A pilot of a smartphone-based intervention to enhance antiretroviral therapy adherence among people with HIV in Vietna

Background: There is limited evidence on whether growing mobile phone/smartphone use in low and middle-income countries can improve adherence to antiretroviral therapy for people living with HIV/AIDS. This study aimed to develop a smartphone-based application and evaluate its feasibility and preliminary efficacy in improving adherence to ART for patients attending a sub-urban outpatient clinic in Vietnam.;Intervention: ARVRemind is an innovative, theory-based, smartphone-based ART adherence support intervention for HIV-positive adult patients that focuses on self-management and education.;Design: A pre- and post-test of the app's usability and a randomized controlled trial to examine the feasibility and preliminary efficacy of intervention.;Methods: Eligible participants were adult patients at the participating clinic receiving ART for at least three months and no more than two years. Usability study -- Nineteen eligible patients were enrolled to assess usability (ease of use, credibility, understandability, acceptability and motivation) and short-term psychosocial outcomes (importance and self-efficacy related to ART adherence). Efficacy Study -- One hundred eligible adult patients were enrolled and randomly assigned to the smartphone use group and control group. Participants in the smartphone group were provided a smartphone installed with ARVRemind and were trained to use the app to self-manage their medications. Adherence was measured using the self-reported Visual Analogue Scale (VAS) for last 30 days. The primary outcome was an ART adherence level exceeding 95% during the last 30 days at the 6-month follow-up. The secondary outcomes were the CD4 cell count and viral load as biomarkers of adherence measured at the 6 month follow-up.;Results: Usability study -- Eighteen participants completed the pre- and post-test usability surveys. Most participants found the app easy to use (73.7%), would be willing to use the application in the long term (89.5%) and to recommend the application to other ART recipients (94.7%). Short-term psychosocial outcomes indicate significant increase in knowledge of HIV and ART medication adherence (p<0.01), self-efficacy to get information about their illness and medications (p<0.05) and intention to take all medications as prescribed in the next 3 months (p<0.05). Other psychosocial outcomes were not significantly impacted. Efficacy study -- Mean VAS scores significantly increased at 6 months in the smartphone group compared with the control group (p=0.05). There was no significant change in viral load suppression and CD4 cell counts lower than 250 (p=0.64 and 0.82 respectively). Participants in the smartphone group also reported significantly greater perceived importance of taking their medications correctly even if their health had greatly improved (p=0.04), greater knowledge of their latest viral load value from a lab report (p=0.02), and greater self-efficacy regarding taking medicine close to the right time every day, and taking medications even when experiencing side effects compared to participants in the control group.;Conclusions: In this pilot study, the use of an innovative smartphone-based application, ARVRemind, was proved to be feasible and efficacious to increase ART adherence among HIV-positive individuals. The ARVRemind significantly improved users' self-reported adherence compared to the control group. Large-scale trials are needed to determine the impact of this intervention on ART adherence and other related health outcomes in people living with HIV/AIDS in resource-limited settings.