Feasibility and Acceptability of iThemba: A mobile health application to support engagement in HIV care and viral load suppression: A pilot study (Preprint)

BACKGROUND South Africa has the highest burden of HIV and the largest HIV treatment programme in the world. However, retention in care and medication adherence remains problematic and innovative solutions for improving HIV care are needed. The increasing availability and use of mobile technology can support positive clinical outcomes for persons living with HIV (PLWH). iThemba is a mobile health application (app), designed with input from South African health professionals and patients, promoting engagement with HIV care through access to medical results. OBJECTIVE The feasibility and acceptability of receiving HIV viral load (VL) results through the app was evaluated. METHODS Using purposive sampling, adults having routine VL phlebotomy were recruited from two Johannesburg health facilities. After signed consent, the app was downloaded to their Android smartphones, phlebotomy performed, and sample barcode scanned through their phone to link the sample and app. Participants received notification of result availability and logged into the app. Results were presented with an explanation and recommended action. RESULTS 750 people were screened to enrol 500 participants. 15·0% (113/750) failed eligibility screening. 21·0% (137/637) had smartphone technical limitations preventing enrolment. Results were released to 92·0% (461/500) of participant’s phones, with app technical issues and laboratory operational issues limiting the number of released results. 360/461 (78·0%) results were viewed in app, with a median time from notification of availability to result viewed being 15·5 hours. Turn-around-time from phlebotomy to result received was 6 days for users vs 56 days with standard-of-care (SOC). 20 users received unsuppressed results (VL>1000copies/mL). Turn-around-time for unsuppressed results was 7days for users vs 37·5days with SOC. 12 users returned for a confirmatory VL within the study period. 262/500(52·4%) users completed an exit survey where 23·2% (58/250) reported challenges viewing their VL result. 58·3% (35/60) reported they overcame challenges with technical assistance from others. 97·3% (255/262) wanted to continue using app to receive VL results. CONCLUSIONS Using iThemba Life to receive VL results was well received by users despite limited smartphone access for some participants. App users received results 10 times sooner than SOC, and five times sooner than SOC if their VL>1000cp/mL. This increased notification speed led to participants wanting to continue iThemba Life usage.