PositiveLinks: A Mobile Health Intervention for Retention in HIV Care and Clinical Outcomes with 12-Month Follow-Up

Rebecca Dillingham, Karen Ingersoll, Tabor E Flickinger, Ava Lena Waldman, Marika Grabowski, Colleen Laurence, Erin Wispelwey, George Reynolds, Mark Conaway, Wendy F Cohn, Rebecca Dillingham, Karen Ingersoll, Tabor E Flickinger, Ava Lena Waldman, Marika Grabowski, Colleen Laurence, Erin Wispelwey, George Reynolds, Mark Conaway, Wendy F Cohn

Abstract

Mobile health interventions may help People Living with HIV (PLWH) improve engagement in care. We designed and piloted PositiveLinks, a clinic-affiliated mobile intervention for PLWH, and assessed longitudinal impact on retention in care and viral suppression. The program was based at an academic Ryan White Clinic serving a nonurban population in Central Virginia. The PL intervention included a smartphone app that connected participants to clinic staff and provided educational resources, daily queries of stress, mood and medication adherence, weekly quizzes, appointment reminders, and a virtual support group. Outcomes were analyzed using McNemar's tests for HRSA-1, visit constancy, and viral suppression and nonparametric Wilcoxon signed-rank tests for CD4 counts and viral loads. Of 77 participants, 63% were male, 49% black non-Hispanic, and 72% below the federal poverty level. Participants' achievement of a retention in care benchmark (HRSA-1) increased from 51% at baseline to 88% at 6 months (p < 0.0001) and 81% at 12 months (p = 0.0003). Visit constancy improved from baseline to 6 months (p = 0.016) and 12 months (p = 0.0004). Participants' mean CD4 counts increased from baseline to 6 months (p = 0.0007) and 12 months (p = 0.0005). The percentage of participants with suppressed viral loads increased from 47% at baseline to 87% at 6 months (p < 0.0001) and 79% at 12 months (p = 0.0007). This study is one of the first to demonstrate that a mobile health intervention can have a positive impact on retention in care and clinical outcomes for vulnerable PLWH. Next steps include integration with clinical practice and dissemination.

Keywords: HIV/AIDS; mobile health; positive links; retention in care; smartphone app.

Conflict of interest statement

No conflicting financial interests exist.

Figures

FIG. 1.
FIG. 1.
Example images of the Positive Links app: (a) app home screen; (b) member dashboard overview; (c) community message board; (d) appointment page.
FIG. 2.
FIG. 2.
Summary of outcomes at baseline, and 6- and 12-month follow-ups.

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