PrEP
Erika Chu, Jackie Ko, Hannah Pham, Jacob Rue
Problem Summary
Researchers within the University of Virginia Health System have long been committed to providing empathetic, effective health care solutions to patients across multiple disciplines - with particular strides in the area of clinical HIV research. A few years ago, the University of Virginia’s Ryan White Clinic launched a project titled Positive Links (PL) which more closely integrated patients with a network of supportive Providers and Navigators, via a mobile application of the same name. PL was ultimately successful in increasing daily medication habits and healthy habit formation among HIV patients, and continues to be used to date.
Patients who do not have HIV and therefore are not eligible for PL, but are at-very-high-risk for HIV may be instead prescribed pre-exposure prophylaxis (PrEP), a medication that has been proven to reduce chance of infection and is also taken daily. It became clear that a PrEP-tailored mobile application, similar to PL, might improve adherence and habit-forming in the PrEP community as it had in the PL community. We were approached by PL researchers Dr. Karen Ingersoll and Ms. Sarah Knight to assist in designing such an app - one which aims to improve the habits and medication adherence of those already on PrEP, while also emphasizing uptake of PrEP for users still in the consideration phase.
Design Goals
1. Ensure that those currently taking PrEP continue to do so on a consistent basis by ensuring a daily check-in process that is immediately accessible and quick to complete
2. Facilitate uptake of PrEP by highlighting to non-users access to resources, providers, and the PrEP community
3. Encourage users to engage with the app regularly by giving the app a welcoming, fun, and modern feel
4. Ensure that user information is kept secure and that users feel safe using the app by enacting security features making users aware of these features
Non-PrEP: users considering PrEP medication
Our first use case involves the narrative of a user not yet on PrEP but who, with encouragement from a past Provider, has made an account to learn more about his options. The user has made a few comments in the Community section and has logged on today looking for additional information on PrEP, to see if he can find a Provider a little closer to home, and to set a reminder for himself about an upcoming checkup.
Users first encounter the login screen, where they are only required to input a unique password matching a username created with a provider. Additional screens show what would appear if the user had been locked out by the app’s security features, and a path for the user to find that information.
Non-PreP users will be asked to take a questionnaire prior to accessing the main app. Questions are posed in a card layout, which will automatically advance as answers are selected and can be moved forward and back with a simple swipe. This design aims to make the process of data entry simple and intuitive, allows for easy error correction, and leaves the user aware of their position in the questionnaire and free to advance or exit as they please.
Within the questionnaire, users are prompted to review their final responses before submitting, reiterating to the user the importance of their responses and allowing them to make corrections as needed. If the user chooses to skip a question and goes to submit, a message pops up to alert the user that there is an unanswered question, and gives options to proceed.
Once the user submits the questionnaire, he is led to the home screen. Non-PrEP users have a custom navigation bar that gives immediate access to the Find a Provider feature; this design is meant to keep PrEP uptake at the front of the user’s mind. They are also offered upfront access to the Community and Resources feeds, both of which are helpful towards the decision to begin PrEP. Here the user has tapped on the Community tab to take a look at recent notifications.
On clicking the Find a Provider icon, the user is immediately led to a screen that uses location data to identify Providers nearby, all of whom can provide the user with additional information and support. Users can refine their search by inputting the name of a provider or a ZIP code at the top of the screen. If the user wishes to contact a provider immediately through the app, he can do so by clicking on the phone number or private message icon.
Once the user makes an appointment with a provider, he can view his personal schedule for the desired month in the form of a calendar or a list view by scrolling through the “Your Schedule” screen. Both display reminders that have been set, but the list view allows for the user to directly see specifics regarding the reminder. To set a reminder, users set a date, time, a potential note, and which time to receive an alert. The Schedule tab is designed to ensure the user stays organized and aware of upcoming events.
PrEP: users currently on PrEP medication
Our second use case focuses on a user who is currently taking PreP. Instead of taking a post-login questionnaire to assess PrEP eligibility, the PrEP user is instead immediately prompted to complete her daily Check In. On completion of her Check In we see that the user has a Labs notification which she chooses to open. She finishes her use of the app by checking Document Upload and Resources.
Once PrEP users log in, they are immediately taken to the check-in process if they have not yet checked in. This is done in order to keep track of the user’s mood, stress level, and adherence to the medication. They can either answer the check-in questions immediately or skip them by clicking “Not Now”.
When the check-in is completed, users are taken to a final screen that allows them to confirm their responses. They can change any of their responses by clicking on the question.
After either checking in or opting to check in later, PrEP users are taken to a homepage that will either thank them for checking in or remind them to eventually check in, respectively.
The home screen immediately shows users their trends of mood, stress, and medication adherence. This history of check-in responses are on the home screen so that users are encouraged to continue taking their medication and checking in to record it. The thought is that if users are continually shown their responses, they are more likely to check in on a daily basis.
First, mood and stress are expressed with a line graph showing the range of a week, month, or year. If they took their medication that day, there is a green check mark under the day. If they did not take their medication, it is left as an empty circle.
Users can swipe to the right in order to display this information on a quadrant, with the x-axis representing stress and the y-axis representing mood. The dot is solid green if they took their medication that day and an empty circle if they did not. This representation was designed as an illustrative alternative to the line graph.
Users can access previous lab results through the hamburger menu in the top right of the screen. If the user has a new lab result, a red notification bubble will show up indicating so.
Users can see all current lab results on this screen. If they click on any of the specific labs, they are able to delve into further detail and look at results of previous tests.
Users can upload documents as well as see documents that have been received by their providers. This screen is thus organized into two sections, a requested documents section and a received documents section. Users receive a notification when a new document is requested by their provider. They can click on the requested documents header in order to submit the requested document or click on a received document for reference.
Users have access to resources through four categories that can be navigated to through the menu in the top bar. Users can also use the search functionality in order to find specific resources. Once users navigate to a resource category page, they are able to scroll through the app’s collection of resources for that given category.
