A Mobile Health App (WYZ) for Engagement in Care and Antiretroviral Therapy Adherence Among Youth and Young Adults Living With HIV: Single-Arm Pilot Intervention Study

Parya Saberi, Nadra E Lisha, Xavier A Erguera, Estie Sid Hudes, Mallory O Johnson, Theodore Ruel, Torsten B Neilands, Parya Saberi, Nadra E Lisha, Xavier A Erguera, Estie Sid Hudes, Mallory O Johnson, Theodore Ruel, Torsten B Neilands

Abstract

Background: Youth are globally recognized as being vulnerable to HIV. Younger age has been correlated with worse health outcomes. Mobile health (mHealth) interventions have the potential to interact with youth where they are, using a device they already access.

Objective: Using predefined benchmarks, we sought to evaluate the feasibility and acceptability of WYZ, an mHealth app, for improved engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV. WYZ was designed and developed with input from youth and young adults living with HIV using a human-centered design approach and was based on the information, motivation, and behavioral skills framework to address common barriers to care and ART adherence among youth and young adults living with HIV.

Methods: We recruited youth and young adults living with HIV (18-29 years old) from the San Francisco Bay Area to take part in a 6-month pilot trial. Their participation included completing baseline and exit surveys, and participating in seven phone check-ins about their use of WYZ.

Results: Youth and young adults living with HIV (N=79) reported high levels of feasibility and acceptability with WYZ use. We met predefined benchmarks for recruitment (79/84, 94%), mean logins per week (5.3), tracking ART adherence (5442/9393, 57.9%), posting chat topics per week (4.8), and app crashes reported per week (0.24). The ease of app download, install, and setup, and comfort with security, privacy, and anonymity were highly rated (all over 91%). Additionally, participants reported high satisfaction for a research project that was remotely conducted. Participants used the app for shorter timeframes compared to the predefined benchmark.

Conclusions: We noted high feasibility and acceptability with WYZ. Further research to examine the efficacy of WYZ will enable youth and young adults living with HIV and their providers to make informed decisions when using, recommending, and prescribing the app for improved engagement in HIV care and ART adherence.

Trial registration: ClinicalTrials.gov NCT03587857; https://ichgcp.net/clinical-trials-registry/NCT03587857.

Keywords: antiretroviral therapy adherence; engagement in care; mobile app; mobile health; pilot; youth living with HIV.

Conflict of interest statement

Conflicts of Interest: None declared.

©Parya Saberi, Nadra E Lisha, Xavier A Erguera, Estie Sid Hudes, Mallory O Johnson, Theodore Ruel, Torsten B Neilands. Originally published in JMIR Formative Research (https://formative.jmir.org), 31.08.2021.

References

    1. Bekker L, Johnson L, Wallace M, Hosek S. Building our youth for the future. J Int AIDS Soc. 2015;18(2 Suppl 1):20027. doi: 10.7448/IAS.18.2.20027. 20027
    1. Kahana SY, Jenkins RA, Bruce D, Fernandez MI, Hightow-Weidman LB, Bauermeister JA, Adolescent Medicine Trials Network for HIV/AIDS Interventions Structural Determinants of Antiretroviral Therapy Use, HIV Care Attendance, and Viral Suppression among Adolescents and Young Adults Living with HIV. PLoS One. 2016 Apr 1;11(4):e0151106. doi: 10.1371/journal.pone.0151106. PONE-D-15-44662
    1. Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDS. 2014 Mar;28(3):128–35. doi: 10.1089/apc.2013.0345.
    1. HIV and Youth. Centers for Disease Control and Prevention. [2021-08-16]. .
    1. Lally M, van den Berg J, Westfall A, Rudy B, Hosek S, Fortenberry J, Monte D, Tanney M, McFarland EJ, Xu J, Kapogiannis BG, Wilson Craig M, Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) HIV Continuum of Care for Youth in the United States. J Acquir Immune Defic Syndr. 2018 Jan 01;77(1):110–117. doi: 10.1097/QAI.0000000000001563.
    1. Wood SM, Lowenthal E, Lee S, Ratcliffe SJ, Dowshen N. Longitudinal Viral Suppression Among a Cohort of Adolescents and Young Adults with Behaviorally Acquired Human Immunodeficiency Virus. AIDS Patient Care STDS. 2017 Sep;31(9):377–383. doi: 10.1089/apc.2017.0078.
    1. Dobroszycki J, Lee P, Romo DL, Rosenberg MG, Wiznia A, Abadi J. Antiretroviral therapy in HIV-infected adolescents: clinical and pharmacologic challenges. Expert Rev Clin Pharmacol. 2017 May 14;10(5):509–516. doi: 10.1080/17512433.2017.1301205.
    1. Rotheram-Borus MJ, Lee S, Swendeman D. Getting to Zero HIV Among Youth: Moving Beyond Medical Sites. JAMA Pediatr. 2018 Dec 01;172(12):1117–1118. doi: 10.1001/jamapediatrics.2018.3672. 2705615
    1. Reeder C, Neilands TB, Palar K, Saberi P. Food Insecurity and Unmet Needs Among Youth and Young Adults Living With HIV in the San Francisco Bay Area. J Adolesc Health. 2019 Aug;65(2):262–266. doi: 10.1016/j.jadohealth.2019.02.023. S1054-139X(19)30134-X
    1. Mobile Fact Sheet. Pew Research Center. 2021. [2020-02-25].
    1. Rideout V, Fox S. Digital Health Practices, Social Media Use, and Mental Well-Being Among Teens and Young Adults in the U.S. Hopelab and Well Being Trust. 2018. [2020-12-07]. .
    1. Social Media Fact Sheet. Pew Research Center. 2021. [2020-03-24].
    1. DiClemente R, Ruiz M, Sales J. Barriers to adolescents' participation in HIV biomedical prevention research. J Acquir Immune Defic Syndr. 2010 Jul;54 Suppl 1:S12–7. doi: 10.1097/QAI.0b013e3181e1e2c0. 00126334-201007011-00004
    1. Escobar-Viera C, Zhou Z, Morano JP, Lucero R, Lieb S, McIntosh S, Clauson KA, Cook RL. The Florida Mobile Health Adherence Project for People Living With HIV (FL-mAPP): Longitudinal Assessment of Feasibility, Acceptability, and Clinical Outcomes. JMIR Mhealth Uhealth. 2020 Jan 08;8(1):e14557. doi: 10.2196/14557. v8i1e14557
    1. Flickinger TE, Ingersoll K, Swoger S, Grabowski M, Dillingham R. Secure Messaging Through PositiveLinks: Examination of Electronic Communication in a Clinic-Affiliated Smartphone App for Patients Living with HIV. Telemed J E Health. 2020 Mar 01;26(3):359–364. doi: 10.1089/tmj.2018.0261.
    1. Whiteley L, Brown LK, Mena L, Craker L, Arnold T. Enhancing health among youth living with HIV using an iPhone game. AIDS Care. 2018 Jan 09;30(sup4):21–33. doi: 10.1080/09540121.2018.1503224.
    1. Hightow-Weidman L, Muessig K, Knudtson K, Srivatsa M, Lawrence E, LeGrand S, Hotten A, Hosek S. A Gamified Smartphone App to Support Engagement in Care and Medication Adherence for HIV-Positive Young Men Who Have Sex With Men (AllyQuest): Development and Pilot Study. JMIR Public Health Surveill. 2018 Apr 30;4(2):e34. doi: 10.2196/publichealth.8923. v4i2e34
    1. Erguera XA, Johnson MO, Neilands TB, Ruel T, Berrean B, Thomas S, Saberi P. WYZ: a pilot study protocol for designing and developing a mobile health application for engagement in HIV care and medication adherence in youth and young adults living with HIV. BMJ Open. 2019 May 05;9(5):e030473. doi: 10.1136/bmjopen-2019-030473. bmjopen-2019-030473
    1. Kempf M, Huang C, Savage R, Safren SA. Technology-Delivered Mental Health Interventions for People Living with HIV/AIDS (PLWHA): a Review of Recent Advances. Curr HIV/AIDS Rep. 2015 Dec 9;12(4):472–80. doi: 10.1007/s11904-015-0292-6. 10.1007/s11904-015-0292-6
    1. Saberi P, Ming K, Dawson-Rose Carol. What does it mean to be youth-friendly? Results from qualitative interviews with health care providers and clinic staff serving youth and young adults living with HIV. Adolesc Health Med Ther. 2018;9:65–75. doi: 10.2147/AHMT.S158759. doi: 10.2147/AHMT.S158759.ahmt-9-065
    1. Norman D, Draper S. User Centered System Design: New Perspectives on Human-computer Interaction. Boca Raton, FL: CRC Press; 1986.
    1. LeRouge C, Wickramasinghe N. A review of user-centered design for diabetes-related consumer health informatics technologies. J Diabetes Sci Technol. 2013 Jul 01;7(4):1039–56. doi: 10.1177/193229681300700429.
    1. Matheson GO, Pacione C, Shultz RK, Klügl M. Leveraging human-centered design in chronic disease prevention. Am J Prev Med. 2015 Apr;48(4):472–9. doi: 10.1016/j.amepre.2014.10.014.S0749-3797(14)00618-7
    1. Kachirskaia I, Mate K, Neuwirth E. Human-Centered Design and Performance Improvement: Better Together. NEJM Catalyst. 2018. [2019-03-14]. .
    1. Saberi P, Yuan P, John M, Sheon N, Johnson MO. A pilot study to engage and counsel HIV-positive African American youth via telehealth technology. AIDS Patient Care STDS. 2013 Sep;27(9):529–32. doi: 10.1089/apc.2013.0185.
    1. Saberi P, Mayer K, Vittinghoff E, Naar-King S, Adolescent Medicine Trials Network for HIV/AIDS Interventions Correlation between use of antiretroviral adherence devices by HIV-infected youth and plasma HIV RNA and self-reported adherence. AIDS Behav. 2015 Jan 31;19(1):93–103. doi: 10.1007/s10461-014-0806-z.
    1. Saberi P, Siedle-Khan R, Sheon N, Lightfoot M. The Use of Mobile Health Applications Among Youth and Young Adults Living with HIV: Focus Group Findings. AIDS Patient Care STDS. 2016 Jun;30(6):254–60. doi: 10.1089/apc.2016.0044.
    1. Fisher JD, Fisher WA, Misovich SJ, Kimble DL, Malloy TE. Changing AIDS risk behavior: effects of an intervention emphasizing AIDS risk reduction information, motivation, and behavioral skills in a college student population. Health Psychol. 1996 Mar;15(2):114–23. doi: 10.1037//0278-6133.15.2.114.
    1. Amico KR, Toro-Alfonso J, Fisher JD. An empirical test of the information, motivation and behavioral skills model of antiretroviral therapy adherence. AIDS Care. 2005 Aug 20;17(6):661–73. doi: 10.1080/09540120500038058.NQ7L488618422303
    1. Fisher JD, Amico KR, Fisher WA, Harman JJ. The information-motivation-behavioral skills model of antiretroviral adherence and its applications. Curr HIV/AIDS Rep. 2008 Nov 25;5(4):193–203. doi: 10.1007/s11904-008-0028-y.
    1. Lewis JR. The System Usability Scale: Past, Present, and Future. International Journal of Human–Computer Interaction. 2018 Mar 30;34(7):577–590. doi: 10.1080/10447318.2018.1455307.
    1. System Usability Scale (SUS) . [2021-03-31]. .
    1. Kalichman SC, Rompa D, Cage M. Reliability and validity of self-reported CD4 lymphocyte count and viral load test results in people living with HIV/AIDS. Int J STD AIDS. 2000 Sep 25;11(9):579–85. doi: 10.1258/0956462001916551.
    1. Wilson IB, Lee Y, Michaud J, Fowler FJ, Rogers WH. Validation of a New Three-Item Self-Report Measure for Medication Adherence. AIDS Behav. 2016 Nov 20;20(11):2700–2708. doi: 10.1007/s10461-016-1406-x. 10.1007/s10461-016-1406-x
    1. Fine TH, Contractor AA, Tamburrino M, Elhai JD, Prescott MR, Cohen GH, Shirley E, Chan PK, Goto T, Slembarski R, Liberzon I, Galea S, Calabrese JR. Validation of the telephone-administered PHQ-9 against the in-person administered SCID-I major depression module. J Affect Disord. 2013 Sep 25;150(3):1001–7. doi: 10.1016/j.jad.2013.05.029.S0165-0327(13)00388-1
    1. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: assessing the ability to bounce back. Int J Behav Med. 2008 Sep;15(3):194–200. doi: 10.1080/10705500802222972.901471909
    1. Mancini JA, Blieszner R. Social provisions in adulthood: concept and measurement in close relationships. J Gerontol. 1992 Jan 01;47(1):P14–20. doi: 10.1093/geronj/47.1.p14.
    1. Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, Amtmann D, Bode R, Buysse D, Choi S, Cook K, Devellis R, DeWalt D, Fries JF, Gershon R, Hahn EA, Lai J, Pilkonis P, Revicki D, Rose M, Weinfurt K, Hays R, PROMIS Cooperative Group The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol. 2010 Nov;63(11):1179–94. doi: 10.1016/j.jclinepi.2010.04.011. S0895-4356(10)00173-3
    1. Johnson MO, Rose CD, Dilworth SE, Neilands TB. Advances in the conceptualization and measurement of Health Care Empowerment: development and validation of the Health Care Empowerment inventory. PLoS One. 2012 Sep 19;7(9):e45692. doi: 10.1371/journal.pone.0045692. PONE-D-12-18268
    1. Chen WT, Wantland D, Reid P, Corless IB, Eller LS, Iipinge S, Holzemer WL, Nokes K, Sefcik E, Rivero-Mendez M, Voss J, Nicholas P, Phillips JC, Brion JM, Rose CD, Portillo CJ, Kirksey K, Sullivan KM, Johnson MO, Tyer-Viola L, Webel AR. Engagement with Health Care Providers Affects Self- Efficacy, Self-Esteem, Medication Adherence and Quality of Life in People Living with HIV. J AIDS Clin Res. 2013 Nov 01;4(11):256. doi: 10.4172/2155-6113.1000256.
    1. Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011 May;45(5):626–9. doi: 10.1016/j.jpsychires.2010.10.008. S0022-3956(10)00292-X
    1. Whitehead AL, Sully BG, Campbell MJ. Pilot and feasibility studies: is there a difference from each other and from a randomised controlled trial? Contemp Clin Trials. 2014 May;38(1):130–3. doi: 10.1016/j.cct.2014.04.001.S1551-7144(14)00049-4
    1. Kraemer HC, Mintz J, Noda A, Tinklenberg J, Yesavage JA. Caution regarding the use of pilot studies to guide power calculations for study proposals. Arch Gen Psychiatry. 2006 May 01;63(5):484–9. doi: 10.1001/archpsyc.63.5.484.63/5/484
    1. Eldridge SM, Lancaster GA, Campbell MJ, Thabane L, Hopewell S, Coleman CL, Bond CM. Defining Feasibility and Pilot Studies in Preparation for Randomised Controlled Trials: Development of a Conceptual Framework. PLoS One. 2016 Mar 15;11(3):e0150205. doi: 10.1371/journal.pone.0150205. PONE-D-15-35699
    1. Agwu AL, Lee L, Fleishman JA, Voss C, Yehia BR, Althoff KN, Rutstein R, Mathews WC, Nijhawan A, Moore RD, Gaur AH, Gebo KA. Aging and loss to follow-up among youth living with human immunodeficiency virus in the HIV Research Network. J Adolesc Health. 2015 Mar;56(3):345–51. doi: 10.1016/j.jadohealth.2014.11.009. S1054-139X(14)00740-X
    1. Farmer C, Yehia BR, Fleishman JA, Rutstein R, Mathews WC, Nijhawan A, Moore RD, Gebo KA, Agwu AL, HIV Research Network Factors Associated With Retention Among Non-Perinatally HIV-Infected Youth in the HIV Research Network. J Pediatric Infect Dis Soc. 2016 Mar 19;5(1):39–46. doi: 10.1093/jpids/piu102. piu102

Source: PubMed

3
Sottoscrivi