Enhancing Chronic Hepatitis B and D Management Through a Tailored Mobile Health Application: Real-World Outcomes From...

Chronic hepatitis B (CHB) and hepatitis D (CHD) remain global health challenges, where sustained care engagement, treatment adherence and regular monitoring are essential but often limited by stigma and healthcare access. Digital health tools offer new opportunities to bridge these gaps. This study aimed to adapt the NORA mobile health app for CHB and CHD patients and evaluate its real-world utility in improving knowledge, adherence, communication and quality of life. We conducted a prospective, comparative study (February 2022-April 2024) including adult CHB (HBsAg-positive, HBeAg-negative) or CHD (anti-HDV or HDV-RNA-positive) patients with mobile access and Spanish proficiency. The app offered educational content, medication reminders, quality-of-life questionnaires (CLDQ, FACIT-F, EQ-5D-5L), a chat function and a knowledge test. Sociodemographic, clinical and usage data were analysed. Of 406 patients evaluated (356 CHB, 50 CHD), 277 CHB and 41 CHD patients were eligible. Participation was high (CHB: 88.4%; CHD: 90.2%), with active use in 48.1% and 70.3%, respectively. App users were more often male and Caucasian, and CHD users more frequently had detectable HDV-RNA. Patients with inactive HBV infection were less likely to use the app over the medium term (OR = 0.462, p = 0.003), and those who did use the app missed fewer clinic visits than nonusers (8.4% vs. 18.1%; OR = 0.41, p = 0.016). Among users, 85 were on antiviral therapy, 67% used the medication reminder, and chat use was higher in CHD and in treated patients (p = 0.004). High adherence (68% CHB, 84% CHD) and knowledge gains were observed, particularly in CHB with higher education. CHD patients showed worse baseline quality of life and greater declines over time. This first real-world study of a tailored mobile health (mHealth) app for CHB and CHD showed improved patient knowledge, adherence, communication and quality-of-life monitoring, with greater engagement in patients with advanced disease.