Implementation of a Mobile Health Strategy to Improve Linkage to and Engagement with HIV Care for People Living with HIV, Tuberculosis, and Substance Use in Irkutsk, Siberia

Jacqueline Hodges, Svetlana Zhdanova, Olga Koshkina, Alexey Suzdalnitsky, Ava Lena Waldman, Jason Schwendinger, Serhiy Vitko, Alexey Plenskey, Yulia Plotnikova, Elena Moiseeva, Mikhail Koshcheyev, Sergey Sebekin, Oleg Ogarkov, Rebecca Dillingham, Scott Heysell, Jacqueline Hodges, Svetlana Zhdanova, Olga Koshkina, Alexey Suzdalnitsky, Ava Lena Waldman, Jason Schwendinger, Serhiy Vitko, Alexey Plenskey, Yulia Plotnikova, Elena Moiseeva, Mikhail Koshcheyev, Sergey Sebekin, Oleg Ogarkov, Rebecca Dillingham, Scott Heysell

Abstract

In Irkutsk, Siberia, there is a high prevalence of HIV and tuberculosis (TB) coinfection. Mobile health (mHealth) strategies have shown promise for increasing linkage to and engagement in care for people living with HIV (PLWH) in other contexts. We evaluated outcomes for a cohort of PLWH, TB, and substance use in Irkutsk after participation in a multi-feature mHealth intervention called MOCT. Sixty patients were enrolled during hospitalization for TB. We evaluated participant app usage, linkage to HIV care postdischarge, perception of self-efficacy related to HIV care, and HIV-related clinical outcomes at 6 months. We also performed an exploratory analysis to compare a subset of 49 patients with a pre-intervention cohort matched for age and gender. Participants demonstrated engagement with app features examined at 6 months. The majority linked to HIV care by 6 months (83%). Self-scoring of confidence in ability to communicate with HIV providers improved from baseline (median score 8, scale 1-10) to 6 months (10, p = 0.004). A higher proportion of the MOCT subset refilled antiretroviral therapy (69% vs. 43% in pre-intervention cohort, p = 0.01), with fewer deaths in the MOCT subset at 6 months (1 death vs. 10 deaths in pre-intervention cohort, p = 0.02) and a decreased likelihood of developing the composite outcome of death/failure to achieve viral suppression at 6 months (adjusted odds ratio = 0.33, p = 0.029). This study demonstrates preliminary intervention uptake and improvement in short-term outcomes for an urban cohort of PLWH, TB, and substance use enrolled in a multi-feature mHealth intervention, a novel strategy for the context. Clinical Trial Registration Number: NCT03819374.

Keywords: acquired immunodeficiency syndrome; human immunodeficiency virus; linkage to care; mobile health; tuberculosis.

Conflict of interest statement

R.D., A.L.W., and J.S. provide consulting services to Warm Health Technology, Inc., an entity that supports dissemination of PositiveLinks. R.D. has also received an investigator-initiated grant from Gilead, Inc., which is unrelated to this study. The other authors have no conflicts of interest to disclose.

Figures

FIG. 1.
FIG. 1.
MOCT platform features. PositiveLinks sidebar with full description of features (A). MOCT platform features include a direct messaging feature that allows patients to communicate with clinic care team members (B), a community message board for anonymous peer messaging (C), tailored educational resources for HIV, TB, and substance use (D), daily queries of stress, mood, and TB and HIV medication adherence, appointment reminders, and access to TB and HIV laboratory results. TB, tuberculosis. (Color image can be found at www.liebertonline.com/apc).

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