Mobile phone technology is increasingly used to overcome traditional barriers limiting access to care. The goal of this study was to evaluate access and willingness to use smart and mobile phone technology for promoting adherence among people attending an urban HIV clinic. One hundred consecutive HIV-positive patients attending an urban HIV outpatient clinic were surveyed. The questionnaire evaluated access to and utilization of mobile phones and willingness to use them to enhance adherence to HIV medication. The survey also included the CASE adherence index as a measure of adherence. The average age was 46.4 ( ). The majority of participants were males (63%), black (93%), and Hispanic (11.4%) and reported earning less than $10,000 per year (67.3%). Most identified themselves as being current smokers (57%). The vast majority reported currently taking HAART (83.5%). Approximately half of the participants reported some difficulty with adherence (CASE < 10). Ninety-six percent reported owning a mobile phone. Among owners of mobile phones 47.4% reported currently owning more than one device. Over a quarter reported owning a smartphone. About 60% used their phones for texting and 1/3 used their phone to search the Internet. Nearly 70% reported that they would use a mobile device to help with HIV adherence. Those who reported being very likely or likely to use a mobile device to improve adherence were significantly more likely to use their phone daily ( ) and use their phone for text messages ( ). The vast majority of patients in an urban HIV clinic own mobile phones and would use them to enhance adherence interventions to HIV medication. 1. Introduction Optimal adherence to HAART strongly predicts HIV viral suppression [1] and is linked to improved survival [2]. Low adherence to HAART in the United States is common with approximately only 50%–70% of prescribed doses taken [3, 4]. One meta-analysis found that those who participated in HAART-related adherence-enhancing interventions were significantly more likely to achieve 95% adherence and viral load suppression compared to the control condition [5]. A recent systematic review analyzed findings from 31 projects assessing use of SMS (short message service) technology, most for patients with HIV/AIDS in developing countries [6]; the findings pointed towards SMS as a promising and mostly well-accepted intervention strategy for use in healthcare. The utilization of technology-based health applications for disease prevention and management has been progressively explored and expanded upon [7–11]. Promising
References
[1]
D. L. Paterson, S. Swindells, J. Mohr et al., “Adherence to protease inhibitor therapy and outcomes in patients with HIV infection,” Annals of Internal Medicine, vol. 133, no. 1, pp. 21–30, 2000.
[2]
F. J. Palella Jr., K. M. Delaney, A. C. Moorman, et al., “Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators,” The New England Journal of Medicine, vol. 338, no. 13, pp. 853–860, 1998.
[3]
D. R. Bangsberg, F. M. Hecht, E. D. Charlebois et al., “Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population,” AIDS, vol. 14, no. 4, pp. 357–366, 2000.
[4]
B. D. Heckman, S. L. Catz, T. G. Heckman, J. G. Miller, and S. C. Kalichman, “Adherence to antiretroviral therapy in rural persons living with HIV disease in the United States,” AIDS Care, vol. 16, no. 2, pp. 219–230, 2004.
[5]
J. M. Simoni, C. R. Pearson, D. W. Pantalone, G. Marks, and N. Crepaz, “Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load: a meta-analytic review of randomized controlled trials,” Journal of Acquired Immune Deficiency Syndromes, vol. 43, supplement 1, pp. S23–S35, 2006.
[6]
C. Deglise, L. S. Suggs, and P. Odermatt, “SMS for disease control in developing countries: a systematic review of mobile health applications,” Journal of Telemedicine and Telecare, vol. 18, no. 5, pp. 273–281, 2012.
[7]
M. C. Gibbons, R. F. Wilson, L. Samal, et al., “Impact of consumer health informatics applications,” Evidence Report/Technology Assessment, no. 188, pp. 1–546, 2009.
[8]
D. L. G. Borzekowski, J. Leith, D. R. Medoff et al., “Use of the internet and other media for health information among clinic outpatients with serious mental illness,” Psychiatric Services, vol. 60, no. 9, pp. 1265–1268, 2009.
[9]
S. Clayton, D. Borzekowski, S. Himelhoch et al., “Media and internet ownership and use among mental health outpatients with serious mental illness,” The American Journal of Drug and Alcohol Abuse, vol. 35, no. 5, pp. 364–367, 2009.
[10]
D. Gandhi, C. Welsh, M. Bennett, J. Carre？o, and S. Himelhoch, “Acceptability of technology-based methods substance abuse counseling in office based buprenorphine maintenance for opioid dependence,” American Journal on Addictions, vol. 18, no. 2, pp. 182–183, 2009.
[11]
S. Himelhoch, D. Mohr, J. Maxfield et al., “Feasibility of telephone-based cognitive behavioral therapy targeting major depression among urban dwelling African-American people with co-occurring HIV,” Psychology, Health and Medicine, vol. 16, no. 2, pp. 156–165, 2011.
[12]
K. E. Heron and J. M. Smyth, “Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments,” British Journal of Health Psychology, vol. 15, part 1, pp. 1–39, 2010.
[13]
S. Krishna, S. A. Boren, and E. A. Balas, “Healthcare via cell phones: a systematic review,” Telemedicine and e-Health, vol. 15, no. 3, pp. 231–240, 2009.
[14]
H. Cole-Lewis and T. Kershaw, “Text messaging as a tool for behavior change in disease prevention and management,” Epidemiologic Reviews, vol. 32, no. 1, pp. 56–69, 2010.
[15]
B. S. Fjeldsoe, A. L. Marshall, and Y. D. Miller, “Behavior change interventions delivered by mobile telephone short-message service,” American Journal of Preventive Medicine, vol. 36, no. 2, pp. 165–173, 2009.
[16]
N. Dowshen, L. M. Kuhns, A. Johnson, B. J. Holoyda, and R. Garofalo, “Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders,” Journal of Medical Internet Research, vol. 14, no. 2, article e51, 2012.
[17]
H. Hardy, V. Kumar, G. Doros et al., “Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy,” AIDS Patient Care and STDs, vol. 25, no. 3, pp. 153–161, 2011.
[18]
M. A. Lewis, J. D. Uhrig, C. M. Bann, et al., “Tailored text messaging intervention for HIV adherence: a proof-of-concept study,” Health Psychology, vol. 32, no. 3, pp. 248–253, 2013.
[19]
T. F. Page, K. J. Horvath, G. P. Danilenko, and M. Williams, “A cost analysis of an internet based medication adherence intervention for people living with HIV,” JAIDS Journal of Acquired Immune Deficiency Syndromes, vol. 60, no. 1, pp. 1–4, 2012.
[20]
J. L. Browna, P. A. Vanableb, M. P. Careyb, and L. Elinc, “Computerized stress management training for HIV+ women: a pilot intervention study,” AIDS Care, vol. 23, no. 12, pp. 1525–1532, 2011.
[21]
J. D. Fisher, K. R. Amico, W. A. Fisher et al., “Computer-based intervention in HIV clinical care setting improves antiretroviral adherence: the lifewindows project,” AIDS and Behavior, vol. 15, no. 8, pp. 1635–1646, 2011.
[22]
E. Aharonovich, E. Greenstein, A. O'Leary, B. Johnston, S. G. Seol, and D. S. Hasin, “HealthCall: technology-based extension of motivational interviewing to reduce non-injection drug use in HIV primary care patients—a pilot study,” AIDS Care, vol. 24, no. 12, pp. 1461–1469, 2012.
[23]
W. N. Gray, D. M. Janicke, E. B. Fennell, D. C. Driscoll, and R. M. Lawrence, “Piloting behavioral family systems therapy to improve adherence among adolescents with HIV: a case series intervention study,” Journal of Health Psychology, vol. 16, no. 5, pp. 828–842, 2011.
[24]
S. C. Kalichman, M. O. Kalichman, C. Cherry et al., “Brief behavioral self-regulation counseling for HIV treatment adherence delivered by cell phone: an initial test of concept trial,” AIDS Patient Care and STDs, vol. 25, no. 5, pp. 303–310, 2011.
[25]
T. M. da Costa, B. J. P. Barbosa, D. A. G. e Costa et al., “Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages,” International Journal of Medical Informatics, vol. 81, no. 4, pp. 257–269, 2012.
[26]
C. Pop-Eleches, H. Thirumurthy, J. P. Habyarimana et al., “Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders,” AIDS, vol. 25, no. 6, pp. 825–834, 2011.
[27]
J. M. Simoni, D. Huh, P. A. Frick et al., “Peer support and pager messaging to promote antiretroviral modifying therapy in seattle: a randomized controlled trial,” Journal of Acquired Immune Deficiency Syndromes, vol. 52, no. 4, pp. 465–473, 2009.
[28]
S. B. Mannheimer, R. Mukherjee, L. R. Hirschhorn et al., “The CASE adherence index: a novel method for measuring adherence to antiretroviral therapy,” AIDS Care, vol. 18, no. 7, pp. 853–861, 2006.
[29]
M. A. Chesney, J. R. Ickovics, D. B. Chambers et al., “Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG Adherence Instruments,” AIDS Care, vol. 12, no. 3, pp. 255–266, 2000.
[30]
M. Duggan and L. Rainie, Cell Phone Activities, Pew Research Center's Internet & American Life Project, Washington, DC, USA, 2012, http://pewinternet.org/~/media//Files/Reports/2012/PIP_CellActivities_11.25.pdf.
[31]
K. C. M. Bahadur and P. J. Murray, “Cell phone short messaging service (SMS) for HIV/AIDS in South Africa: a literature review,” Studies in Health Technology and Informatics, vol. 160, part 1, pp. 530–534, 2010.
[32]
T. Horvath, H. Azman, G. E. Kennedy, and G. W. Rutherford, “Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection,” Cochrane Database of Systematic Reviews, no. 3, Article ID CD009756, 2012.
[33]
R. T. Lester, P. Ritvo, E. J. Mills et al., “Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial,” The Lancet, vol. 376, no. 9755, pp. 1838–1845, 2010.
[34]
K. Sidney, J. Antony, R. Rodrigues, et al., “Supporting patient adherence to antiretrovirals using mobile phone reminders: patient responses from South India,” AIDS Care, vol. 24, no. 5, pp. 612–617, 2012.
[35]
M. Bachhuber, W. B. Bilker, H. Wang, J. Chapman, and R. Gross, “Is antiretroviral therapy adherence substantially worse on weekends than weekdays?” Journal of Acquired Immune Deficiency Syndromes, vol. 54, no. 1, pp. 109–110, 2010.
[36]
D. Skinner, U. Rivette, and C. Bloomberg, “Evaluation of use of cellphones to aid compliance with drug therapy for HIV patients,” AIDS Care, vol. 19, no. 5, pp. 605–607, 2007.
[37]
W. H. Curioso and A. E. Kurth, “Access, use and perceptions regarding Internet, cell phones and PDAs as a means for health promotion for people living with HIV in Peru,” BMC Medical Informatics and Decision Making, vol. 7, article 24, 2007.
[38]
W. H. Curioso, D. A. Quistberg, R. Cabello, et al., “‘It's time for your life’: how should we remind patients to take medicines using short text messages?” AMIA Annual Symposium Proceedings, vol. 2009, pp. 129–133, 2009.
