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Use of mHealth Technology for Supporting Symptom Management in Underserved Persons Living with HIV

Project Final Report (PDF, 526.82 KB) Disclaimer

mHealth technologies can decrease HIV-related symptoms in medically underserved populations.

Project Details -
Completed

The success of HIV medications and treatments has significantly altered the course of the disease. While AIDS-related illnesses are no longer typically fatal, treatment does not fully restore immune health, and chronic co-morbidities create a lifetime of symptom management. The ability to self-manage symptoms of HIV has been shown to improve patient-centered outcomes. Self-management involves helping patients set achievable goals and learn problem-solving techniques that will improve their outcomes and quality of life.

This project tested a mobile health application (app) called mobile Video Information Provider (mVIP) that incorporated findings from patient-centered outcomes research (PCOR). It used smartphones and tablets to provide people living with HIV (PLWH) real-time feedback and access to symptom management strategies. The project focused on communities with the greatest burden of HIV in the United States, including racial and ethnic minorities and those of low socioeconomic status.

The specific aims of the project were as follows:

  • Apply participatory design methods to incorporate PCOR evidence for HIV symptom management into the mVIP app for use in patient self-care. 
  • Using a randomized design, examine the effect of mVIP as compared to a control group on primary outcomes of symptom frequency and intensity. 
  • Guided by the PRECEDE-PROCEED model of health program planning and evaluation, examine perceptions of the predisposing, enabling, and reinforcing factors for mVIP use among PLWH. 

Researchers conducted a 12-week feasibility study with 80 PLWH in New York City. Participants were randomized to either the mVIP intervention, which included self-care strategies for improving 13 commonly experienced symptoms in PLWH, or to the control version of mVIP without self-care strategies. Findings indicated that use of the app was associated with improvement in symptoms and was easy to use. Intervention group participants showed a significantly greater improvement than the control group in five symptoms: anxiety; depression; neuropathy; fever, chills, or sweating; and weight loss or wasting. This group also showed greater improvement in adherence to their antiretroviral medications. Researchers believe that future studies should consider the long-term effect of the intervention to demonstrate sustainability, evaluate implementation across other settings, and examine the use of this intervention in other languages.

Using Mobile Technology to Self-Manage HIV Symptoms

Key Finding and Impact:

mHealth technologies can decrease HIV-related symptoms in medically underserved populations.

HIV has evolved from an acute illness to a chronic disease that requires chronic disease management.

People with HIV are living longer due to the availability of improved treatments, including medication regimes that may have symptoms and side effects. Managing these symptoms is crucial for maintaining quality of life; however, overburdened providers often have limited time to optimally manage symptoms. Racial and ethnic minorities, as well as those of low socioeconomic status, often have less access to health information and consequently experience symptoms at higher rates than other people with HIV.

Developing a health IT tool that is useful and helpful to underserved populations.

“This is an opportunity to be able to disseminate this health information to communities that are the most at risk for not being able to access their health information, are least likely to self-manage their health, and have the poorest health outcomes.”
- Dr. Rebecca Schnall

Recognizing the importance of symptom management in at-risk populations, Dr. Rebecca Schnall and her Columbia University-based research team developed an mHealth app, called the mobile Video Information Provider (mVIP), with evidence-based self-care strategies that guide people with HIV in self-managing their HIV-related symptoms. Tested using a rigorous user-centered design process, Dr. Schnall’s randomized pilot study is one of the first to examine mobile app use within a population of individuals of low income and largely racial and ethnic minorities.

mVIP users reported a decrease in HIV-related symptoms.

mVIP use was associated with an improvement in symptoms, high user satisfaction, and a self-reported increase in medication adherence. Persons who had access to mVIP’s care strategies reported less anxiety, depression, fevers, neuropathy, and weight loss than persons who did not have access to the care strategies. Technologies such as mVIP could result in increased quality of life, reduced administrative burden, and reduced health care costs due to decreased visit complexity and overall fewer visits. While Dr. Schnall recommends a larger and longer study be conducted of this app, she believes the current findings could guide future work in the application of the app to other chronic care diseases.