Development of PositiveLinks: A Mobile Phone App to Promote Linkage and Retention in Care for People With HIV

Colleen Laurence, Erin Wispelwey, Tabor E Flickinger, Marika Grabowski, Ava Lena Waldman, Erin Plews-Ogan, Claire Debolt, George Reynolds, Wendy Cohn, Karen Ingersoll, Rebecca Dillingham, Colleen Laurence, Erin Wispelwey, Tabor E Flickinger, Marika Grabowski, Ava Lena Waldman, Erin Plews-Ogan, Claire Debolt, George Reynolds, Wendy Cohn, Karen Ingersoll, Rebecca Dillingham

Abstract

Background: Linkage to and retention in HIV care are challenging, especially in the Southeastern United States. The rise in mobile phone app use and the potential for an app to deliver just in time messaging provides a new opportunity to improve linkage and retention among people living with HIV (PLWH).

Objective: This study aimed to develop an app to engage, link, and retain people in care. We evaluated the acceptability, feasibility, and impact of the app among users.

Methods: App development was informed by principles of chronic disease self-management and formative interviews with PLWH. Once developed, the app was distributed among participants, and usability feedback was incorporated in subsequent iterations. We interviewed app users after 3 weeks to identify usability issues, need for training on the phone or app, and to assess acceptability. We tracked and analyzed usage of app features for the cohort over 2 years.

Results: A total of 77 participants used the app during the pilot study. The query response rate for the first 2 years was 47.7%. Query response declined at a rate of 0.67% per month. The community message board was the most popular feature, and 77.9% (60/77) of users posted on the board at least once during the 2 years.

Conclusions: The PositiveLinks app was feasible and acceptable among nonurban PLWH. High participation on the community message board suggests that social support from peers is important for people recently diagnosed with or returning to care for HIV.

Keywords: HIV; mHealth; retention in care; treatment adherence and compliance.

Conflict of interest statement

Conflicts of Interest: RD, KI, and ALW have consulting agreements with Warm Health Technology, Inc. This company was formed in April 2018 to support dissemination of PositiveLinks to other entities caring for PLWH. The other authors have no conflicts of interest to declare.

©Colleen Laurence, Erin Wispelwey, Tabor E Flickinger, Marika Grabowski, Ava Lena Waldman, Erin Plews-Ogan, Claire Debolt, George Reynolds, Wendy Cohn, Karen Ingersoll, Rebecca Dillingham. Originally published in JMIR Formative Research (http://formative.jmir.org), 20.03.2019.

Figures

Figure 1
Figure 1
Screenshots of key app features: a: app home screen; b: medication query; c: mood query; d: appointment page; e: community message board; f: FAQ section.
Figure 2
Figure 2
Screen shot of graphs showing mood, stress, and medication tracking: a: dashboard overview; b: medication calendar view; c: mood graph; d: stress graph.
Figure 3
Figure 3
Graphs of cohort engagement over the first 2 years of the pilot study: a. monthly query response rates; b. community board usage per enrolled member.
Figure 4
Figure 4
Cohort screen views over the first 2 years of the pilot study: a: monthly screen views for the cohort; b: monthly screen views per enrolled member.
Figure 5
Figure 5
Split notification screen: a: home screen before feedback; b: home screen after member feedback.

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