BACKGROUND
Advances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and non-perinatally infected youth living with HIV (YLWH) remain relatively high today.
OBJECTIVE
The goal of this project is to assess the usage, utility, and cost-effectiveness of PlusCare, a mobile/web application (app) for HIV case management for YLWH. The app supports routine case management tasks such as scheduling follow-up visits, sharing documents for review and signature, lab test results, and between-visit communications (e.g., encouraging messages).
METHODS
We conducted a single-group mixed-methods, pre-post study conducted with HIV case management programs in 2 large, urban hospitals in the Boston metro area. Case management staff (CMs, N=20) and YLWH patients (N=45) participated in the study with access to PlusCare for up to 15 months and 12 months, respectively.
RESULTS
CMs and YLWH reported System Usability Scale scores of 51 (SD=7.9) and 63 (SD=10.6), respectively. Although marginally significant, total charges billed at one of the two sites compared to the 12 months prior to app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in YLWH self-reported self-efficacy (SEMCD6) and quality of life (CDC HRQOL-4) from baseline to 12-month follow-up (P=.02 and P=.03, respectively) and increases in self-efficacy from 6-month to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression or appointment or medication adherence in this small sample pilot study.
CONCLUSIONS
While perceived usability was low, qualitative feedback from CMs and usage patterns suggest direct messaging and timely, remote, and secure sharing of lab results and documents (including electronic signatures) between CMs and YLWH can be particularly useful and have potential value in supporting care coordination and promotion of patient self-efficacy and quality of life.
CLINICALTRIAL
ClinicalTrials.gov NCT03758066