Creating Effective Mobile Phone Apps to Optimize Antiretroviral Therapy Adherence: Perspectives From Stimulant-Using HIV-Positive Men Who Have Sex With Men

Abstract

BackgroundThe use of stimulant drugs among men who have sex with men (MSM) with human immunodeficiency virus (HIV) is associated with decreased odds of antiretroviral therapy (ART) adherence and elevated risk of forward HIV transmission. Advancing tailored and innovative mobile phone–based ART adherence app interventions for stimulant-using HIV-positive MSM requires greater understanding of their needs and preferences in this emerging area.ObjectiveThe purpose of this study is to (1) assess reasons that stimulant-using HIV-positive MSM download and sustain their use of mobile phone apps in general, and (2) obtain feedback on features and functions that these men prefer in a mobile phone app to optimize their ART adherence.MethodsFocus groups were conducted with stimulant-using HIV-positive MSM (24-57 years of age; mostly non-Hispanic white; 42% once a week or more frequent stimulant drug use) in San Francisco and Minneapolis. Our aim was to explore the mobile phone app features and functions that they considered when deciding to download and sustain their use of general apps over time, as well as specific features and functions that they would like to see incorporated into an ART adherence mobile app. Focus groups were audiorecorded and transcribed verbatim. Thematic analysis was applied to transcripts using line-by-line open coding and organizing codes into meaningful themes.ResultsMen reported that they currently had a variety of health and wellness, social media and networking, gaming and entertainment, and utility apps on their mobile phones. Downloading apps to their mobile phones was influenced by the cost of the app, recommendations by a trusted source, and the time it takes to download. In addition, downloading and sustained use of apps was more likely to occur when men had control over most features of the app and apps were perceived to be useful, engaging, secure, and credible. Participants suggested that ART adherence mobile phone apps include social networking features, connections to local resources and their medical chart, and breaking HIV news and updates. Although some men expressed concerns about daily self-monitoring of HIV medication doses, many appreciated receiving a summary of their medication adherence over time and suggested that feedback about missed doses be delivered in an encouraging and humorous manner.ConclusionsIn this study, we were able to recruit a relatively high proportion (42%) of HIV-positive MSM reporting weekly or more stimulant use. These results suggest critical design elements that may need to be considered during development of ART adherence-related mobile phone apps for this, and possibly other, high-risk groups. In particular, finding the optimal balance of security, engagement, usefulness, control capabilities, and credibility will be critical to sustained used of HIV treatment apps.

Health literacy in selected populations: Individuals, families, and communities from the international and cultural perspective

“…Mobile apps have been developed to support patients in the various aspects of their involvement in promoting, maintaining and improving health, such as disease prevention, medication adherence, illness management, lifestyle modification and in navigating the health care system including making appointments in health services [4,9,18,19,40,51]. The most common disease-specific apps aim to provide education on diabetes, hypertension and hepatitis [19].…”

Experience of Using an App in HIV Patients Older Than 60 Years: Pilot Program (Preprint)

“…Experiences of the development of apps in HIV have been published with the purpose of improving adherence [12], but perhaps elderly HIV infected patients represent a group in which this type of apps can promote stigma reduction and sharing experience between peers. The use of mobile applications, where anonymity is preserved, can help reduce the social barriers that these patients have to confront [13].…”

Recommendations for the Development of a Mobile HIV Prevention Intervention for Men Who Have Sex With Men and Hijras in Mumbai: Qualitative Study (Preprint)

“…We utilized snowball sampling [21,24] to recruit MSM into focus groups. Hijras and healthcare providers were asked to participate in individual interviews.…”

“…For persons living with HIV/AIDS (PLHA), preferred content includes information about health care providers and treatment, especially regarding linkage and retention into care and medication adherence [21,22]. Additional features include use of geo-location of HIV testing centers; automated reminders for testing, appointment, and medication adherence; use of existing public or private social networking apps and chat rooms to increase social support; links to role model videos; self-assessment tools; access to sexual health experts; referrals to healthcare providers; and telemedicine [21,[23][24][25][26].…”