The Effectiveness of a Smartphone Application in Improving Adherence to Antiretroviral Therapy

Abstract

Combination antiretroviral therapy (ART) has transformed the management of Human Immunodeficiency Virus (HIV) infection from an ultimately fatal disease into a chronic condition. Successful treatment requires a near perfect level of adherence to the ART regimen and a lifelong commitment to therapy. Poor adherence to ART is a major global challenge, owing to the large numbers of non-adherent individuals and the harmful consequences of suboptimal adherence for the individual and wider society. Patients’ conceptualisations of their HIV infection and ART regimen are strongly implicated in adherence behaviour. While existing adherence-promoting interventions have had limited efficacy, recent advances in mobile technologies may provide a platform to improve adherence to ART through increasing patient awareness of the link between medication-taking behaviour and clinical outcomes. This study aimed to investigate the effects of a smartphone application on adherence to ART, illness perceptions, and medication beliefs. Twenty eight people on ART were randomised to use either a standard or augmented version of a smartphone application. The augmented version contained additional components which illustrated to the participant, in real-time, the estimated concentrations of antiretroviral agents in his or her blood plasma and the immune activity occurring in his or her body. These features were intended to modify participants’ conceptualisations of their HIV infection and ART regimen to be more conducive to optimal adherence. Adherence to ART was assessed at baseline and three month follow-up using self-report measures, HIV viral load, and pharmacy dispensings. Information was also collected on illness perceptions, medication beliefs, and participants’ usage and evaluations of their smartphone application. Provision of the augmented version of the application improved adherence to ART. Participants who received the augmented application displayed a significantly higher level of self-reported adherence to ART at three month follow-up, in comparison to individuals who received the standard version. Further, there was a significant decrease from baseline to three month follow-up in the proportion of participants classified as non-adherent in the group who used the augmented version. Greater usage of the extra components of the augmented application was associated with improvements in the perceived understanding of HIV infection, increases in the perceived necessity for ART, and accordingly, positive changes in necessity-concerns differentials. Compared to the standard version, the augmented application was rated as a significantly more effective source of motivation to take ART and was given a higher overall rating. This research suggests that a smartphone application, intended to modify the cognitive determinants of non-adherence through the provision of personalised health-related imagery and real-time feedback, is effective in facilitating adherence to ART. Study findings indicate that such an intervention may have considerable utility in the clinical care of people with HIV infection.