Uptake of an App-Based Case Management Service for HIV-Positive Men Who Have Sex With Men in China: Process Evaluation Study

Abstract

Background Men who have sex with men (MSM) in China are disproportionately affected by the HIV epidemic, and medication adherence to antiretroviral treatment in this vulnerable population is suboptimal. To address this issue, we developed an app-based case management service with multiple components, informed by the Information Motivation Behavioral skills model. Objective We aimed to conduct a process evaluation for the implementation of an innovative app-based intervention guided by the Linnan and Steckler framework. Methods Process evaluation was performed alongside a randomized controlled trial in the largest HIV clinic in Guangzhou, China. Eligible participants were HIV-positive MSM aged ≥18 years planning to initiate treatment on the day of recruitment. The app-based intervention had 4 components: web-based communication with case managers, educational articles, supportive service information (eg, information on mental health care and rehabilitation service), and hospital visit reminders. Process evaluation indicators of the intervention include dose delivered, dose received, fidelity, and satisfaction. The behavioral outcome was adherence to antiretroviral treatment at month 1, and Information Motivation Behavioral skills model scores were the intermediate outcome. Logistic and linear regression was used to investigate the association between intervention uptake and outcomes, controlling for potential confounders. Results A total of 344 MSM were recruited from March 19, 2019, to January 13, 2020, and 172 were randomized to the intervention group. At month 1 follow-up, there was no significant difference in the proportion of adherent participants between the intervention and control groups (66/144, 45.8% vs 57/134, 42.5%; P=.28). In the intervention group, 120 participants engaged in web-based communication with case managers and 158 accessed at least 1 of the delivered articles. The primary concern captured in the web-based conversation was the side effects of the medication (114/374, 30.5%), which was also one of the most popular educational articles topics. The majority (124/144, 86.1%) of participants that completed the month 1 survey rated the intervention as “very helpful” or “helpful.” The number of educational articles accessed was associated with adequate adherence in the intervention group (odds ratio 1.08, 95% CI 1.02-1.15; P=.009). The intervention also improved the motivation score after adjusting for baseline values (β=2.34, 95% CI 0.77-3.91; P=.004). However, the number of web-based conversations, regardless of conversation features, was associated with lower motivation scores in the intervention group. Conclusions The intervention was well-received. Delivering educational resources of interest may enhance medication adherence. The uptake of the web-based communication component could serve as an indicator of real-life difficulties and could be used by case managers to identify potential inadequate adherence. Trial Registration Clinicaltrial.gov NCT03860116; https://clinicaltrials.gov/ct2/show/NCT03860116 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-020-8171-5

Enhancing HIV Cognitive Abilities and Self-Management through Information Technology-Assisted Interventions: A Scoping Review (Preprint)

“…However, among the 60 studies included in this article, only 42% (n=25) of the intervention schemes were based on theory-driven approaches, with the remaining studies either not reporting the research framework used or not employing any theoretical framework. Among these 25 studies, the most commonly used theory was the Information-Motivation-Behavior (IMB) theory 13 purposes 16,[65][66][67][68] . The customization of applications tailored to specific populations, such as men who have sex with men (MSM) 40,55,70,71 ,vulnerable adolescents 58 , and transgender women 49 , highlights the flexibility and adaptability of smartphone applications in meeting the diverse health needs of different groups.…”

“…Two studies integrated phone and text message modules to build applications to enhance treatment adherence 65,66 . Communication-oriented mobile applications, such as WhatsApp, WeChat, and Line, were used to create group discussions for implementing interventions 16,67,68 . Lastly, one study utilized the entertainment features of smartphones to develop an iPhone platform game to enhance the subject's compliance 69 .…”