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(70) Using mHealth to enhance HIV, HCV, and buprenorphine treatment: a pilot RCT


Authors:

Babak Tofighi, MD, MSc – Assistant Professor, New York University Medical Center

Joshua D. Lee, MD, MSc – Associate Professor, New York University School of Medicine

Abstract:

Background: Text message (TM) interventions have demonstrated promising clinical outcomes in primary care yet integration in office-based opioid treatment (OBOT), HIV, and HCV care remains limited. Objectives: 1) Design a mHealth prototype for office-based treatment with buprenorphine (OBOT) based on qualitative interviews (patients, providers, and administrators) addressing medication adherence, patient-provider communication, self-management, abstinence, and counseling/self-help group participation 2) Conduct a pilot randomized controlled trial testing among inpatient detoxification program patients transitioning to OBOT
Methods: The study was conducted at Bellevue Hospital’s Adult Primary Care Clinic in NYC. mHealth design was based on the medical management model, the service oriented architecture model, and evaluated per the technology acceptance model. During Aim 1, prototype mock-ups and ‘test’ messages were provided to participants and elicited feedback on content and design features (version 1.0). During Aim 2, usability testing of the refined prototype (version 2.0) was conducted among newly enrolled OBOT program patients.
Results: Adoption of the TM intervention was high (n=23/28, 82%) among a mostly underserved sample of OBOT program patients [African-American (42%), Hispanic/Latino (23%), medicaid (62%), unemployed (34%), street homeless (45%)]. Clinical characteristics were representative of the general clinic population, including HIV+ (22%) and HCV+ (48%) status, and depression (21%). Usability testing revealed delays in software programming, de-bugging, dashboard design, inability to deliver algorithmic or sequential messages during induction, inability to link with the hospital EMR or appointment scheduling software, and need for real-time feedback to patient queries by providers. At 8 weeks, most were highly satisfied with the intervention (93%) and reported no adverse events (privacy, cost, increased cravings). Suggestions also included personalizing the frequency and timing of messages, providing more CBT-based content, and peer support.
Conclusions: TM based interventions are a feasible approach for enhancing linkage and retention in OBOT, HIV, and HCV care.

 

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