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App helps HIV patients report medication, substance use

Taking a daily regimen of HIV medicines, exactly as prescribed, can be difficult enough, but add alcohol or drugs to the mix and there is the potential for disrupting medication adherence.

HIV medicines help patients live longer, healthier lives by preventing the virus from destroying their immune systems. Yet, with alcohol and drug use being particularly prevalent among HIV-positive adults, substance use is one of the most reliable predictors of poor adherence to antiretroviral therapy.

That’s the reason researchers from the State University of New York at Buffalo developed a smartphone app to enable HIV-infected adults to self-report on daily substance use and medication adherence.

The study recruited 26 participants from two Buffalo-area HIV primary care clinics; they were asked to use the app, called Daily Reports of Using Medications (DRUM), over a two-week period.

“This was just a small-scale pilot study to look at the feasibility,” says Sarahmona Przybyla, clinical assistant professor of community health and health behavior at the University of Buffalo’s School of Public Health and Health Professions. “When you look at the demographic characteristics of the sample, it’s not all the different from what the HIV positive population looks like in Western New York.”

Three-quarters of the study volunteers were male, slightly more than half were African Americans, about a third were Caucasian, while the average age was 48. In addition, the average time since diagnosis among study participants was 17 years.

The results of the study, published this month in the journal AIDS Research and Treatment, included a 95 percent compliance rate for daily reporting. A change in daily routine was the most commonly reported reason participants didn’t take their HIV medication, followed by simply forgetting. And, the third most common reason for poor medication adherence was use of alcohol or drugs.

Overall, participants reported drinking alcohol on 51.6 percent of the 14 reporting days and smoking marijuana on 35.4 percent of those days. “Alcohol consumption and marijuana use was relatively high in the sample when you compare it to the general population,” observes Przybyla.

Among other findings: study participants found the app easy and convenient to use. According to Przybyla, this was all the more surprising given the fact that two-thirds of the volunteers had never used a smartphone previously. However, she says that they were all offered smartphones with the app installed as well as “pretty extensive” training on how to use them.

“High completion rates and participant acceptability suggest that smartphones are a feasible, acceptable method for collecting substance use and antiretroviral therapy data among people living with HIV (PLH),” concludes the article. “Potential areas of concern such as sufficient training and assistance for those with limited smartphone experience should be considered for future app-based research studies among PLH.”

Przybyla, the lead author of the article, adds that some participants in the study reported that the app helped them know exactly how much they were drinking and could result in quicker interventions by caregivers in cases where patients have missed HIV medication doses.

“We, as health practitioners, can do a better job of using these kinds of apps not only for assessment but for monitoring,” she concludes.

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