{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:45:14Z","timestamp":1785545114234,"version":"3.56.0"},"reference-count":39,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Active substance use, food or housing insecurity, and criminal legal system involvement can disrupt HIV care for people living with HIV and opioid use disorder (OUD). These social determinants of health are not routinely captured in clinical settings.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n We evaluated whether real-time reports of social and behavioral factors using a smartphone app could predict viral nonsuppression and missed care visits to inform future mobile health interventions.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We enrolled 59 participants from the AIDS Linked to the Intravenous Experience (ALIVE) Study in Baltimore, Maryland, into a 12-month substudy between February 2017 and October 2018. Participants were eligible if they had OUD and had either a measured HIV RNA \u22651000 copies\/mL or a \u22651-month lapse in antiretroviral therapy in the preceding 2 years. Participants received a smartphone and reported HIV medication adherence, drug use or injection, and several disruptive life events, including not having a place to sleep at night, skipping a meal due to lack of income, being stopped by police, being arrested, or experiencing violence on a weekly basis, through a survey on a mobile health app. We described weekly survey completion and investigated which factors were associated with viral nonsuppression (HIV RNA \u2265200 copies\/mL) or a missed care visit using logistic regression with generalized estimating equations adjusted for age, gender, smartphone comfort, and drug use.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Participants were predominantly male (36\/59, 61%), Black (53\/59, 90%), and had a median of 53 years old. At baseline, 16% (6\/38) were virally unsuppressed. Participants completed an average of 23.3 (SD 16.3) total surveys and reported missing a dose of antiretroviral therapy, using or injecting drugs, or experiencing any disruptive life events on an average of 13.1 (SD 9.8) weekly surveys over 1 year. Reporting use of any drugs (adjusted odds ratio [aOR] 2.3, 95% CI 1.4\u20103.7), injecting drugs (aOR 2.3, 95% CI 1.3\u20103.9), and noncompletion of all surveys (aOR 1.6, 95% CI 1.1\u20102.2) were associated with missing a scheduled care visit over the subsequent 30 days. Missing \u22652 antiretroviral medication doses within 1 week was associated with HIV viral nonsuppression (aOR 3.7, 95% CI: 1.2\u201011.1) in the subsequent 30 days.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Mobile health apps can capture risk factors that predict viral nonsuppression and missed care visits among people living with HIV who have OUD. Using mobile health tools to detect sociobehavioral factors that occur prior to treatment disengagement may facilitate early intervention by health care teams.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/59953","type":"journal-article","created":{"date-parts":[[2025,3,2]],"date-time":"2025-03-02T11:00:08Z","timestamp":1740913208000},"page":"e59953-e59953","source":"Crossref","is-referenced-by-count":0,"title":["Mobile Health Tool to Capture Social Determinants of Health and Their Impact on HIV Treatment Outcomes Among People Who Use Drugs: Pilot Feasibility Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7022-6385","authenticated-orcid":false,"given":"Rachel E","family":"Gicquelais","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2842-5607","authenticated-orcid":false,"given":"Caitlin","family":"Conway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3085-6067","authenticated-orcid":false,"given":"Olivia","family":"Vjorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5636-6827","authenticated-orcid":false,"given":"Andrew","family":"Genz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7829-1405","authenticated-orcid":false,"given":"Gregory","family":"Kirk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5701-4516","authenticated-orcid":false,"given":"Ryan","family":"Westergaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,3,26]]},"reference":[{"key":"R1","unstructured":"Ending the HIV epidemic HIV.gov 2022. US Department of Health and Human Services. 2022. URL: https:\/\/www.hiv.gov\/federal-response\/ending-the-hiv-epidemic\/overview [Accessed 26-04-2023]"},{"issue":"3","key":"R2","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1111\/hiv.13156","article-title":"Alcohol, smoking, recreational drug use and association with virological outcomes among people living with HIV: cross-sectional and longitudinal analyses","volume":"23","author":"Jones","journal-title":"HIV Med"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","first-page":"19","DOI":"10.3851\/IMP3265","article-title":"Substance use patterns and HIV-1 RNA viral load rebound among HIV-positive illicit drug users in a Canadian setting","volume":"24","author":"Ladak","journal-title":"Antivir Ther"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1186\/PREACCEPT-1453408941291432","article-title":"Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis","volume":"12","author":"Langebeek","journal-title":"BMC Med"},{"issue":"16","key":"R5","doi-asserted-by":"publisher","first-page":"2559","DOI":"10.1097\/QAD.0b013e328363bff2","article-title":"Longitudinal changes in engagement in care and viral suppression for HIV-infected injection drug users","volume":"27","author":"Westergaard","journal-title":"AIDS"},{"issue":"Suppl 1","key":"R6","first-page":"S135","volume":"117","author":"Galea","journal-title":"Public Health Rep"},{"issue":"12","key":"R7","doi-asserted-by":"publisher","first-page":"2238","DOI":"10.2105\/AJPH.2006.090209","article-title":"Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV\/AIDS","volume":"97","author":"Kidder","journal-title":"Am J Public Health"},{"issue":"S7","key":"R8","doi-asserted-by":"publisher","first-page":"S552","DOI":"10.2105\/AJPH.2018.304772","article-title":"Longitudinal determinants of housing stability among people living with HIV\/AIDS experiencing homelessness","volume":"108","author":"Marcus","journal-title":"Am J Public Health"},{"issue":"1058","key":"R9","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-1058","article-title":"Frequent food insecurity among injection drug users: correlates and concerns","volume":"12","author":"Strike","journal-title":"BMC Public Health"},{"issue":"12","key":"R10","doi-asserted-by":"publisher","first-page":"2204","DOI":"10.1017\/S1368980016000306","article-title":"Food insecurity among people who inject drugs in Los Angeles and San Francisco","volume":"19","author":"Schmitz","journal-title":"Public Health Nutr"},{"issue":"8","key":"R11","doi-asserted-by":"publisher","first-page":"1510","DOI":"10.1007\/s10461-014-0873-1","article-title":"Does food insecurity undermine adherence to antiretroviral therapy? A systematic review","volume":"19","author":"Singer","journal-title":"AIDS Behav"},{"issue":"5","key":"R12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0061277","article-title":"Relationship between food insecurity and mortality among HIV-positive injection drug users receiving antiretroviral therapy in British Columbia, Canada","volume":"8","author":"Anema","journal-title":"PLoS ONE"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-021-00536-x","article-title":"Food access among people who inject drugs in West Virginia","volume":"18","author":"Rouhani","journal-title":"Harm Reduct J"},{"issue":"16","key":"R14","doi-asserted-by":"publisher","first-page":"2037","DOI":"10.1097\/QAD.0b013e32834b35c9","article-title":"Severe food insecurity is associated with elevated unprotected sex among HIV-seropositive injection drug users independent of HAART use","volume":"25","author":"Shannon","journal-title":"AIDS"},{"issue":"11","key":"R15","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1097\/QAD.0b013e3282fbd1ed","article-title":"A review of barriers and facilitators of HIV treatment among injection drug users","volume":"22","author":"Wood","journal-title":"AIDS"},{"issue":"7","key":"R16","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1093\/cid\/cir491","article-title":"Incarceration predicts virologic failure for HIV-infected injection drug users receiving antiretroviral therapy","volume":"53","author":"Westergaard","journal-title":"Clin Infect Dis"},{"issue":"9","key":"R17","doi-asserted-by":"publisher","first-page":"2549","DOI":"10.1007\/s10461-019-02437-4","article-title":"Effect of patient navigation on transitions of HIV care after release from prison: a retrospective cohort study","volume":"23","author":"Westergaard","journal-title":"AIDS Behav"},{"key":"R18","unstructured":"mHealth: New Horizons for Health through Mobile Technologies. World Health Organization; 2011. ISBN: 9789241564250"},{"issue":"3","key":"R19","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/j.jana.2013.10.007","article-title":"Exploring the medical home in Ryan White HIV care settings: a pilot study","volume":"25","author":"Beane","journal-title":"J Assoc Nurses AIDS Care"},{"issue":"4","key":"R20","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1177\/002204269102100406","article-title":"The ALIVE Study: a longitudinal study of HIV-1 infection in intravenous drug users: description of methods","volume":"21","author":"Vlahov","journal-title":"J Drug Issues"},{"issue":"3","key":"R21","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1111\/add.15659","article-title":"Mortality among people who inject drugs: a prospective cohort followed over three\u2009decades in Baltimore, MD, USA","volume":"117","author":"Sun","journal-title":"Addiction"},{"issue":"5","key":"R22","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1001\/jamapsychiatry.2013.4642","article-title":"A smartphone application to support recovery from alcoholism: A randomized clinical trial","volume":"71","author":"Gustafson","journal-title":"JAMA Psychiatry"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-016-1726-1","article-title":"The effect of bundling medication-assisted treatment for opioid addiction with mHealth: study protocol for a randomized clinical trial","volume":"17","author":"Gustafson","journal-title":"Trials"},{"issue":"2","key":"R24","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1176\/appi.ajp.20230055","article-title":"Effects of bundling medication for opioid use disorder with an mHealth intervention targeting addiction: a randomized clinical trial","volume":"181","author":"Gustafson","journal-title":"Am J Psychiatry"},{"key":"R25","doi-asserted-by":"crossref","unstructured":"Deci EL Ryan RM . Intrinsic Motivation and Self-Determination in Human Behavior. Plenum Press; 1985. ISBN: 978-0-306-42022-1","DOI":"10.1007\/978-1-4899-2271-7"},{"key":"R26","unstructured":"HIV treatment as prevention?HIV.gov. 2023. URL: https:\/\/www.hiv.gov\/tasp [Accessed 18-03-2025]"},{"issue":"6","key":"R27","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1056\/NEJMoa1105243","article-title":"Prevention of HIV-1 infection with early antiretroviral therapy","volume":"365","author":"Cohen","journal-title":"N Engl J Med"},{"issue":"4","key":"R28","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1007\/s11904-020-00507-0","article-title":"A systematic review of recent methodological approaches for using ecological momentary assessment to examine outcomes in U.S. based HIV research","volume":"17","author":"Smiley","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"4","key":"R29","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.1109\/JBHI.2019.2937116","article-title":"Context-aware delivery of ecological momentary assessment","volume":"24","author":"Aminikhanghahi","journal-title":"IEEE J Biomed Health Inform"},{"issue":"26\u201330","key":"R30","first-page":"26","volume":"2007","author":"Ash","journal-title":"AMIA Annu Symp Proc"},{"issue":"1","key":"R31","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-13-295","article-title":"Public health communications and alert fatigue","volume":"13","author":"Baseman","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"R32","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1097\/NAQ.0000000000000119","article-title":"A systematic review of nurses\u2019 experiences with unintended consequences when using the electronic health record","volume":"39","author":"Gephart","journal-title":"Nurs Adm Q"},{"issue":"5","key":"R33","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.7463","article-title":"More than a text message: dismantling digital triggers to curate behavior change in patient-centered health interventions","volume":"19","author":"Muench","journal-title":"J Med Internet Res"},{"key":"R34","doi-asserted-by":"publisher","DOI":"10.1177\/11782218211053360","article-title":"Clinician perspectives on barriers and facilitators to implementing e-health technology in substance use disorder (SUD) treatment facilities","volume":"15","author":"Fleddermann","journal-title":"Subst Abuse"},{"issue":"3","key":"R35","doi-asserted-by":"publisher","DOI":"10.2196\/35125","article-title":"Implementation of smartphone systems to improve quality of life for people with substance use disorder: interim report on a randomized controlled trial","volume":"9","author":"Gustafson","journal-title":"JMIR Hum Factors"},{"issue":"1","key":"R36","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8928","article-title":"Implementing a mobile health system to integrate the treatment of addiction into primary care: a hybrid implementation-effectiveness study","volume":"20","author":"Quanbeck","journal-title":"J Med Internet Res"},{"issue":"2","key":"R37","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1111\/add.12768","article-title":"Capturing illicit drug use where and when it happens: an ecological momentary assessment of the social, physical and activity environment of using versus craving illicit drugs","volume":"110","author":"Linas","journal-title":"Addiction"},{"issue":"1","key":"R38","doi-asserted-by":"publisher","DOI":"10.2196\/10681","article-title":"Promising approaches for engaging youth and young adults living with HIV in HIV primary care using social media and mobile technology interventions: protocol for the SPNS social media initiative","volume":"8","author":"Medich","journal-title":"JMIR Res Protoc"},{"issue":"5","key":"R39","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1177\/1524839920938704","article-title":"Qualitative evaluation of social media and mobile technology interventions designed to improve HIV health outcomes for youth and young adults living with HIV: a HRSA SPNS initiative","volume":"21","author":"Brooks","journal-title":"Health Promot Pract"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e59953","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:32:12Z","timestamp":1785537132000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e59953"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,26]]},"references-count":39,"URL":"https:\/\/doi.org\/10.2196\/59953","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,26]]},"article-number":"v9i3e59953"}}