OPT-In For LifeJohn Zurlo, MD

PennState Health (Thomas Jefferson University)

Cynthia Whitener, MD

Ping Du, MD, Ph.D

Matt Mahoney

Collaborators• Penn State Health, Hershey Medical Center

• Division of Infectious Diseases

• Public Health Sciences

• Pinnacle Health System• REACCH Program

• Hamilton Health Center• Hamilton HOPE Program

• Alder Health Services

• Duet Health• App developer

Background

• HIV care model in southcentral PA• Small urban centers: Harrisburg metro area, Lebanon, Carlisle

• Dauphin County (Harrisburg) – ranks 5th in PA for cumulative AIDS cases

• Relatively large AA population (Harrisburg) and Latinos (Harrisburg, Lebanon), both disproportionately affected

• Large rural population: 10+ counties• Largely Caucasian population

• Increasing proportion of MSM, young and youngish

Objectives

• Link all Ryan White-funded providers in the greater Harrisburg area in a collaborative project

• Unmet need #1• Extend the existing OPT-In For Life brand (http://optinforlife.org) to include all

individuals on our web and all social media sites• Market/outreach the brand to at-risk, infected, and affected individuals in the age group 13-34

• Unmet need #2• Develop the OPT-In For Life app to target our new and existing patients, ages 13-34 for

whom we have already demonstrated a high dropout rate• Enable secure communications across the app• Develop app specific features such as access to their medical data, tools, goals, information,

evaluation (journaling)

Demographics

• Recruitment (N=92)

Patients’ Characteristics N (%)

Age

18-21 9

22-25 26

26-29 30

30-34 27

Sex

Male 67

Female 23

Transgender 2

Race

Black or AA 40

White 49

Other 3

Ethnicity

Hispanic 15

Non-Hispanic 77

Eligibility criteria *

Retention 54

Viral Load>200 28

Newly diagnosed 22

VL at baseline

<=200 63

>200 28

Mobile App (OPT-In For Life)• DuetHealth (MedData)• Current Functions & Features

Tracking app usageBackend data

Tracking App Usage

Qualitative Analysis for Text Messages

124

9332

52

26

3911

28

Regular check in

Followup

Appointmentreminder

Lab results

Medicationadherence

Other clinicalissues

App feedback

Supportiveservices

Number of messages by topics

Original messages

Comparison Study

• Quasi-experiment study designed to compare the rates of retention in care and HIV viral suppression every 6 months between study participants and YPLWH who were eligible but not enrolled in the study.

Results

• On average study participants used the app 1-2 times/week• Discuss various clinical issues/support services

• Access HIV-related health information

• Manage their HIV care

• Six-month data

HIV care continuum 6-month results – SPNS patients onlyRetention in Care

92

69

38* (54%)

58 (84%)

Baseline 6-month follow-up

Total In Care

* Newly diagnosed patients were excluded from the analysis.

88 88

23 (26%) 22 (25%)

Baseline 6-month follow-up

Total In Care

HIV care continuum 6-month results - SPNS Eligible, not EnrolledRetention in Care

HIV Viral Suppression (<200/copies/mL)

• SPNS Patients (92 patients)• Baseline 66% virally suppressed

• Six months: 80% virally suppressed

• SPNS Eligible, not Enrolled (88 patients)• Baseline 56% virally suppressed

• Six months: 60% virally suppressed

Preliminary Wave 5 Data

• Includes patients largely in the 12 to 18 month f/u range

• 56 of 93 (60%) patients with visits

• 52 of 58 (89%) with viral load measurements: suppressed

Project Successes and Limitations(Lessons Learned)

• Successes• We have shown early

outcome success• App is easy to enroll, easy to

use, easily scalable• Data are stored safely and in

perpetuity• Back end allows for unlimited

flexibility and analysis• Little site maintenance

required• Telehealth capability

• Limitations

• App usage is variable, reduced over time, lower than hoped for

• Aggressiveness in getting patients back for survey completion may have skewed the data

• Uncertain relationship between content creation and usage/outcomes

• Difficult to gain traction with social media sites

• ?Patient portals

Sustainability Plans

• Extend the use of OPT-In For Life to a larger group of patients beginning with five sites across Pennsylvania, including Philadelphia, Pittsburgh, and central Pennsylvania

• Second phase of investigation• Continued focus on primary outcomes (engagement in care,

antiviral suppression)• Determine the feasibility and scalability of mobile app technology

for this population• Continue to explore the relationship between unique, relevant

content creation and engagement in the app

Project Outline• Three-year project

• Primary grantee with 4 sub-grantees

• Consider adding other sites sequentially

Inclusion Criteria

• HIV-infected patients at any age group with any of the following:

• Newly diagnosed (within the prior 12 months)

• All pregnant women

• Any patient whose last 2 viral load measurements exceed 200 copies/mL

• Any patient with demonstrated lost-to-follow-up

• ? Patients in certain demographic groups (e.g. IDU, transwomen)

• HIV-at-risk patients (PrEP)

Data Collection• Clinical/demographic data (similar to RSR)

• App usage data

Study Evaluation

Analysis Plan:• The primary outcome of interest is HIV viral suppression in HIV+ patients and will be assessed as a percentage of the entire study sample at a given time point.• Individual patient suppression trends will also be captured. • Patient retention in care (HIV+ and HIV-) will be measured by the proportion of visits attended versus missed (without documented reschedule). • Patient app usage trends (feature/content clicks, content view time, feature utilization, etc.) will be monitored and reported per feature (as applicable) in relation to specific content.