Peer-supported digital collection of patient-reported outcomes in HIV care: Promise, practical barriers and lessons from a pilot study within the ICONA cohort

Purpose: To explore whether peer support could enhance patient-reported outcome (PRO) completion through a mobile health platform within the ICONA cohort of people with HIV in Italy, and to identify practical lessons for integrating peers into digital, person-centred HIV care. Materials and Methods: A pilot intervention was implemented in four cohort centres where trained peers, affiliated with the ICONA Community Advisory Board, supported PRO completion using the e-QoL mobile app over a five-month period. Fourteen additional centres without peer involvement served as comparisons. The primary outcome was the proportion of people with HIV fully completing ≥1 PRO before and during the intervention. A Difference-in-Difference (DiD) model, adjusted for demographic, HIV-related and socioeconomic variables, estimated the effect of the peer intervention. Results: During the intervention, 2421 people with HIV were followed in peer-supported centres and 2640 in peer-free centres. PRO completion increased from 1.24% to 3.08% in peer-supported sites, while a slight decline was observed in comparison centres (0.97% to 0.83%). The adjusted DiD analysis indicated a 2.0% absolute increase (95% CI: −0.40 to 4.5) attributable to peer support. Respondents were predominantly cisgender Italian men with higher education, suggesting limited reach to more digitally or socially vulnerable groups. Conclusion: Peer support modestly improved PRO completion and fostered greater awareness of PROs within HIV care.