Mobile Health Application to Improve HIV Medication Adherence

The CDC estimates that 1.1 million people living in the U.S. are infected with HIV [1]. Only
a quarter of person living with HIV (PLWH) successfully keep the virus under control [2].
Medication non-adherence is a significant contributor to unsuccessful viral suppression; a
recent meta-analysis found that only an estimated 59% of participants in North American
studies were adherent at a commonly accepted minimal threshold for successful viral
suppression [3]. While newer antiretroviral therapy (ART) medications can produce viral
suppression at lower levels of adherence, relatively high adherence is still necessary to
avoid disease progression and shortened lifespan [4-6]. In addition, low levels of adherence
increase the risk of infecting others and contribute to the development of treatment
resistant strains of HIV [7;8].

Interventions have been developed to address the significant public health problem presented
by poor adherence, with most studies demonstrating some degree of success in the short-term
[9]. However, the impact of the interventions is generally not sustained over time [9], and
most HIV treatment settings do not have the resources to deliver more intensive
interventions. As a result, there has been interest in developing efficacious
electronically-delivered interventions. Very little research has focused on establishing the
efficacy of mobile health applications for ART adherence. Further, no published studies have
examined a single session face-to-face intervention combined with a mobile application and
coaching support to reinforce sustained adherence.

Delivered over a smartphone, portable applications would allow for real-time adherence
tracking and feedback and ready access to content or services to enhance adherence. 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. The objective of
this application is to develop a mobile health ART adherence application, to pilot the
application, and to conduct a preliminary randomized controlled trial of the application.

Inclusion Criteria:

- Prescribed ART, infected with HIV, have a detectable viral load (>20 copies/mL) with
the past 6 months, report less than 100% medication adherence, and have a smart phone
capable of downloading the mARTAA application.

Exclusion Criteria:

- Physical impairments that prevent completion of the intervention, cognitive
impairments that jeopardize informed consent and/or intervention comprehension, active
psychosis, and not fluent in English.