Long term impact of PositiveLinks: Clinic-deployed mobile technology to improve engagement with HIV care

Chelsea E Canan, Marika E Waselewski, Ava Lena D Waldman, George Reynolds, Tabor E Flickinger, Wendy F Cohn, Karen Ingersoll, Rebecca Dillingham, Chelsea E Canan, Marika E Waselewski, Ava Lena D Waldman, George Reynolds, Tabor E Flickinger, Wendy F Cohn, Karen Ingersoll, Rebecca Dillingham

Abstract

Background: PositiveLinks (PL) is a smartphone-based platform designed in partnership with people living with HIV (PLWH) to improve engagement in care. PL provides daily medication reminders, check-ins about mood and stress, educational resources, a community message board, and an ability to message providers. The objective of this study was to evaluate the impact of up to 24 months of PL use on HIV viral suppression and engagement in care and to examine whether greater PL use was associated with improved outcomes.

Setting: This study occurred between September 2013 and March 2017 at a university-based Ryan White HIV clinic.

Methods: We assessed engagement in care and viral suppression from study baseline to the 6-, 12-, 18- and 24-month follow-up time periods and compared trends among high vs. low PL users. We compared time to viral suppression, proportion of days virally suppressed, and time to engagement in care in patients with high vs. low PL use.

Results: 127 patients enrolled in PL. Engagement in care and viral suppression improved significantly after 6 months of PL use and remained significantly improved after 24 months. Patients with high PL use were 2.09 (95% CI 0.64-6.88) times more likely to achieve viral suppression and 1.52 (95% CI 0.89-2.57) times more likely to become engaged in care compared to those with low PL use.

Conclusion: Mobile technology, such as PL, can improve engagement in care and clinical outcomes for PLWH. This study demonstrates long-term acceptability of PL over two years and provides evidence for long-term improvement in engagement in care and viral suppression associated with PL use.

Conflict of interest statement

Dr. Karen Ingersoll, Ms. Ava Lena Waldman, Ms. Marika Waselewski, and Dr. Rebecca Dillingham all serve as consultants for Warm Health Technology, Inc. This is an entity owned by the University of Virginia that supports dissemination of PositiveLinks. Dr. Rebecca Dillingham has received an investigator-initiated grant from Gilead, Inc for unrelated work. Mr. George Reynolds is the owner and director of Health Decision Technologies. This is a company that produces mHealth tools. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Change in clinical outcomes over…
Fig 1. Change in clinical outcomes over time.
Fig 1 shows the change in the viral suppression and engagement in care from baseline to each 6-month follow-up period. PL users are included in the sample for each time point during which they were still enrolled in PL. PL enrollment ended when members finished the study (N = 26), dropped out (N = 4), died (N = 2), or reached the end of the data collection period (N = 95). Viral suppression is defined as having a viral load

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