effects of housing status on health-related outcomes in people living with HIV: a systematic review of the literature. AIDS Behav. 2007;11(6 Suppl):85–100. doi: 10.1007/s10461-007-9246-3.
    1. Singer AW, Weiser SD, McCoy SI. Does food insecurity undermine adherence to antiretroviral therapy? A systematic review. AIDS Behav. 2015;19(8):1510–1526. doi: 10.1007/s10461-014-0873-1.
    1. Samji H, Cescon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, Burchell AN, Cohen M, Gebo KA, Gill MJ, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013;8(12):e81355. doi: 10.1371/journal.pone.0081355.
    1. Gardner LI, Metsch LR, Anderson-Mahoney P, Loughlin AM, del Rio C, Strathdee S, Sansom SL, Siegal HA, Greenberg AE, Holmberg SD. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. Aids. 2005;19(4):423–431. doi: 10.1097/01.aids.0000161772.51900.eb.
    1. Kushel MB, Colfax G, Ragland K, Heineman A, Palacio H, Bangsberg DR. Case management is associated with improved antiretroviral adherence and CD4 + cell counts in homeless and marginally housed individuals with HIV infection. Clin Infect Dis. 2006;43(2):234–242. doi: 10.1086/505212.
    1. Bradford JB, Coleman S, Cunningham W. HIV system navigation: an emerging model to improve HIV care access. Aids Patient Care STDS. 2007;21(Suppl 1):S49–S58.
    1. Metsch LR, Feaster DJ, Gooden L, Matheson T, Stitzer M, Das M, Jain MK, Rodriguez AE, Armstrong WS, Lucas GM, et al. Effect of patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use: a randomized clinical trial. JAMA. 2016;316(2):156–170. doi: 10.1001/jama.2016.8914.
    1. Pew Research Center: The smartphone difference. . 2015.
    1. Kirk GD, Himelhoch SS, Westergaard RP, Beckwith CG. Using mobile health technology to improve HIV care for persons living with HIV and substance abuse. AIDS Res Treat. 2013;2013:194613.
    1. Naslund JA, Marsch LA, McHugo GJ, Bartels SJ. Emerging mHealth and eHealth interventions for serious mental illness: a review of the literature. J Ment Health. 2015;24(5):321–332. doi: 10.3109/09638237.2015.1019054.
    1. Kirk GD, Linas BS, Westergaard RP, Piggott D, Bollinger RC, Chang LW, Genz A. The exposure assessment in current time study: implementation, feasibility, and acceptability of real-time data collection in a community cohort of illicit drug users. AIDS Res Treat. 2013;2013:594671. doi:10.1155/2013/594671.
    1. Linas BS, Latkin C, Genz A, Westergaard RP, Chang LW, Bollinger RC, Kirk GD. Utilizing mHealth methods to identify patterns of high risk illicit drug use. Drug Alcohol Depend. 2015;151:250–7. doi:10.1016/j.drugalcdep.2015.03.031.
    1. Linas BS, Latkin C, Westergaard RP, Chang LW, Bollinger RC, Genz A, Kirk GD. Capturing illicit drug use where and when it happens: an ecological momentary assessment of the social, physical and activity environment of using versus craving illicit drugs. Addiction. 2015;110(2):315–325. doi: 10.1111/add.12768.
    1. Gustafson DH, McTavish FM, Chih MY, Atwood AK, Johnson RA, Boyle MG, Levy MS, Driscoll H, Chisholm SM, Dillenburg L, et al. A smartphone application to support recovery from alcoholism: a randomized clinical trial. JAMA Psychiatry. 2014;71(5):566–572. doi: 10.1001/jamapsychiatry.2013.4642.
    1. Gustafson DH, Sr, Landucci G, McTavish F, Kornfield R, Johnson RA, Mares ML, Westergaard RP, Quanbeck A, Alagoz E, Pe-Romashko K, et al. The effect of bundling medication-assisted treatment for opioid addiction with mHealth: study protocol for a randomized clinical trial. Trials. 2016;17(1):592. doi: 10.1186/s13063-016-1726-1.
    1. Swendeman D, Ramanathan N, Baetscher L, Medich M, Scheffler A, Comulada WS, Estrin D. Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study. J Acquir Immune Defic Syndr. 2015;69(Suppl 1):S80–S91. doi: 10.1097/QAI.0000000000000570.
    1. Himelhoch S, Kreyenbuhl J, Palmer-Bacon J, Chu M, Brown C, Potts W. Pilot feasibility study of Heart2HAART: a smartphone application to assist with adherence among substance users living with HIV. AIDS Care. 2017;1–7. doi:10.1080/09540121.2016.1259454.
    1. Westergaard RP, Hess T, Astemborski J, Mehta SH, Kirk GD. Longitudinal changes in engagement in care and viral suppression for HIV-infected injection drug users. AIDS. 2013;27(16):2559–2566. doi: 10.1097/QAD.0b013e328363bff2.
    1. Maryland Dept. of Health and Mental Hygiene. Baltimore City HIV/AIDS Epidemiological Profile. . Archived at on 01/21/16. 2013.
    1. Moore RD, Bartlett JG. Dramatic decline in the HIV-1 RNA level over calendar time in a large urban HIV practice. Clin Infect Dis. 2011;53(6):600–604. doi: 10.1093/cid/cir467.
    1. Vlahov D, Anthony JC, Munoz A, Margolick J, Nelson KE, Celentano DD, Solomon L, Polk BF. The ALIVE study, a longitudinal study of HIV-1 infection in intravenous drug users: description of methods and characteristics of participants. NIDA Res Monogr. 1991;109:75–100.
    1. Amico KR. A situated-information motivation behavioral skills model of care initiation and maintenance (sIMB-CIM): an IMB model based approach to understanding and intervening in engagement in care for chronic medical conditions. J Health Psychol. 2011;16(7):1071–81.
    1. Magnus M, Franks J, Griffith S, Arnold MP, Goodman K, Wheeler DP. Engaging, recruiting, and retaining black men who have sex with men in research studies: don’t underestimate the importance of staffing—lessons learned from HPTN 061, the BROTHERS study. J Public Health Manag Pract: JPHMP. 2014;20(6):E1–E9. doi: 10.1097/PHH.0000000000000025.
    1. HPTN 061 Study Group: HPTN 061 Peer Health Navigation Operations Manual. ; Archived at on 01/14/16. 2009.
    1. Curran SL, Andrykowski MA, Studts JL. Short form of the profile of mood states (POMS-SF): psychometric information. Psychol Assess. 1995;7(1):80–83. doi: 10.1037/1040-3590.7.1.80.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Sullivan KA, Schultz K, Ramaiya M, Berger M, Parnell H, Quinlivan EB. Experiences of women of color with a nurse patient navigation program for linkage and engagement in HIV care. AIDS Patient Care STDs. 2015;29(Suppl 1):S49–S54. doi: 10.1089/apc.2014.0279.
    1. Paskett ED, Katz ML, Post DM, Pennell ML, Young GS, Seiber EE, Harrop JP, DeGraffinreid CR, Tatum CM, Dean JA, et al. The Ohio patient navigation research program: does the american cancer society patient navigation model improve time to resolution in patients with abnormal screening tests? Cancer Epidemiol Biomarkers Prev. 2012;21(10):1620–1628. doi: 10.1158/1055-9965.EPI-12-0523.
    1. Koester KA, Morewitz M, Pearson C, Weeks J, Packard R, Estes M, Tulsky J, Kang-Dufour MS, Myers JJ. Patient navigation facilitates medical and social services engagement among HIV-infected individuals leaving jail and returning to the community. AIDS Patient Care STDS. 2014;28(2):82–90. doi: 10.1089/apc.2013.0279.
    1. Greysen SR, Horwitz LI, Covinsky KE, Gordon K, Ohl ME, Justice AC. Does social isolation predict hospitalization and mortality among HIV + and uninfected older veterans? J Am Geriatr Soc. 2013;61(9):1456–1463. doi: 10.1111/jgs.12410.
    1. Gustafson D, Wise M, Bhattacharya A, Pulvermacher A, Shanovich K, Phillips B, Lehman E, Chinchilli V, Hawkins R, Kim JS. The effects of combining web-based eHealth with telephone nurse case management for pediatric asthma control: a randomized controlled trial. J Med Internet Res. 2012;14(4):e101. doi: 10.2196/jmir.1964.
    1. Hull SJ, Abril EP, Shah DV, Choi M, Chih MY, Kim SC, Namkoong K, McTavish F, Gustafson DH. Self-determination theory and computer-mediated support: modeling effects on breast cancer patient’s quality-of-life. Health Commun. 2016;31(10):1205–1214. doi: 10.1080/10410236.2015.1048422.
    1. Tomlinson M, Rotheram-Borus MJ, Swartz L, Tsai AC. Scaling up mHealth: where is the evidence? PLoS Med. 2013;10(2):e1001382. doi: 10.1371/journal.pmed.1001382.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel