Dissemination of the WiseApp for Improving Health Outcomes Across Settings

By adapting WiseApp for Spanish-speaking patients living with HIV, this research has the potential to improve medication adherence, potentially slowing progression of HIV and decreasing premature deaths.

Project Details -
Ongoing

Adherence to antiretroviral therapy (ART) is critical to the health of people living with HIV (PLWH), slowing the progression of the disease, and decreasing premature deaths. While ART is critical, half of patients are estimated to have missed a dose in the prior 2 to 4 weeks, and 10 percent miss one of more doses on any given day. Treatment success of HIV has pronounced gaps in racial and ethnic populations, particularly among Latinos in the Northeast United States and the Caribbean. Given that smartphones are the primary method of access to the internet for underserved populations, the use of mobile apps by this population has the potential to improve medication adherence, provide bi-directional communication, and improve access to health information.

In previous AHRQ-funded research, WiseApp was developed and integrated with a smart pill box that enables PLWH to self-monitor their medication adherence and provide real-time feedback (The Wise App Trial for Improving Health Outcomes in PLWH). This current study will evaluate the transferability, efficacy, and implementation factors of WiseApp to Latinos in the United States and the Dominican Republic (DR) by adapting it for these cultures and determining its efficacy.

The specific aims of the research are the following:

  • Adapt and ensure the usability of the WiseApp for Spanish-speaking PLWH.
  • Conduct a randomized controlled trial to assess the efficacy and sustainability of the WiseApp compared to a usual care control in a transnational sample of Spanish-speaking PLWH at 3, 6, and 12 months.
  • Identify multilevel barriers and facilitators to satisfaction and widespread implementation of the WiseApp.

This research is a collaboration between Columbia University and Clínica de Familia in the DR. The Washington Heights neighborhood of New York City will be targeted due to their strong presence of Latinos; the DR is included because it experiences disproportionately high rates of HIV.

To begin, the WiseApp will be translated into ‘broadcast Spanish’—Spanish that is understood by most Spanish speakers regardless of country of origin or ethnic background. Strategies used for cultural adaptation of survey instruments and interventions will be used to ensure cultural relevance, equivalence, and generalizability of the app. Ease of use and usability testing will be done with in-person groups. A randomized controlled trial of Spanish-speaking Latinos living with HIV from the United States and DR will compare an intervention group who have the WiseApp with a linked electronic pill bottle, versus a control group. The researchers hypothesize that the intervention group will have improved medication adherence, improved health-related quality of life, decreased symptom burden, improved engagement with healthcare providers, and decreased HIV-related stigma. Evaluation of implementation will be done through a mixed-methods approach. Efficacy, adoption, and long-term efficacy will be measured. Post-intervention interviews with study participants and clinic administration and staff will assess acceptability and perceived usefulness of the app.

This research has the potential to improve medication adherence in PLWH potentially slowing progression of HIV and decreasing premature deaths.