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

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.

Long term impact of PositiveLinks: Clinic-deployed mobile technology to improve engagement with HIV care

“…Two iterations of the PL app were used during this study: PL 1.0 (launched September 2013) and PL 2.0 (launched June 2016). Details of the development of PL 1.0 and its preliminary findings have been previously published, including a summary of early formative and pilot work and qualitative assessments of PL users and features [24][25][26][27][28]. PL 2.0 was developed as a result of feedback from usability interviews with PL participants ("members") and providers.…”

“…PositiveLinks (PL) is a clinic-based mobile platform designed to increase engagement in care among PLWH. Details of the development of PL have been published elsewhere [24]. Briefly, PL was developed using evidence-based principles for chronic disease self-management and iterative formative research with the target clinic population.…”

“…Briefly, PL was developed using evidence-based principles for chronic disease self-management and iterative formative research with the target clinic population. PL has a patient mobile app that contains features such as medication reminders, mood and stress check-ins, provider messaging, informational resources, and an anonymous community board that allows users to interact with one another [24]. Results from a prospective observational pilot study demonstrated an improvement in viral suppression and engagement in care among PL users 12 months after receiving the app [25].…”

Iterative Development of a Mobile Phone Application to Support Community Health Volunteers during Cervical Cancer Screening in Western Kenya

“…The iterative development process, whereby relevant stakeholders with a diversity of perspectives provided input in a cyclical manner, proved to be effective at creating a viable, functioning application for use in small-scale pilot testing. The stakeholder-engaged, iterative process, which has been employed in many studies, [18][19][20]35,36 yielded critical insight that could not have been gathered otherwise. For example, many of the word choices and sentence structures included within the platform were considered to be unclear and not likely to be understood by clients during use, even though this language originated from materials provided by Kenyan research staff.…”

“…[11][12][13][14][15] There is a large body of evidence supporting the feasibility, acceptability, and usability of a variety of mhealth interventions that target a wide range of health conditions such as depression, diabetes, HIV/AIDS, and cancer. [16][17][18][19][20][21][22] While many mhealth interventions are patient-sided, there are a growing number of provider-sided applications which seek to support and improve the delivery of health services. 10,16 These novel approaches provide a platform for the effective delivery of evidence-based practices targeting a range of health outcomes in often unreached or hard-to-reach populations, and can be used to support task shifting of health delivery to CHVs or other lay health workers.…”