There are more than a million Americans who are infected with HIV. Highly effective antiretroviral therapy (ART) makes it possible for persons living with HIV (PLWH) to have longer, healthier lives. Despite treatment advances, only a quarter of PLWH successfully keep the virus under control. Medication non-adherence is a significant contributor to unsuccessful viral suppression. As a result, interventions targeting adherence have been developed, with most interventions demonstrating some degree of success in the short-term. However, the impact of these interventions is generally not sustained over time, and it is not feasible to deliver more intensive adherence interventions in most HIV treatment settings. As a result, there has been interest in developing efficacious electronically-delivered interventions. This work is still in its infancy, and there is a paucity of work that has been done to establish the efficacy of mobile health ART adherence applications. A mobile health application would maximize the portability of the intervention and allow for real-time adherence tracking and feedback and ready access to content or services to enhance adherence. The present proposal aims to develop and refine a mobile health ART adherence application and to conduct a preliminary randomized controlled trial (RCT) comparing a face-to-face ART adherence intervention followed by the mobile health ART adherence application (mARTAA) to the face-to-face adherence intervention alone, which approximates standard-of-care (SOC). The long-term goal of this line of research is to disseminate an efficacious, mobile health ART adherence application that can be integrated readily into clinical care. In Phase 1 of the proposed study, we will develop and refine mARTAA using an iterative process of piloting and modification based on data collected from pilot participants (n=20). Phase 2 (n=60) will consist of a preliminary RCT comparing mARTAA and SOC. Participants in the RCT will complete a baseline interview and follow-up interviews at 1, 3, 6, and 12 months. The primary outcome variable will be ART adherence based on electronic pill box data. We expect that, as a result of this project, we will have developed and demonstrated the efficacy of a mobile health application to improve ART adherence that can be disseminated easily into real-world clinical settings. Such an intervention holds the promise of improving HIV viral suppression, slowing disease progression, reducing HIV-related morbidity and mortality, decreasing the risk of HIV infection in others, and minimizing the production of treatment resistant strains of HIV.

Public Health Relevance

HIV medications can be very effective at helping patients have longer, healthier lives. However, many patients do not take their HIV medications as prescribed. The proposed study aims to develop and test a mobile health application to improve HIV medication adherence.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
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Stirratt, Michael J
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Rhode Island Hospital
Independent Hospitals
United States
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