EmERGE: Evaluating mHealth technology in HIV to improve empowerment and healthcare utilisation

With the advent of effective antiretroviral therapy (ART), HIV is now regarded as a chronic illness with a normal life expectancy in individuals who have access to testing, treatment and care. This 5 –year ‘Research and Innovation Action’ project, funded under the EU’s Horizon 2020 programme and led by Brighton and Sussex University Hospital Trust (BSUHT), is developing and evaluating a sustainable co-designed mHealth platform for people living with medically stable HIV in diverse care settings across 5 European countries.

The mHealth platform provides patients with a mobile device application which interfaces securely with relevant medical data and facilitates remote access to test results and key healthcare providers, facilitating a ‘reduced visit’ pathway. The project seeks to provide evidence for use of the new mHealth-based care pathway, showing that it can maintain quality of care while reducing patient appointments. The project aims to ensure sustainability and future innovation in mHealth through commercialising the technology produced on a not-for-profit basis.

EmERGE has adopted MAST (Model for Assessment of Telemedicine Applications) as its overall approach to evaluation. MAST was developed as part of an EC initiative aimed at providing a structured framework for assessing the effectiveness and contribution to quality of care provided by telemedicine. The EmERGE evaluation looks at patient empowerment, health economics, sociotechnical aspects, clinical outcomes, patient-related outcomes and quality of life.

The University of Brighton leads on two workpackages: ‘sociotechnical evaluation and co-design’ (Professor Flis Henwood, Dr Mary Darking and Dr Benjamin Marent) and ‘innovation and sustainability’ (Dr Mary Darking). Working closely with our partners- the European Aids Treatment Group (EATG), based in Brussels, and their community partners in all 5 sites (Brighton, Barcelona, Antwerp, Lisbon and Zagreb), the sociotechnical and codesign workpackage has developed and implemented a co-design process for engaging both HIV patients and clinicians in the development and implementation of the mHealth platform/ new care pathway. Patient and clinician views are being sought at 3 stages- before, during and after implementation, with experiences and insights from this process being used to influence its development. Further ‘wide lens’ work is being undertaken to better understand the 5 different social and organisational contexts within which the new care pathway is being developed, implemented and used. These insights are shared within the project to enhance opportunities for successful implementation across all sites. The ‘innovation and sustainability’ workpackage has developed an integrated approach to technology design and business planning that will embed the values and priorities stemming from the codesign process into a business model. The approach aims to recognise the social and economic value of digital health service design. A commercial, not-for-profit company will be created by project partners that will maintain the mHealth service at the 5 clinical sites ensuring future development and service innovation.

If the project is a success, and we can show that the quality of care can be sustainably provided for HIV patients on a new ‘reduced visit’ mHealth platform-based care pathway, it should have siginificant impact- for health care providers, clinicians and patients across Europe. Health care providers will be able to reduce their costs by reducing the number of face-to-face visits required, clinicians will be able to stay connected with patients with stable HIV while having more time to see those with more complex needs, and patients will save time and money by making less clinic visits while still having access to test results and maintaining connection with their doctors.

While we won’t know any of this for sure until the project is complete, what we do know is that, as a result of the sociotechnical evaluation, led by UoB, we will have clear insights into why some of these desired outcomes might not be reached- insights that will be useful for others working on mHealth in HIV as well as in other chronic conditions. Furthermore, through the UoB-led co-design approach, with key stakeholders being fully engaged in the process of developing and implementing the new care pathway from start to finish, we have built capacity for engagement in mHealth developemnts that can have impact well beyond the EmERGE project itself.

The EmERGE project is developing, implementing and evaluating a new care pathway for HIV care, based around an mHealth platform. The platform consists of a web-based clinical interface (for clinicians to use) and a mobile phone-based interface (for patients to use). The new care pathway involves less patient visits to the clinic as test results are sent direct from the clinic's database to the patient's mobile phone, together with a message about the results and what, if any, action is needed. The project has sought input from patients and clinicians through all stages of design, implementation and use of the new platform through a process of 'co-design' led by the University of Brighton team, working closely with our partners in the European Aids Treatment Group (EATG). The University is also leading on making the mHealth platform sustainable after the project ends through developing a new business that will ensure the technology is maintained and developed. Other partners on the project are undertaking evaluations of health economics, clinical outcomes, patient-related outcomes and quality of life.

Findings that present and analyse clinician and patient views at the pre-implementation stage can be found in outputs linked to this project.