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Hartch CE, Dietrich MS, Lancaster BJ, Stolldorf DP, Mulvaney SA. Effects of a medication adherence app among medically underserved adults with chronic illness: a randomized controlled trial. J Behav Med 2024; 47:389-404. [PMID: 38127174 PMCID: PMC11026187 DOI: 10.1007/s10865-023-00446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/16/2023] [Indexed: 12/23/2023]
Abstract
For individuals living with a chronic illness who require use of long-term medications, adherence is a vital aspect of successful symptom management and outcomes. This study investigated the effect of a smartphone app on adherence, self-efficacy, knowledge, and medication social support in a medically underserved adult population with various chronic illnesses. Participants were randomized to a group who used the app for one month or a control group provided with a printed medication list. Compared to the control group, participants receiving the intervention had significantly greater medication adherence (Cohen's d = -0.52, p = .014) and medication self-efficacy (Cohen's d = 0.43, p = .035). No significant effects were observed related to knowledge or social support. The findings suggest use of the app could positively impact chronic disease management in a medically underserved population in the United States.
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Affiliation(s)
- Christa E Hartch
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA.
- School of Nursing and Health Sciences, Manhattanville College, 2900 Purchase Street, Purchase, NY, 10577, USA.
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1100, Nashville, TN, 37203, USA
| | - B Jeanette Lancaster
- Sadie Heath Cabiness Professor and Dean Emerita, School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
| | - Deonni P Stolldorf
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA
| | - Shelagh A Mulvaney
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, #1475, Nashville, TN, 37203, USA
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Horvath KJ, Helm JL, Black A, Chase GE, Ma J, Klaphake J, Garcia-Myers K, Anderson PL, Baker JV. A Pilot Randomized Controlled Trial of an mHealth Intervention to Improve PrEP Adherence Among Young Sexual Minority Men. AIDS Behav 2024:10.1007/s10461-024-04374-3. [PMID: 38816592 DOI: 10.1007/s10461-024-04374-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
This randomized controlled study assessed the feasibility, acceptability, and preliminary impact of the PrEP iT! mHealth intervention designed to improve PrEP adherence among young men who have sex with men (YMSM). A national sample of 80 YMSM in the U.S. (Mage = 25 years; 54% racial/ethnic minority), recruited through social media ads, were randomized to either the PrEP iT! or usual PrEP care conditions. Participants completed online surveys and submitted self-collected dried blood sample (DBS) data as measures of PrEP adherence. Differences in PrEP adherence across treatment arms and between participants with high versus low engagement in PrEP iT! were assessed. Retention was high at the three (94%) and six (93%) month assessment, and participants in PrEP iT! reported satisfactory acceptability of the intervention. There were no significant differences in self-reported or DBS-derived PrEP adherence between randomized groups. However, YMSM in the PrEP iT! group with high PrEP adherence (the equivalent of four or more doses/week through self-report and DBS-derived measures) demonstrated significantly higher engagement in the intervention than those with low PrEP adherence (the equivalent of 3 or fewer doses/week). Overall, the PrEP iT! intervention demonstrated strong feasibility and acceptability. The finding that high PrEP iT! intervention engagement was associated with protective levels of PrEP adherence suggests it is a viable adherence support tool that should be further evaluated in definitive trial among YMSM who need basic support, or as part of a more comprehensive adherence support package for those who need greater assistance.Trial registration Clinical Trials # NCT04509076 (registered August 10, 2020).
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Affiliation(s)
- Keith J Horvath
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, San Diego, CA, 92120, USA.
| | - Jonathan L Helm
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Ashley Black
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Gregory E Chase
- Department of Psychology, University of North Carolina at Greensboro, 296 Eberhart Building, P.O. Box 26170, Greensboro, NC, 27402, USA
| | - Junye Ma
- San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, San Diego, CA, 92120, USA
| | - Jonathan Klaphake
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Kelly Garcia-Myers
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Peter L Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, 12850 East Montview Boulevard, Aurora, CO, 80045, USA
| | - Jason V Baker
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
- Department of Medicine, University of Minnesota, 401 East River Parkway VCRC 1st Floor, Suite 131, Minneapolis, MN, 55455, USA
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Garcia C, Rehman N, Matos-Silva J, Deng J, Ghandour S, Huang Z, Mbuagbaw L. Interventions to Improve Adherence to Oral Pre-exposure Prophylaxis: A Systematic Review and Network Meta-analysis. AIDS Behav 2024:10.1007/s10461-024-04365-4. [PMID: 38814406 DOI: 10.1007/s10461-024-04365-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/31/2024]
Abstract
For people at risk of HIV infection, pre-exposure prophylaxis (PrEP) can reduce the risk of infection in anticipation of exposure to HIV. The effectiveness of PrEP relies upon a user's adherence to their PrEP regimen. We sought to assess the effect of PrEP adherence interventions compared to usual care or another intervention for people at risk of HIV. We searched electronic databases from 2010 onwards for randomized controlled trials (RCTs) involving persons at risk of HIV randomized to an adherence promoting intervention vs usual care or another intervention. We used network meta-analyses to compare PrEP adherence for all participant populations. Certainty of evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). 21 trials (N = 4917) were included in qualitative analysis (19 in network meta-analyses (N = 4101)). HIV self-testing interventions with adherence feedback elements improved adherence compared to usual care (risk ratio (RR): 1.83, 95%CI 1.19, 2.82). In contrast, HIV self-testing alone was inferior to HIV self-testing with adherence feedback (RR: 0.58, 95%CI 0.37-0.92). Reminders alone also were inferior to HIV self-testing with adherence feedback on adherence (RR: 0.53, 95%CI 0.34-0.84) and had similar effects on adherence as usual care (RR: 0.98, 95%CI: 0.86-1.11). Interventions with only one component were inferior for adherence than those with two components (RR: 0.74, 95%CI 0.62-0.88) and those with three components (RR: 0.78, 95%CI 0.65-0.93). The certainty of evidence was moderate for HIV self-testing plus adherence feedback and interventions with two or three components. When designing future PrEP adherence interventions, we recommend strategies with more than one but no more than three components.
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Affiliation(s)
- Cristian Garcia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Nadia Rehman
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jéssyca Matos-Silva
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jiawen Deng
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sara Ghandour
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zhongyu Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Liu AY, Alleyne CD, Doblecki-Lewis S, Koester KA, Gonzalez R, Vinson J, Scott H, Buchbinder S, Torres TS. Adapting mHealth Interventions (PrEPmate and DOT Diary) to Support PrEP Retention in Care and Adherence Among English and Spanish-Speaking Men Who Have Sex With Men and Transgender Women in the United States: Formative Work and Pilot Randomized Trial. JMIR Form Res 2024; 8:e54073. [PMID: 38536232 PMCID: PMC11007601 DOI: 10.2196/54073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND A growing number of mobile health (mHealth) technologies are being developed to support HIV preexposure prophylaxis (PrEP) adherence and persistence; however, most tools have focused on men who have sex with men (MSM), and few are available in Spanish. To maximize the potential impact of these tools in reducing gender and racial/ethnic disparities and promoting health equity, mHealth tools tailored to Spanish-speaking people and transgender women are critically needed. OBJECTIVE The aim of this study is to adapt and tailor 2 mHealth technologies, PrEPmate and DOT Diary, to support daily PrEP adherence and persistence among Spanish-speaking MSM and English- and Spanish-speaking transgender women and to evaluate the feasibility and acceptability of these tools. METHODS PrEPmate, an interactive, bidirectional, text messaging intervention that promotes personalized communication between PrEP users and providers, and DOT Diary, a mobile app that promotes self-management of PrEP use and sexual health through an integrated electronic pill-taking and sexual activity diary, were previously developed for English-speaking MSM. We conducted 3 focus groups with 15 English- and Spanish-speaking transgender women and MSM in San Francisco and Miami to culturally tailor these tools for these priority populations. We then conducted a 1-month technical pilot among 21 participants to assess the usability and acceptability of the adapted interventions and optimize the functionality of these tools. RESULTS Participants in focus groups liked the "human touch" of text messages in PrEPmate and thought it would be helpful for scheduling appointments and asking questions. They liked the daily reminder messages, especially the fun facts, gender affirmations, and transgender history topics. Participants recommended changes to tailor the language and messages for Spanish-speaking and transgender populations. For DOT Diary, participants liked the adherence tracking and protection level feedback and thought the calendar functions were easy to use. Based on participant recommendations, we tailored language within the app for Spanish-speaking MSM and transgender women, simplified the sexual diary, and added motivational badges. In the technical pilot of the refined tools, mean System Usability Scale scores were 81.2/100 for PrEPmate and 76.4/100 for DOT Diary (P=.48), falling in the "good" to "excellent" range, and mean Client Satisfaction Questionnaire scores were 28.6 and 28.3 for PrEPmate and DOT Diary, respectively (maximum possible score=32). Use of both tools was high over the 1-month pilot (average of 10.5 messages received from each participant for PrEPmate; average of 17.6 times accessing the DOT Diary app), indicating good feasibility for both tools. CONCLUSIONS Using a user-centered design approach, we culturally tailored PrEPmate and DOT Diary to support daily PrEP use among Spanish-speaking MSM and English- and Spanish-speaking transgender women. Our positive findings in a technical pilot support further testing of these mHealth interventions in an upcoming comparative effectiveness trial.
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Affiliation(s)
- Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Cat-Dancing Alleyne
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Susanne Doblecki-Lewis
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kimberly A Koester
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Rafael Gonzalez
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Janie Vinson
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Bragazzi NL, Crapanzano A, Converti M, Zerbetto R, Khamisy-Farah R. The Impact of Generative Conversational Artificial Intelligence on the Lesbian, Gay, Bisexual, Transgender, and Queer Community: Scoping Review. J Med Internet Res 2023; 25:e52091. [PMID: 37864350 PMCID: PMC10733821 DOI: 10.2196/52091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Despite recent significant strides toward acceptance, inclusion, and equality, members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community still face alarming mental health disparities, being almost 3 times more likely to experience depression, anxiety, and suicidal thoughts than their heterosexual counterparts. These unique psychological challenges are due to discrimination, stigmatization, and identity-related struggles and can potentially benefit from generative conversational artificial intelligence (AI). As the latest advancement in AI, conversational agents and chatbots can imitate human conversation and support mental health, fostering diversity and inclusivity, combating stigma, and countering discrimination. In contrast, if not properly designed, they can perpetuate exclusion and inequities. OBJECTIVE This study aims to examine the impact of generative conversational AI on the LGBTQ community. METHODS This study was designed as a scoping review. Four electronic scholarly databases (Scopus, Embase, Web of Science, and MEDLINE via PubMed) and gray literature (Google Scholar) were consulted from inception without any language restrictions. Original studies focusing on the LGBTQ community or counselors working with this community exposed to chatbots and AI-enhanced internet-based platforms and exploring the feasibility, acceptance, or effectiveness of AI-enhanced tools were deemed eligible. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). RESULTS Seven applications (HIVST-Chatbot, TelePrEP Navigator, Amanda Selfie, Crisis Contact Simulator, REALbot, Tough Talks, and Queer AI) were included and reviewed. The chatbots and internet-based assistants identified served various purposes: (1) to identify LGBTQ individuals at risk of suicide or contracting HIV or other sexually transmitted infections, (2) to provide resources to LGBTQ youth from underserved areas, (3) facilitate HIV status disclosure to sex partners, and (4) develop training role-play personas encompassing the diverse experiences and intersecting identities of LGBTQ youth to educate counselors. The use of generative conversational AI for the LGBTQ community is still in its early stages. Initial studies have found that deploying chatbots is feasible and well received, with high ratings for usability and user satisfaction. However, there is room for improvement in terms of the content provided and making conversations more engaging and interactive. Many of these studies used small sample sizes and short-term interventions measuring limited outcomes. CONCLUSIONS Generative conversational AI holds promise, but further development and formal evaluation are needed, including studies with larger samples, longer interventions, and randomized trials to compare different content, delivery methods, and dissemination platforms. In addition, a focus on engagement with behavioral objectives is essential to advance this field. The findings have broad practical implications, highlighting that AI's impact spans various aspects of people's lives. Assessing AI's impact on diverse communities and adopting diversity-aware and intersectional approaches can help shape AI's positive impact on society as a whole.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, CA, United States
| | - Manlio Converti
- Department of Mental Health, Local Health Unit ASL Napoli 2 Nord, Naples, Italy
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Mustanski B, Ryan DT, Spinelli MA, Gandhi M, Newcomb ME. Urine point-of-care tenofovir test demonstrates strong predictive clinical and research utility. AIDS 2023; 37:2381-2387. [PMID: 37696260 PMCID: PMC10841269 DOI: 10.1097/qad.0000000000003710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) significantly reduces HIV infection risk but is dependent on adherence. Available approaches to measuring adherence have limitations related to accuracy, cost, practicality, and timeliness. This study compared the performance of two methods implementable in clinics and research studies [interview and urine point of care (POC) assay] to the gold-standard for measuring recent and longer term adherence in dried blood spots (DBS). METHODS Participants were recruited from RADAR, a cohort study of young MSM, or via online advertisements. At 3 monthly visits, an interviewer administered 7-day timeline follow-back (TLFB) questionnaire, DBS samples were tested for tenofovir-diphosphate (TFV-DP) to estimate average dosing over the prior month and emtricitabine-triphosphate (FTC-TP) to assess recent dosing (past 2-3 days), and a urine POC TFV test to qualitatively assess recent adherence (past 4 days). RESULTS Eighty-three PrEP users contributed 163 observations. At visit 1, self-reported adherence was 86% (4+ doses in last 7 days), versus urine TFV (74%), DBS FTC-TP (76%), and DBS TFV-DP (69%). The objective measures of short-term adherence performed similarly well in predicting longer term adherence. In multivariable logistic regression analyses, the urine assay was a significant predictor of DBS TFV-DP (adjusted OR = 19.4, P < 0.0001); self-report did not add significantly. CONCLUSION The urine POC TFV assay had excellent predictive values for adherence and self-report did not add significantly to prediction. The POC assay provides results in several minutes to enable same-visit counseling, requires no specialized training, and is projected to be low-cost.
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Affiliation(s)
- Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel T. Ryan
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | | | - Monica Gandhi
- School of Medicine, University of California, San Francisco, CA, USA
| | - Michael E. Newcomb
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
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