Usability of a Mobile Health Application in Older HIV...

Usability of a Mobile Health Application in Older HIV-Infected Patients: An Emerging Tool for Care, Education

and Prevention

Jordi Puig Pla, RN

Fundació Lluita Contra la Sida. Germans Trias University Hospital. Badalona,Spain

Background Objectives Methods

• HIV is becoming a complex chronic disease associated with numerous

medical, psychological and social problems, which requires the attention

and experience of a wide range of health specialists

• In 2015, about 50% of HIV-infected patients had more than 50 years

• Increase in the cost of HIV care associated with aging:

• More expensive ART (more complex regimes)

• More comorbidities

• Concomitant medication interactions

• Adherence problems

DiscussionResults

• The development of mobile devices has growing in the health field

• This technology could influence the prevention or treatment of patients

with chronic disease (diabetes, HTA, etc ...)

• Information and communication technologies are a new strategic

element to improve the health of citizens and ensure a quality, modern

and sustainable health system.

• APPs in health can help in greater involvement and co-responsibility of

users through self-care and self-management of health.

Background Objectives Methods DiscussionResults


1) Previously the clinical trial: To determine the interest of our patients

with respect to a medical APP as well as the sections of interest to

monitor their health using a self-report 8-item survey

2) To determine the usability of a specific APP among HIV-infected

patients aged 60 years or older at week 24 and a final analysis at

week 48 was repeated to determine the usability at the end of the

study.

DiscussionResults

Secondary objectives

1) To compare the number of presently visits to the HIV Unit over the

study period between both groups (APP vs controls);

2) To compare the patients’ satisfaction in the APP group assessed by a

test ad hoc ranging from 1 (worst) to 5 (best) between baseline and

week 48;

3) To compare between both groups the quality of life at week 48 by a

test of life, SERAD, patients adherence by an adherence test, MOS

and some clinical parameters.



Design:

A prospective, randomized, case-control, 48-week, pilot study was

conducted in HIV-infected population aged 60 years or older, to assess

the usability of a specific APP for these population and changes in

their satisfaction and quality of life.

Subjects:

One hundred patients were randomized to:

- APP group: APP+routine medical controls (N:50) or

- Control group: routine medical controls (N:50).

DiscussionResults


• Inclusion Criteria:

o Patient aged 60 years or older infected with HIV in antiretroviral treatment.

o Experience to the use Smartphone.

o Commitment to regular monitoring of scheduled visits.

o Acceptance and signature of informed consent.

o Exclusion Criteria:

o Patients with pathology that hinders the understanding and use of mobile

applications were excluded.

DiscussionResults


Parameter Baseline visit24 week

follow-up

48 week

follow-up

Informed consent (IC) X

Randomization XA

Training App XA

Physical examination X X

DXA scan XB X

Laboratory test X X

Viral Load X X

CD4/CD8 t-cell count X X

HCV serology XC X

HBV serology XC X

Syphilis (VDRL test) X X

Quality of life test (MOS-HIV test)

X X

Satisfaction test (Likert scale) X X

Interim questionnaire XD

Adverse Events X X

Comorbidities X X

Concomitant medication X X

Adherence to ART (SMAQ questionnaire)

X X


Health Center

iOS and Android

Patients

Backoffice from web browser


Medical records: documents, images, graphs


Apointments: Scheduled visits, changes, cancelations


Communication with health center

PUSH

Notifications

Mail

SMS

Video calls

Ceter Pacient


Medication reminders, Delivery at home


Educational trainings, videos, diets, Forms

Background Objectives DiscussionResultsMethods

Total APP Control

Age(Years;IQR) 65 (63-69) 66(63-69) 64 (62-70)

Sex (% Male) 39 (78%) 43 (86%)

HIV History (Years) 21(16-25) 23(18-26) 20 (15-25)

Total ART Time (Years) 19 (13-23) 21 (13-23) 18 (13-23)

Actual ART Time (Years) 1.2(0.4-2.6) 1.3(0.3-3.1) 1.0 (0.6-2.4)

Actual ART(%)

PI 24% 23% 26%

NUNC 2% 3% 4%

INI 38% 39% 37%

Other 36% 35% 33%

Risk Group (%)

MSM 46% 52% 40%

HSM 25% 18% 32%

Drug users 9% 8% 10%

Hepatitis C positive (%) 12 (12%) 4 (8%) 8 (16%)

Undetectable HIV-1 RNA

(Cops per ml)

94 (96%) 48(96%) 47(94%)

CD4 count (cells per ml)

Median (IQR) 562 (422-746) 596(472-782) 536(380-696)

<200 3(3%) 2(4%) 1(2%)

• In the APP group, the percentage of patients who used the APP increased from

52.2% at week 24 to 73.8% at week 48 after a weekly reminder, as well as the

different days that patients used the APP (from 14.2 to 23.7).

• The most visualized screens were health counseling educational

recommendations and medical record [24.8% and 22.2% respectively].

• Patients aged from 60 to 65 years old were the patients that most actively used

the APP (P=0.029).


• At week 48, 85.2% of patients thought that the APP was useful and 91.4% of

patients would recommend the APP to other friends or relatives.

• The APP was well valuated by participants [4.79 (±0.41) out of 5.00] and 64.6%

thought that the APP improved their health attention.

• The number of presently visits in the HIV unit over the study were significative

lower in the APP group (4.29 to 5.33 p=0.03).

• There were no significant changes in patient’s quality of life, adherence and

clinical parameters recorded.


Background Objectives DiscusionMethods Results

• Our study shows a low usability of the APP among this population (mainly among

those aged over 65 years old), that increased a weekly reminders suggesting that

an appropriate training would increase their use.

• It is therefore necessary to promote the knowledge and motivation of this age

group about the mobile applications since this is a target group for using new

strategies to better manage them. Meanwhile, young HIV-infected people could

take advantage of these applications.

• The m-health will be a basic element for monitoring chronic diseases. A large

proportion of adults, especially those who are older than 65, have a chronic

pathology that requires a closer attention. When the percentage of older people

who handle APP rises, a solid and proven strategy for use should already be

established.

Acknowledgments

Funding

The study was supported by Gilead grant (Goshape 2015).

Acknowledgments:

Usability of a Mobile Health Application in Older HIV...

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