Social media as a tool to monitor adherence to HIV antiretroviral therapy

Abstract

Keywords: intestinal failure liver disease enterohepatic cycle bile salt signaling FXR enterocutaneous fistula Although strict adherence to antiretroviral therapy (ART) lowers morbidity and mortality for people living with HIV and AIDS, there are a number of behavioral, cultural, and psychosocial factors that prevent people from adhering to their medication [1]. Within African-American and Latino communities, for example, stigma around sexual identity and behavior hinders open dialogue about the value and proper use of HIV treatment medications [2,3]. In addition, misunderstandings about how ART affects the body have led some patients to believe that they can skip doses without experiencing negative consequences. For example, in 2015, the actor Charlie Sheen-who has been influential in raising public awareness about HIV-announced on The Dr. Oz Show that he has strayed from his ART regimen [4]. As a result, public health researchers require innovative methods for monitoring and improving adherence to HIV and other medications. A number of factors affect medication adherence, including potential stigmatization from taking medication or being associated with testing positive for HIV [5, 6]. As patients are publicly sharing personal information, including HIV related behaviors, on social media [7,8,9], health systems may be able to gain insights into patients' adherence by gaining consent from patients to follow and monitor their social media accounts. Health systems could use that information to assist with health care decisions. However, many patients and health systems might be uncomfortable with the potential legal and ethical issues associated with tracking individual patients. Therefore, it's also possible to avoid directly following individuals and instead use patients' publicly-available aggregated data to understand and predict adherence-related behaviors. For example, hospital patients are actively using Twitter to ask questions and express concerns about their healthcare experiences [10], and this information can be mined to improve patient outcomes. People also use social media to express their emotions and stress levels, including anger, fear, happiness, and others [11]. This psychological information has been used