Date: Mar 03, 2013 Author: Ted Strong Source: The Daily Progress (
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Researchers at the University of Virginia are hoping that a smartphone application could become a powerful new tool in the fight to contain HIV and AIDS, which often go untreated in rural Virginia.
Treating HIV is key to preventing its spread, but most people who have HIV in Virginia aren't treating it.
About 1.1 million people 13 and older in the United States have HIV, and roughly a fifth of them don't know it, according to the Centers for Disease Control and Prevention.
In Virginia, the best estimate is that about 60 percent of people who know that they have HIV aren't treating it, even though it often takes only one pill a day and that pill is often subsidized, according to UVa's Dr. Rebecca Dillingham.
Dillingham and others are hoping that they can use smartphone applications to boost patients' engagement with their care.
There were already investigations into the use of mobile devices to keep patients engaged in their treatment, Dillingham said, but the hope is that smartphones will allow the use of more advanced tools.
The program is being supported by a $525,000 grant from the AIDS United Foundation, and the technology is being paired with counseling and a priority path to care.
According to a National Institutes of Health news release from July, recent studies have shown that treating HIV helps not just the patient, but also the community.
"... [Researchers] found that earlier HIV treatment is also cost-effective because it increases survival, prevents costly opportunistic infections and averts transmission of the virus to uninfected individuals," reads the release.
The CDC also backs the use of treatment as prevention, and lists four key fundamentals: knowing HIV status through testing; getting into care soon after diagnosis and starting treatment; remaining in care and staying in treatment; and modifying behaviors to reduce the risk of getting or spreading HIV.
The UVa application will offer reminders about medication and visits, but also more advanced functions, including questions for the patient, and possibly quizzes and testimonial videos to help patients feel engaged and part of a community.
Some of the queries, such as those asking if patients are taking alcohol or drugs, will likely be coded, Dillingham said, so that patient confidentiality isn't breached, including during police searches.
One code that has proved popular with clients is a weather theme, she said. For example, a patient indicating he or she is drinking alcohol on a given day might report that the weather is "rainy," Dillingham said.
Patients are provided with phones for the duration of the study in order to minimize variables, said George L. Reynolds, president of Health Decision Technologies, the company developing the application.
The social side of such services has proven unexpectedly effective, Dillingham said.
"The technology provides a social support beyond the relationship with the provider that we did not anticipate," she said.
Patients feel less stigmatized and isolated, she said.
Both individuals and the population as a whole see benefits when HIV is treated, Dillingham said, pointing, for instance, to research indicating that those being effectively treated are much less likely to pass on the disease to others.
But many people who know they have HIV aren't in treatment, and that boosts risks. The goal of programs such as the smartphone study is to reach out to those patients from the outset and get them integrated into a treatment program early.
It's especially important here.
"The rates of HIV infection are disproportionately high in the Southeast, and particularly in the rural Southeast," Dillingham said.
Patients at the UVa Ryan White Clinic miss an average of 1.7 scheduled appointments before actually making it in, UVa said.
While the reason for that isn't exactly clear, she said, clues include the other problems people struggle with in the rural South, including poverty and unemployment. For many, she said, treatment is distant and difficult or expensive to get to.
Work is still under way on the actual application.
"The app isn't created yet because we are designing it in conjunction with clients," Dillingham said.
Reynolds said the application faces atypical challenges. Because it's designed for those who've just had a life-changing diagnosis, it has to be sensitive to their emotional state, and work correctly and easily the first time.
"It's very different, say, from downloading a cool new game or downloading the Facebook app," he said.
The rural setting involved also means developers have to worry about bandwidth constraints, he said.
Researchers hope that once the program is up and running, it can be used as a model for similar programs across the country.
