Improving Linkage to and Retention in Care in Newly Diagnosed HIV-Positive Patients Using Smartphones in South Africa: Randomized Controlled Trial
Improving Linkage to and Retention in Care in Newly Diagnosed HIV-Positive Patients Using Smartphones in South Africa: Randomized Controlled Trial
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DOI：
10.2196/12652
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发表时间：
2019-04-02
影响因子：
5
通讯作者：
Fraser-Hurt, Nicole
中科院分区：
文献类型：
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作者：
Venter, Willem Daniel Francois;Fischer, Alex;Fraser-Hurt, Nicole
背景：南非为近500万艾滋病毒感染者提供免费抗逆转录病毒治疗，但只有71%的符合条件的人接受治疗，这表明在护理梯级方面存在不足，特别是在男性和青年中。许多发展中国家扩大了智能手机的使用范围；健康应用程序的成功提高了改善这种连锁反应的可能性。目的：SmartLink是一款针对Android智能手机的健康应用程序，提供与艾滋病毒相关的实验室结果、信息、支持和预约提醒，以吸引患者并将其与护理联系起来。本研究旨在评估SmartLink改善艾滋病毒阳性智能手机用户护理联系的能力。方法：本研究是在约翰内斯堡进行的多地点随机对照试验。干预组接受应用程序（以及转介到治疗地点），对照组接受标准护理（仅转介）。在开始治疗后2周至8个月期间，国家卫生实验室服务数据库中报告的艾滋病毒相关血液检测证实了与护理的联系。结果：共招募了345名参与者；64.9%（224/345）为女性，44.1%（152/345）年龄在30岁以下。此外，46.7%（161/345）是全职工作，95.9%（331/345）至少受过中学教育，35.9%（124/345）来自津巴布韦。干预组在2周至8个月期间与护理的关联度为48.6%(88/181)，而对照组为45.1% (74/164)(P= 0.52)，在最初的8个月后分别增加到64.1%（116/181）和61.0% (100/164)（P= 0.55）。此外，18至30岁的年轻人在干预组中与护理的联系增加了20%，这在统计学上具有显著意义。结论：30岁以下的年轻人历来难以通过传统干预措施接触到，而SmartLink应用程序提供了一个概念证明，即这一人群对让患者参与艾滋病毒护理的移动卫生干预措施有反应。
Background: South Africa provides free antiretroviral therapy for almost 5 million people living with HIV, but only 71% of the eligible people are on treatment, representing a shortfall in the care cascade, especially among men and youth. Many developing countries have expanded access to smartphones; success in health apps raises the possibility of improving this cascade.Objective: SmartLink is a health app for Android smartphones providing HIV-related laboratory results, information, support, and appointment reminders to engage and link patients to care. This study aimed to evaluate the ability of SmartLink to improve linkage to care for HIV-positive smartphone owners.Methods: This study was a multisite randomized controlled trial in Johannesburg. The intervention arm received the app (along with referral to a treatment site) and the control arm received the standard of care (referral alone). Linkage to care was confirmed by an HIV-related blood test reported on the National Health Laboratory Service database between 2 weeks and 8 months after initiation.Results: A total of 345 participants were recruited into the study; 64.9% (224/345) of the participants were female and 44.1% (152/345) were aged less than 30 years. In addition, 46.7% (161/345) were employed full time, 95.9% (331/345) had at least secondary school education, and 35.9% (124/345) were from Zimbabwe. Linkage to care between 2 weeks and 8 months was 48.6% (88/181) in the intervention arm versus 45.1% (74/164) in the control (P=.52) and increased to 64.1% (116/181) and 61.0% (100/164) (P=.55), respectively, after the initial 8-month period. Moreover, youth aged 18 to 30-years showed a statistically significant 20% increase in linkage to care for the intervention group.Conclusions: Youth aged less than 30 years have been historically difficult to reach with traditional interventions, and the SmartLink app provides a proof of concept that this population reacts to mobile health interventions that engage patients in HIV care.