Development and Evaluation of a Mobile Directly Observed Therapy Smartphone App for Immunosuppressive Adherence in Transplant Patients

Project Summary Outcomes following solid organ transplantationSOTare generally excellent withyear survival exceedingfor most graft types and age groupsImmunosuppression nonadherence is an important factor leading to graft failure and patient mortality in SOT recipients since individuals are required to make a lifelong commitment to a strict medication scheduleNonadherence has been reported to range fromtoamong liver patients and more thanamong kidney patientsMobile applicationsappsprovide a low cost and scalable opportunity to improve medication adherence through more consistent monitoringearlier detection of nonadherenceand frequent patient provider communication with nonadherent patientsWe have developed a patient facing mHealth appmDOT for Transplantationthat enables patients to view their immunosuppression regimenrecord themselves taking doses of their medicationtrack and visualize progress on their own and with their transplant coordinatordocument symptoms and side effectsand access educational contentThere is a transplant provider webbased platform where they can review patient submitted videosprovide feedback about accepting the video as evidence of adherenceand receive notifications when patients report symptomsThe proposed project seeks to optimize this tool to increase medication adherence in transplant recipientsThe aims of the project areto enhance mDOT for Transplantation withway patient provider communication messaging capabilities and standardized text messages to promote behavior change andto perform a pilot randomized controlled trial of mDOT for Transplantation compared to standard of care in SOT patients Project Narrative Immunosuppression nonadherence is a leading cause of rejectionde novo DSAgraft lossand death among kidney and liver transplant recipientsof kidney and liver transplant recipients are nonadherent to their immunosuppression medicationsWe have developed a patient facing mHealth app that enables patients to view their immunosuppression regimenrecord themselves taking doses of their medicationtrack and visualize progress on their own and with their transplant coordinatordocument symptoms and side effectsand access educational contentThe goal of this project is tooptimize this system with two way communication capacity in order to foster greater patient provider engagement andconduct a randomized controlled trial to compare medication adherence between app users and standard of care patients