Effect of a Smartphone Application Incorporating Personalized Health-Related Imagery on Adherence to Antiretroviral Therapy: A Randomized Clinical Trial

Abstract

Poor adherence to combination antiretroviral therapy (ART) is a major global challenge. In this study we examined the efficacy of a smartphone application incorporating personalized health-related visual imagery that provided real-time information about the level of medication and the patient's level of immunoprotection, in order to improve adherence to ART. We randomized 28 people on ART to either a standard or augmented version of the smartphone application. The augmented version contained components that illustrated participants' current estimated plasma concentrations of antiretroviral drugs and the immune protection provided by ART. Adherence to ART was assessed at baseline and at 3 months using self-reported adherence, pharmacy dispensing records, and HIV viral load. Information was also collected on illness and medication beliefs and use of the application. Participants who received the augmented application showed a significantly higher level of self-reported adherence to ART at 3 months (p=0.03) and decreased viral load (p=0.023) as compared to individuals using the standard version. Greater usage of the extra components of the augmented application was associated with greater perceived understanding of HIV infection and increased perceived necessity for ART. Smartphone applications that incorporate personalized health-related visual imagery may have potential to improve adherence to ART.

Importance of Self-Motivation and Social Support in Medication Adherence in HIV-Infected Adolescents in the United Kingdom and Ireland: A Multicentre HYPNet Study

“…A randomized controlled trial (n = 431) of text reminders in adults have been shown to improve adherence to ART, 23 and requires further investigation in adolescents and young adults. Another smaller randomized controlled trial (n = 28) 24 showed improved adherence with a smartphone adherence application, demonstrating the potential for innovative technological approaches in improving medication compliance.…”

Mobile App Usage Patterns of Patients Prescribed a Smoking Cessation Medicine: Prospective Observational Study (Preprint)

“…Advantages associated with the smartphone-enabled survey that was accessible via the Pfizer Meds application included increased accuracy of data entry relative to paper surveys, timely 17 Final PfizerMeds Chantix App Manuscript.doc collection of participant responses, and a relative cost reduction compared to survey administration by a separate stand-alone data source.…”

“…Several studies have demonstrated the efficacy of medication and counseling to support smoking cessation. In a large prospective, randomized, double-blind, active-and placebo-controlled pharmacotherapy trial which evaluated the neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine replacement therapy (NRT) patch, versus placebo, varenicline showed superior efficacy to placebo (p <0.0001) and both bupropion and NRT patch (p <0.0001) at the end of treatment (weeks 9 through 12) and follow-up (weeks [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Bupropion showed similar efficacy to NRT patch (p=0.6002) and both showed superior efficacy versus placebo (p <0.0001).…”

“…Patient educational programs have proliferated to provide health and wellness support through tools such as apps and including a focus on improving adherence to medications [13][14][15][16][17][18]. High levels of medication adherence are associated with better clinical outcomes, greater treatment satisfaction, better quality of life, and lower overall health care costs [19].…”

Participatory medicine: model based tools for engaging and empowering the individual

“…This study found that the visual animations promoted more positive beliefs about the illness, and motivated behavioural change including enhanced exercise and quicker return to normal activities. Another computer simulation of HIV virus infection and the protection provided by medication resulted in improved patient adherence to prescribed medication [12].…”