The Wise App Trial for Improving Health Outcomes in PLWH

Although HIV is now considered a chronic condition, sustained adherence to antiretroviral therapy (ART) is essential to disease management and maintaining viral suppression. Despite the development of simplified, single-tablet regimens, adherence remains difficult for some people with HIV. There is growing evidence across a variety of chronic diseases that the use of mobile health (mHealth) applications (apps) can support self-management of chronic disease management, including medication adherence and improvement in symptom burden. Based on this need and growing evidence, the research team used participatory research methods to design and develop a self-management mHealth app (“WiseApp”) for HIV self-management to help these individuals better manage their health and monitor their medication adherence.

The specific aims were as follows:

• Build a functional app for HIV self-management linked to a smart pill box (WiseApp) for people with HIV, and assess its usability.
• Evaluate the impact of the Wise App on medication adherence in people with HIV.
• Assess perceptions of the predisposing, enabling, and reinforcing factors for WiseApp use through theoretically guided focus group sessions.

The development of the app was guided by the Information Systems Research (ISR) framework and incorporated end-user feedback throughout the design process. The resultant WiseApp includes the following components: 1) testimonial videos of people with HIV; 2) push-notification reminders; 3) medication trackers; 4) health surveys; and 5) a “To-Do” list outlining tasks for the day, such as medications and goal steps to take. A key component of the app is a medication tracker linked to an electronic pill bottle and a capability to link to a fitness tracker and monitor physical activity. The app can send tailored reminders based on feedback from the linked devices, such as medication reminders if the pill bottle has not been opened, or reminders to walk more steps. In addition to the home screen, the WiseApp has three additional domains, including a screen to review medication adherence; a chat room; and a “Me” screen, where users can set up their preferences and settings.

The team conducted a randomized controlled trial to evaluate the impact of the app on ART adherence and found a statistically significant improvement in ART adherence in the intervention arm compared to the attention control arm for the first 59 days of the study period. From day 60 to 120, the intervention arm still had higher adherence rates, but the difference was not statistically significant. Interviews with WiseApp users revealed that the app and pill box were easy to use, supported their self-efficacy for disease management, and helped them to take their medication as specific times.