Abstract
The Philippines HIV epidemic is among the fastest growing globally. Infections among men who have sex with men are rising at an alarming rate, necessitating targeted evidence-based interventions to retain people living with HIV in care, support adherence, and reach viral suppression. We conducted a 48-week prospective cohort study of 462 participants in which we provided a mobile health (mHealth) adherence support intervention using the Connect for Life platform. We observed an improvement in adherence, with the proportion of participants taking more than 95% of their antiretroviral therapy (ART) doses increasing from 78.6% at baseline to 90.3% at 48 weeks. Among treatment experienced participants, adherence improved significantly (McNemar’s test = 21.88, P < 0.001). Viral load suppression did not change, with 92.6% suppression at baseline and 92.0% at 48 weeks. Illicit drug use was associated with reduced adherence (aOR = 0.56, 95%CI 0.31–1.00, P = 0.05) and being on second-line therapy was associated with poor viral load suppression (aOR = 0.33, 95%CI 0.14–0.78, P = 0.01). Quality of life improved following ART initiation, from a mean of 84.6 points (of a possible 120) at baseline to 91.01 at 48 weeks. Due to technical issues, fidelity to the intended intervention was low, with 22.1% (102/462) of participants receiving any voice calls and most others receiving a scaled-back SMS intervention. The mHealth intervention did not have any observed effect on adherence or on viral load suppression. While evidence of effectiveness of mHealth adherence interventions is mixed, these platforms should continue to be explored as part of differentiated treatment support services.
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Data Availability
The datasets generated during and/or analyzed during the current study are not publicly available until after the study outcome evaluation is complete, but are available from the corresponding author upon reasonable request.
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Acknowledgements
This study received sponsorship from Johnson & Johnson Global Public Health. We are thankful to our collaborators in the Johnson & Johnson team for develo** the Connect for LifeTM platform and for their extensive work to tailor the technology to the Philippine setting: Randeep Gill, Paula McKenna, Piet Knaepen, Avinash Agrawal, and Jurgen de Beckker. Furthermore, this study would not have been possible without the efforts of our implementing partner the STI/AIDS Guidance Intervention & Prevention Unit at the Philippine General Hospital. Thank you to Cari Free, Ford Hickson, and James Hargreaves at London School of Hygiene and Tropical Medicine for their guidance during protocol development, especially regarding intervention development, behavior change theory, and process evaluation methodology.
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This study received sponsorship from Johnson & Johnson Global Public Health.
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CO: Co-principal Investigator responsible for protocol development, data collection and analysis, development of manuscript. Trustee, Sustained Health Initiatives of the Philippines (SHIP). KL: Co-investigator responsible for medical services provision to patients in SHIP clinic. Medical Director, SHIP. Provided editorial input on manuscript. AMD: PhD co-supervisor, responsible for technical input on data analysis plan and editorial input on manuscript. Associate Professor of Epidemiology, LSHTM. JJL: Co-investigator and PhD co-supervisor responsible for technical input on protocol development and data analysis plan and editorial input on manuscript. Professor, Cardiff University. EMS: Co-principal Investigator responsible for oversight of research protocol. Provided editorial input on manuscript. Clinician at STI/AIDS Guidance Intervention & Prevention Unit at the Philippine General Hospital.
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The authors declare that they have no competing interests. The study was funded through a sponsorship agreement with Johnson & Johnson Global Public Health (J&J), the developer of the Connect for Life™ platform. Per the licensing agreement all platform content and data are owned solely by the licensee (SHIP). While J&J had a collaborative role in the intervention development phase, all data collection and analysis herein were conducted by the study team at Sustained Health Initiatives of the Philippines.
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Ethical clearance for the study was obtained from the University of the Philippines Manila Research Ethics Board (protocol number 2016-265-01) and from the London School of Hygiene and Tropical Medicine (reference number 11631).
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O’Connor, C., Leyritana, K., Doyle, A.M. et al. Changes in Adherence and Viral Load Suppression Among People with HIV in Manila: Outcomes of the Philippines Connect for Life Study. AIDS Behav 28, 837–853 (2024). https://doi.org/10.1007/s10461-023-04190-1
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DOI: https://doi.org/10.1007/s10461-023-04190-1