The American Academy of HIV Medicine and the Institute for Technology in Health Care have awarded the 2020 Caceres Award for Technology in HIV Practice to Dr. Rebecca Dillingham and Dr. Karen Ingersoll of the University of Virginia Ryan White Clinic for their PositiveLinks digital application.
PL is a clinic-deployed, smartphone-based platform that provides tools and support to people with HIV to improve medication adherence and engagement with care. It includes a patient-facing app, a provider-facing app, a web portal for providers, and an on-line training system.
See website here: www.positivelinks4ric.com.
The technology was developed to address the stigma, poor access to transportation, isolation, substance use, and mental health challenges facing many PWH in rural Virginia.
Dr. Dillingham, an infectious disease physician, and Dr. Ingersoll, a clinical health psychologist, collaborated to create PL by adapting evidence-based behavioral interventions to improve adherence to ART, as well as to reduce stigma, depression, and isolation.
The PL patient app features include medication reminders, mood and stress check-ins, educational resources, an anonymous community message board, secure document upload, and private provider messaging. PL shrinks physical and psychological distance between patients and care providers.
It expands connections among PWH in a space that is experienced as safe. It provides important tools that support self-monitoring, care coordination, and social support – all in a secure mobile app.
The provider-facing PL app and web portal facilitate providers’ ability to monitor patient-reported data about adherence and mood. They also permit “texting”-like messaging in a health system-approved environment that allows for the flexibility and efficiency of texting. Embedded telehealth capability was recently added to PL, allowing PWH who participate in the program the option of securely accessing medical and mental health care through the PL app while maintaining social distancing.
Development of PL was supported originally by AIDS United beginning in late 2012. Since 2017, based on the successful pilot, the Virginia Department of Health has supported expansion of PL as a usual care service at UVA and at other organizations that support the care of PWH.
Thanks to the visionary support of the Virginia Department of Health (VDH), the tool is available at no cost to clients, and, in fact, if used regularly, can qualify clients for assistance with cellular voice and data access, an increasingly recognized social determinant of health.
“The ability to remain in touch through a cell phone, whether with calls or through an app, may become increasingly important as the recommended number of visits to an HIV care provider decreases based on the less frequent need for CD4 and viral load monitoring,” stated Dr. Dillingham. “In addition, care coordination and secure messaging is growing in importance for our aging PWH population who have a rising number of medical co-morbidities.”
Dr. Dillingham, Dr. Ingersoll and their team have documented the impact of PositiveLinks in a demonstration project with the first 77 enrollees. PL implementation resulted in a 30 percent absolute increase in engagement in care (51% to 81%) and a 22 percent absolute increase in viral suppression (47% to 79%) at 12 months in a population of PWH who were identified by providers as being poorly engaged in care. These positive results have now been extended to 24 months, as reported in a recent publication.
PL is running in multiple different settings in the US including a rural-based academic hospital; an urban health system; a rural Federally Qualified Health Center; a community-based organization serving a large population of people who speak Spanish; an adolescent clinic; and an independent RW clinic associated with a community-based organization. PL has also been adapted for a regional AIDS center in Siberia; a semi-rural clinic in Southwestern Uganda; and a clinic network in rural KwaZulu Natal, South Africa. PL is available in English, Spanish, Russian, and isiZulu.
In its ninth year, the Caceres Award for Technology in HIV Practice seeks to acknowledge those who have created, adapted and/or used innovative technology in their HIV practice and to share that technological knowledge with others in the practice of HIV medicine to improve patient care. The name of the award was recently changed to honor the passing of Dr. Cesar Caceres, founder of the Institute for Technology in Health Care.
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Chris Graham
