Topics discussed include care workflow, app functionalities, problems and disadvantages, and benefits for HIV experts.
Experts in the treatment of HIV were recently invited to discuss organizational conditions and necessary functionalities of the Communication and Tracing App HIV (COMTRAC-HIV), and collectively agreed that the app should have aspects including a symptom diary, a video call and chat option, and appointment organization, according to the results of a qualitative study published in Healthcare.
More than 36.7 million people were infected with HIV or developed AIDS in 2016. Despite significant advances in treatment for HIV—including antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP)—challenges in health services for patients with HIV remain.
Specifically, in Germany, eHealth measures for providing continuity of care (CoC) are persistent, despite their proven efficacy at improving targeted outcomes. There are few applications, such as mobile apps for HIV/AIDS, that are available in the country.
To address these gaps in care, the COMTRAC-HIV project aims to develop and enable a system for HIV-related care, specifically targeting late presenters (LPs) and PrEP users, through a mobile app. The investigators conducted a study to examine the relevant organizational conditions for operating the app and determine the app functionalities necessary from a physician’s point of view.
HIV experts were invited to participate in the study and participate in interviews discussing aspects of the app that should be implemented. Eight experts who were contacted accepted the invitation and subsequently participated in the study.
Experts were asked to describe the current care workflow of HIV patients, to which they said that LPs were often diagnosed in a hospital. Many of these patients have had prior indicator diseases but were not previously diagnosed as having HIV. After diagnosis, these patients are typically treated in an HIV outpatient clinic. Experts said they primarily use email and telephone to communicate with their patients.
The experts indicated that a symptom diary that can identify small changes in the health status of LPs would be advantageous but noted that some LPs may not be able to record symptoms. Experts mentioned different aspects of symptoms and intensities that should be recorded; they ranged from fever and lymph node swelling to rash and signs of bleeding. Further, they said intensity, frequency, and duration should be recorded on a scale.
Study participants emphasized that the app’s chat functionality could provide a quick answer to acute questions of LPs—within hours—and could avoid a visit to the emergency department or an appointment. It could also be useful if the findings could be transmitted directly to the patient through the chat feature.
Other features the experts discussed as being potentially useful app functionalities include displaying CD4 results, the documentation of medication intake, and an avenue to upload information and findings from patients, as well as physicians who do not work in an HIV outpatient clinic but are involved in the care of the patients. Additionally, experts said the app should remind users of appointments for checkups.
Experts said that the app should only be used when necessary, and that it should not replace the patients’ regular quarterly visits. They also noted that the information in the app could be misunderstood or misinterpreted by patients, and said the app is not suitable at the beginning of treatment.
Benefits of the app to HIV experts include that more patients could be cared for, and it would facilitate communication with patients who are unable to come to consultation hours for various reasons. Furthermore, experts said that processes could be simplified, and unnecessary visits could be avoided.
The investigators discussed that the interviews indicated there are differences between LPs and PrEP users regarding possible app usage. The experts stated that LPs are often non-native German speakers and thus many have language problems, so the app must consider a wide variety of languages. In addition, the experts considered PrEP users to be more apt at using the app, because they are usually younger and technology-oriented.
“Further work and studies are necessary, such as the assessment of the app’s sustainability, integration into existing healthcare systems and long-term effects on patient outcomes,” the study authors concluded.
Schaaf J, Weber T, von Wagner M, et al. Interviews with HIV experts for development of a mobile health application in HIV care—a qualitative study. Healthcare. 2023;11(15):2180. Doi:10.3390/healthcare11152180