Effectiveness of mHealth on Adherence to Antiretroviral Therapy in Patients Living With HIV: Meta-analysis of Randomized Controlled Trials

Intervention With WhatsApp Messaging to Compare the Effect of Self-Designed Messages and Standardized Messages in Adherence to Antiretroviral Treatment in Young People Living With HIV in a Hospital in Lima, Peru: Protocol for a Nonblinded Randomized Controlled Trial

BACKGROUND

Young people living with HIV face challenges in consistently adhering to antiretroviral therapy (ART). Although mobile health interventions, particularly those using SMS text messaging, have been implemented to improve ART adherence, many lack a focus on specific behavioral mechanisms. Interventions incorporating behavioral change techniques (BCTs), especially those emphasizing customization, may enhance effectiveness. WhatsApp offers potential for delivering tailored, behaviorally grounded interventions with diverse communication features. We hypothesize that WhatsApp messages self-designed by participants, with spontaneous targeting of BCTs, could be more effective than standard WhatsApp messages designed by the researchers to improve ART adherence.

OBJECTIVE

The objective of this study is to evaluate the effectiveness of WhatsApp messages created by participants (self-designed) compared to WhatsApp messages designed by the researchers (standardized) over adherence to ART at 16 weeks of intervention in young people living with HIV who receive HIV care under routine conditions at a public hospital in Lima, Peru.

METHODS

A 2-arm randomized controlled trial with a parallel assignment of 1:1, with no blinding of study intervention, was performed. Eligible participants are consenting people living with HIV aged 18-29 years who receive HIV care at the study center and whose mobile phones support WhatsApp. Following informed consent and a baseline survey on clinical and personal preferences (eg, timing and frequency of messages), participants are randomized to the control group (messages designed by the research team) or to the experimental group (messages designed by participants), stratified by sex, educational level, current ART intake, and history of ART abandonment. Participants in both groups receive up to 3 WhatsApp messages per week for 16 weeks. ART adherence, the primary outcome, is measured using the Simplified Medication Adherence Questionnaire (SMAQ) at 4, 8, 12, and 16 weeks. Monthly feedback questionnaires on user experience are also administered. The WhatsApp chat format allows two-way communication between participants and the research team throughout the study. We will compare ART adherence between 2 groups at 16 weeks under the intention-to-treat principle, with no interim analysis planned. Based on an estimated 10% difference in adherence, 78.9% power, and a 2-sided α of .05, the target sample size was set at 120, later increased to 131 to include a 2-week pilot phase.

RESULTS

In March 2024, we started enrolling and randomizing participants. The study follow-up will continue until the last participant completes 16 weeks of intervention (November 2024). As of February 2025, we are in the process of data curation.

CONCLUSIONS

This trial will compare the effectiveness of standardized vs self-designed WhatsApp messages on ART adherence measured at 16 weeks among young people living with HIV receiving routine care in a low-resource setting in Lima.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06500013; https://clinicaltrials.gov/ct2/show/NCT06500013.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/66941.

Telehealth Interventions to Improve HIV Care Continuum Outcomes: A Narrative Review

Interventions that leverage telehealth technologies have the potential to improve health outcomes among people with HIV who experience multiple complex barriers to care. To assess the current state of knowledge on telehealth interventions for people with HIV in the United States, we searched the literature for recent (2019-2023) telehealth interventions designed to improve outcomes along the HIV care continuum, including linkage to care, retention in care, antiretroviral therapy adherence, and viral suppression. Our search identified 23 interventions. Text messaging was the most common telehealth delivery mode, followed by videoconferencing, commercially available applications, and novel applications. Nine interventions used more than one delivery mode. Common features across interventions to address barriers along the HIV care continuum included: HIV care self-management and monitoring tools; HIV treatment and adherence education; resources and referrals provision; live messaging for ongoing support or urgent issues; videoconference-based coaching, counseling, case management, or care; online peer-to-peer support; ecological momentary assessments to monitor and address barriers; and game-based elements to increase engagement. Interventions were reported as acceptable and feasible, with several showing an effect on antiretroviral therapy adherence. Further research is needed to fully leverage the potential of telehealth for ending the HIV epidemic in the United States.

Low cluster of differentiation 4+ T-cell count associated with thrombocytopenia among people living with human immunodeficiency virus-1 receiving antiretroviral in West Papua

Introduction. Anaemia and thrombocytopenia are blood-related irregularities linked to an increased likelihood of disease progression, leading to death in people living with human immunodeficiency virus 1 (PLHIV).Gap statement. Severe clinical conditions associated with human immunodeficiency 1 (HIV-1) infection may be related to blood irregularities among PLHIV.Aim. The study aimed to examine the factors correlated with blood irregularities among PLHIV receiving antiretroviral treatment in West Papua.Methodology. We conducted a study at hospitals in West Papua involving 80 participants who received antiretroviral therapy (ART) and agreed to provide informed consent. Standardized and validated questionnaires were used for data collection. Sequential assessment of haematological and immunological parameters was performed using Sysmex haematology and PIMA CD4+ analyser. Fisher's exact test and logistic regression analysis were applied, with a significance level set at P<0.05, to identify the key factors positively associated with blood irregularities.Results. The overall incidences of anaemia and thrombocytopenia were 56.3 and 40%, respectively. Fisher's exact test indicated that anaemia [adjusted odds ratio (AOR): 3.02; 95% confidence interval (CI): 1.160-7.866; P<0.05] and low CD4+ T-cell count (AOR: 3.81; 95 % CI: 1.485-9.820, P<0.05) were significantly associated with thrombocytopenia. Logistic regression analysis revealed that the most influential factor contributing to thrombocytopenia-related blood irregularities was the clinical CD4+ T-cell count (B=3.818; 95% CI: 1.485-9.820, P<0.05).Conclusion. CD4+ T-cell count was indicated as the main factor causing thrombocytopenia among PLHIV receiving ART in West Papua. It is crucial to conduct screening and regular haematological assessments among PLHIV having low CD4+ T-cell counts to mitigate morbidity and mortality risks.

Brief communication: Effect of mobile health intervention on medication time adherence among people living with HIV/AIDS receiving care at selected hospitals in Owerri, Imo State Nigeria

AIM

This study aimed to assess the impact of Mobile health (M-health) on medication time adherence among people living with HIV/AIDS (PLWHA).

METHODS

The study included all PLWHA who were receiving care at the Federal University Teaching Hospital Owerri (FUTH) and Imo State Specialist Hospital (ISSH) Umugumma during the study duration. The test group (FUTH) received a 2-way text message sent three times a week and a once-a-week phone call, while the control group (ISSH) received only the standard care.

FINDINGS

The result shows that the adherence was higher among PLWHA in the test group compared to those in the control group (P = 0.000, χ2 = 168.62, 95% confidence interval (CI): 7.22 to 16.19).

CONCLUSION

M-health intervention significantly improved the medication time adherence among the participants in the test group compared to those in the control group.

Alignment and specifics of Brazilian health agencies in relation to the international premises for the implementation of digital health in primary health care: a rhetorical analysis

Digital health and sustainable development goals have had strong impacts with the COVID-19 pandemic. In Brazil, the health crisis scenario required changes in social welfare programs and policies, based on recommendations from international agencies, such as the UN and WHO. This study aims to analyze the alignment of the arguments of Brazilian and international organizations for the adoption of digital health in Primary Health Care based on the COVID-19 pandemic. This is a qualitative documentary study of the rhetorical analysis type, based on Perelman and Obrechts-Tyteca's Theory of Argumentation. The search for documents was carried out by two independent researchers, between December 2021 and June 2022, through the websites of the World Health Organization, the Pan American Health Organization, the Brazilian Ministry of Health, and the Federal Councils of Medicine and Brazilian nursing, with the terms "digital health," "telehealth," "telemedicine," "e-health," "telehealth," "telenursing," "telemedicine," and "digital health." Twenty official documents were analyzed and identified in terms of context, authorship, authenticity, reliability, nature, and key concepts. The international and Brazilian arguments emphasize the applicability of Information and Communication Technologies (ICTs) in the health field. In logical arguments, based on the structure of reality, international agencies emphasize the overlap between health needs and the conditions for the applicability of ICTs. In Brazil, however, there was a need to regulate the digital practices of health professionals. In the international discourse, in the structuring of reality, there are illustrations of the relationship between the context of the health crisis caused by COVID-19 and the concrete conditions for the applicability of digital health; while in the Brazilian discourse, the need to strengthen an environment conducive to digital health is explicit. The Brazilian alignment in relation to the international premises is evident. Yet, there is a need, socially and economically sustainable, to strengthen the inclusion of digital health in PHC policy.

A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol

BACKGROUND

While there is no cure for HIV, adherence to antiretroviral therapy can extend the lifespan and improve the quality of life of people with HIV. Despite the global reduction of HIV infection rates in recent years, New York City and La Romana, Dominican Republic, continue to report high infection rates among Latino populations. Many people with HIV remain virally unsuppressed in these geographic hotspots, suggesting a need for additional interventions to overcome medication adherence barriers. Tailored and culturally appropriate mobile health (mHealth) technology can be an engaging way to improve adherence. The primary objective of this trial is to test the effectiveness of an mHealth tool to improve HIV medication adherence among Spanish-speaking people living in New York City and the Dominican Republic.

METHODS

The WiseApp study is a two-arm randomized controlled trial among 248 people with HIV across the New York and Dominican Republic sites over the course of 12 months. Participants are randomly assigned to either receive a CleverCap pill bottle that is linked to the WiseApp (intervention) or standard of care (control). All participants complete surveys at baseline, 3-month, 6-month, and 12-month follow-up visits and the study team obtains HIV-1 viral load and CD4 count results through blood draw at each study timepoint.

DISCUSSION

The use of mHealth technologies to improve medication adherence among people with HIV has been implemented in recent years. Although some studies have found improvement in adherence to antiretroviral therapy in the short term, there is limited information about how these interventions improve adherence among Spanish-speaking populations. Disproportionate rates of HIV infection among Latinos in New York City suggest an existing inequitable approach in reaching and treating this population. Due to a lack of mHealth studies with Latino populations, and apps tailored to Spanish-speakers, the WiseApp study will not only demonstrate the effectiveness of this particular mHealth app but will also contribute to the mHealth research community as a whole.

TRIAL REGISTRATION

This trial was registered with Clinicaltrials.gov (NCT05398185) on 5/31/2022.

Scheduling of Remote Monitoring for Peritoneal Dialysis Patients

Peritoneal dialysis (PD) is performed as a home-based treatment and in this context, telemedicine has been proven helpful for improving clinicians' surveillance and maintaining PD patients in their home setting. The new e-health devices make remote patient monitoring (RPM) for automated peritoneal dialysis (APD) treatment possible, evaluating the data at the end of every treatment and adapting the prescription at distance if necessary. This paper aims to share a method for improving clinical surveillance and enabling PD patients to receive their treatment at home. In the present case series, we delineate the clinical protocol of the Vicenza PD Center regarding patient characteristics, timing, and the purpose of the APD-RPM. We present the Vicenza PD Center's experience, illustrating its application through three case reports as exemplars. Telemedicine helps to carefully allocate healthcare resources while removing the barriers to accessing care. However, there is a risk of data overload, as some data might not be analyzed because of an increased workload for healthcare professionals. A proactive physician's attitude towards the e-health system has to be supported by clinical instructions and legislative rules. International and national guidelines may suggest which patients should be candidates for RPM, which parameters should be monitored, and with what timing. According to our experience, we suggest that the care team should define a workflow that helps in formulating a correct approach to RPM, adequately utilizing resources. The workflow has to consider the different needs of patients, in order to assure frequent remote control for incident or unstable patients, while prevalent and stable patients can perform their home treatment more independently, helped by periodic and deferred clinical supervision.

Interviews with HIV Experts for Development of a Mobile Health Application in HIV Care-A Qualitative Study

The Communication and Tracing App HIV (COMTRAC-HIV) project aims to develop a mobile health application for integrated care of HIV patients due to the low availability of those apps in Germany. This study addressed organizational conditions and necessary app functionalities, especially for the care of late diagnosed individuals (late presenters) and those using pre-exposure prophylaxis. We followed a human-centered design approach and interviewed HIV experts in Germany to describe the context of use of the app. The interviews were paraphrased and analyzed with a qualitative content analysis. To define the context of use, user group profiles were defined and tasks derived, which will represent the functionalities of the app. A total of eight experts were included in the study. The results show that the app should include a symptom diary for entering symptoms, side effects, and their intensity. It offers chat/video call functionality for communication with an HIV expert, appointment organization, and sharing findings. The app should also provide medication overview and reminders for medications and appointments. This qualitative study is a first step towards the development of an app for HIV individuals in Germany. Further research includes involving patients in the initial app design and test design usability.