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BackgroundDespite advances in testing and treatment, HIV incidence rates within European countries are at best stable or else increasing. mHealth technology has been advocated to increase quality and cost-effectiveness of health services while dealing with growing patient numbers. However, studies suggested that mHealth apps are rarely adopted and often considered to be of low quality by users. Only a few studies (conducted in the United States) have involved people living with HIV (PLWH) in the design of mHealth. ObjectiveThe goal of this study was to facilitate a co-design process among PLWH and clinicians across 5 clinical sites in the European Union to inform the development of an mHealth platform to be integrated into clinical care pathways. We aimed to (1) elicit experiences of living with HIV and of working in HIV care, (2) identify mHealth functionalities that are considered useful for HIV care, and (3) identify potential benefits as well as concerns about mHealth. MethodsBetween January and June 2016, 14 co-design workshops and 22 semistructured interviews were conducted, involving 97 PLWH and 63 clinicians. Data were analyzed thematically and iteratively, drawing on grounded theory techniques. ResultsFindings were established into 3 thematic clusters: (1) approaching the mHealth platform, (2) imagining the mHealth platform, and (3) anticipating the mHealth platform’s implications. Co-design participants approached the mHealth platform with pre-existing concerns arising from their experiences of receiving or providing care. PLWH particularly addressed issues of stigma and questioned how mHealth could enable them to manage their HIV. Clinicians problematized the compatibility of mHealth with existing information technology systems and questioned which patients should be targeted by mHealth. Imagining the potential of mHealth for HIV care, co-design participants suggested medical functionalities (accessing test results, managing medicines and appointments, and digital communication channels), social functionalities (peer support network, international travel, etc), and general features (security and privacy, credibility, language, etc). Co-design participants also anticipated potential implications of mHealth for self-management and the provision of care. ConclusionsOur approach to co-design enabled us to facilitate early engagement in the mHealth platform, enabling patient and clinician feedback to become embedded in the development process at a preprototype phase. Although the technologies in question were not yet present, understanding how users approach, imagine, and anticipate technology formed an important source of knowledge and proved highly significant within the technology design and development process.

We examined the impact of Covid-19 restrictions on the wellbeing and access to care among people living with HIV (PLWH) in the UK. A cross-sectional anonymous online survey was circulated to PLWH attending care at three HIV services in Sussex. The questionnaire covered key themes: socio-demographic characteristics; changes in physical and mental health; accessibility of essential health services and information; and socio-economic concerns. Free-text qualitative responses were examined through framework analysis. Quantitative data from 653 respondents were available, with a subset of 385 free-text qualitative responses. In terms of mental health, 501 (77.6%) respondents reported feeling more anxious; 464 (71.8%) reported feeling more depressed than usual; and 128 (19.8%) reported having suicidal thoughts since the start of the pandemic. Respondents worried about running out of HIV medicine (n = 264, 40.7%); accessing HIV services (n = 246, 38.0%) as well as other health services (n = 408, 63.0%). Widespread resilience was also noted: 537 (83.3%) of respondents felt that living with HIV had equipped them with the strength to adapt to the Covid-19 pandemic. Findings highlight important gaps between the multifaceted needs of PLWH. Multisectoral collaborations and investments are needed to adequately support PLWH and to build resilience to future shocks within HIV services. [ABSTRACT FROM AUTHOR]

This study examines the impact of English local government finance reform after the 2008 Financial Crisis. It uses advances in case-based methods, combined into Dynamic Pattern Synthesis, to explore changes. Reductions in central government financing threaten the continuation of local services. The results show significant political and management differences as local authorities adapt to manage their survival. Disadvantaged areas are worse affected and to deliver local services are increasingly dependent on 'market innovations' to secure income. Previous research has explained the marketization of supply, this new research explores the turn to the 'marketization of income'. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Individual responsibility and self‐care are seen as ways to overcome some of the challenges for long‐term health care provision. Patients are being encouraged to take an active role in their health care. Access to health information via a web‐based, patient‐facing portal is an innovative way to engage in self‐care. PatientView is one such portal, which was developed to allow patients with kidney disease access to parts of their health record. It was thought that the use of PatientView would improve self‐care activity but there was little evidence to support this claim. Objective: To gain an understanding of how patients with kidney disease use PatientView in their self‐care practice. Participants: Six users and four non‐users of PatientView. Design: Qualitative, semi‐structured interviews and participant observation. Approach: A practice‐based approach was used to collect qualitative data to better understand how patients use PatientView in daily life to enable self‐care. Participants were invited to "show the researcher" how they use PatientView and to describe how they translated the information into actions of self‐care. Inductive analysis was used to identify themes. Results: The analysis identified four key themes, which were non‐linear inter‐related. Patients engage with PatientView because it supports ways of knowing that are of direct importance to self‐care activity. Patients interact with PatientView and translate the information they gain from using it into actions that support self‐care. A consequence of engaging with PatientView is that patients can involve their family more in their care and this helps to reduce the burden on health care professionals. Conclusion: Patient interactions with PatientView are inter‐related, multi‐dimensional and differ according to the individual's positioning within a continuum of care. Nonetheless, these interactions can be captured and doing so provides a basis for understanding of how patients create and sustain opportunities for care through information technology. [ABSTRACT FROM AUTHOR]

In this paper we present empirical work detailing the engagement practices of a large FLOSS project, the Digital Business Ecosystem (DBE). In common with many other FLOSS projects, the DBE project focused on the development of infrastructural software components. Infrastructures and FLOSS software exhibit multiplicity: as objects they both change and stay the same. Whilst the implications of multiplicity with respect to infrastructure have been well-documented, with respect to FLOSS, they remain under-explored. Through examining how the DBE engaged new participants we were able to explore the nature of the FLOSS software object by asking the implied question: engagement with what? We draw on recent analysis by Law and Singleton to show how the innovative yet non-existent potentiality of the DBE was as signifi cant to engagement as its steadily growing codebase. We argue that acknowledging the materiality and immateriality of the FLOSS software object has important consequences for management of, and engagement with, FLOSS projects. [ABSTRACT FROM AUTHOR]

Background: The control of HIV/AIDS has been a contemporary public health success story however, whilst infection rates are falling and people are living longer due to antiretroviral therapy, adolescents and young people remain disproportionally affected. Infection rates and AIDS-related deaths continue to increase in these age groups in some areas globally. This has been primarily attributed to structural barriers including HIV-services not being youth friendly with opening hours conflicting with school time, fears around unintended disclosure and confidentiality, and the attitudes of healthcare professionals-but research targeting these specific age groups remains limited. Early mHealth (i.e., the use of mobile and wireless devices to assist in achieving health objectives) projects have been shown to improve health outcomes in other disease areas and health settings however, amongst people living with HIV, current research is limited. The aim of this study was to explore barriers to HIV care and the acceptability and feasibility of using mHealth to improve retention into care and ART adherence for young people living with HIV (16-24 years old) in Lusaka, Zambia., Methods: Qualitative in-depth interviews and focus group discussions were carried out in four CIDRZ-supported health facilities in Lusaka, Zambia. Six interviews were carried out with nurses and peer-support workers working with young people living with HIV and three focus groups with a total of 24 young people. Recruitment was via purposive sampling. Interviews and focus groups were recorded, translated and transcribed and entered into NVivo for thematic analysis., Results: Twenty-four of the young persons interviewed had access to mobile phones and reported using them for social networking, information gathering and regular communication. Barriers to HIV care and adherence were largely underpinned by stigma. Participants described healthcare facilities as not being conducive for confidentiality and therefore were reluctant to be seen attending or collecting medication from the pharmacy due to possible unintended disclosure and consequential HIV-related stigma. Clinic opening and waiting times and experiences with healthcare professionals also served as barriers. It was felt unanimously by participants that mHealth would be beneficial in improving retention into care and ART adherence in young people living with HIV., Conclusions: HIV-related stigma remains a barrier to care. With growing access to mobile phones and internet, and a growing population of adolescents who are already using their phones to support each other and seek information, mHealth appears to be both a feasible and acceptable tool to support retention, provide young people with information, and potentially reduce time spent at health facilities via appointment reminders and electronic drug refill requests., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2019 mHealth. All rights reserved.)