Feasibility and Acceptability of the Adherence Connection Counseling, Education, and Support (ACCESS) Proof of Concept: A Peer-Led, Mobile Health (mHealth) Cognitive Behavioral Antiretroviral Therapy (ART) Adherence Intervention for HIV-Infected (HIV+) Adolescents and Young Adults (AYA)

Individual and Contextual Determinants of ART Adherence Among a Sample of Young Black Gay, Bisexual, and Other Men Who Have Sex with Men Living with HIV in the United States

The Information-Motivation-Behavioral Skills (IMB) model of antiretroviral therapy (ART) adherence describes self-reported ART adherence determinants among people living with HIV (PLWH) who struggle to achieve optimal adherence, but less is known about young Black gay, bisexual, and other men who have sex with men (MSM), a group reported to have less than optimal ART adherence levels, partially affected by depression. Using the IMB model, we analyzed baseline data from 315 Black MSM living with HIV aged 18-34 years struggling with ART adherence enrolled in a multi-state mobile health (mHealth) randomized controlled trial. Generalized structural equation modeling was used to estimate the direct and indirect effects of (1) ART-related information, (2) motivation and (3) behavioral skills, or treatment self-efficacy, on non-optimal self-reported ART adherence (< 80%, Wilson's adherence measure). Prevalence of non-optimal ART adherence was 28.3%. Low behavioral skills were directly associated with non-optimal ART adherence (β = 0.69, SE = 0.10, p <.001). Low behavioral skills significantly mediated the relationship between low motivation and non-optimal ART adherence (Sobel z = 4.12, p <.001). Low information was not associated with treatment self-efficacy. Low motivation had a greater overall effect on non-optimal ART adherence among those with none/mild depressive symptomatology (β = 0.30, SE = 0.13, p <.001), and the direct effect of low motivation on non-optimal adherence was null among those with moderate/severe depressive symptomatology. Development of combination HIV prevention interventions designed to improve ART adherence should combine culturally appropriate mental health care into HIV treatment that go beyond social support among those who may be experiencing depressive symptomatology.

Patient perceptions and predictors of intention to use telehealth for follow-up care: a mixed methods study among adults living with HIV in Kampala, Uganda

BACKGROUND

The human immunodeficiency virus (HIV) remains a significant global public health challenge. Despite progress in addressing the pandemic, people living with HIV continue to report challenges in accessing HIV testing, care, and treatment services. Telehealth presents a promising solution to some of these barriers. However, its potential remains unrealized, particularly in low- and middle-income settings, partly due to insufficient supporting evidence.

METHODS

Our mixed methods study investigated patient perceptions and predictors of intention to use telehealth for follow-up HIV care in Uganda. Quantitative data were collected from 266 participants using a questionnaire, followed by one-on-one interviews with 12 people living with HIV. Quantitative analysis involved Chi-square tests, t-tests, and binary logistic regression, while qualitative data were analyzed using conventional content analysis.

RESULTS

Our findings show that the intention to use telehealth was significantly associated with effort expectancy (aOR 1.26, CI 1.13-1.41), facilitating conditions (aOR 1.44, CI 1.19-1.73), estimated monthly income (aOR 2.94, CI 1.05-8.23; aOR 7.29, CI 1.12-47.49), and antiretroviral medication adherence (aOR 1.93, CI 1.12-3.33). Qualitative insights underscore the importance of digital literacy and availability of support services to enhance the utilization of telehealth. While performance expectation and stigma score did not significantly predict intention to use telehealth, participants perceived telehealth to be beneficial in combating stigma and improving access to HIV care services.

CONCLUSIONS

To optimize the utilization of telehealth, we recommend measures aimed at addressing economic disparities and enhancing digital literacy among people living with HIV. Future research should explore the effectiveness of economic empowerment programs in promoting telehealth use and investigate the impact of telehealth on HIV care models, stigma reduction, and linkage and retention in HIV care.

Telehealth Interventions to Improve HIV Care Continuum Outcomes: A Narrative Review

Interventions that leverage telehealth technologies have the potential to improve health outcomes among people with HIV who experience multiple complex barriers to care. To assess the current state of knowledge on telehealth interventions for people with HIV in the United States, we searched the literature for recent (2019-2023) telehealth interventions designed to improve outcomes along the HIV care continuum, including linkage to care, retention in care, antiretroviral therapy adherence, and viral suppression. Our search identified 23 interventions. Text messaging was the most common telehealth delivery mode, followed by videoconferencing, commercially available applications, and novel applications. Nine interventions used more than one delivery mode. Common features across interventions to address barriers along the HIV care continuum included: HIV care self-management and monitoring tools; HIV treatment and adherence education; resources and referrals provision; live messaging for ongoing support or urgent issues; videoconference-based coaching, counseling, case management, or care; online peer-to-peer support; ecological momentary assessments to monitor and address barriers; and game-based elements to increase engagement. Interventions were reported as acceptable and feasible, with several showing an effect on antiretroviral therapy adherence. Further research is needed to fully leverage the potential of telehealth for ending the HIV epidemic in the United States.

Enhancing HIV Cognitive Abilities and Self-Management Through Information Technology-Assisted Interventions: Scoping Review

BACKGROUND

HIV/AIDS remains a significant global challenge, and with the rapid advancement of technology, there has been an increasing number of interventions aimed at improving HIV/AIDS cognition and self-management behaviors among patients. However, there is still a lack of detailed literature integrating relevant evidence.

OBJECTIVE

This study aims to comprehensively review existing research on interventions using modern information methods to improve HIV/AIDS cognition and enhance self-management behaviors among patients. It systematically reports the theoretical frameworks and specific intervention strategies used in current research, providing a comprehensive overview of the development status of relevant studies. We aim to compile existing evidence through this scoping review to identify potential avenues for future research.

METHODS

We followed the scoping review framework proposed by the Joanna Briggs Institute for the synthesis and reporting of evidence. Relevant literature was searched using electronic databases, including PubMed, Web of Science, Embase, CINAHL, and Cochrane Library. The time frame for inclusion was from 2018 to December 1, 2023. Inclusion criteria were (1) interventions using modern information technology or new digital media, (2) studies focusing on improving HIV awareness or self-management behaviors among people living with HIV, (3) intervention studies or evaluations of intervention effects, and (4) studies published within the last five years. Two reviewers (HH and MX) independently assessed each study at both the title and abstract screening stage and the full-text review stage, resolving any disagreements through discussion.

RESULTS

A total of 55 studies that met the inclusion criteria were included. The Information-Motivation-Behavioral Skills model, Social Cognitive Theory, Health Belief Model, Theory of Planned Behavior, and Information Systems Research Framework are among the most commonly used theoretical frameworks. Modern information technology interventions are mainly constructed using smartphone apps, SMS text messaging, internet-based platforms, audiovisual materials, and digital health education platforms, with smartphone apps and SMS text messaging being the most widely used intervention media.

CONCLUSIONS

Modern information technology is becoming an important tool for health interventions among people living with HIV/AIDS. However, future research should focus on integrating theoretical framework guidance with intervention design, further exploring the diversity of intervention implementations, the applicability of different technological methods, their long-term effects, and how to more effectively combine traditional intervention strategies to maximize intervention outcomes.

Developing and testing a web-based platform for antiretroviral therapy (ART) adherence support among adolescents and young adults (AYA) living with HIV

Objective

Describe the development and testing of a web-based platform for antiretroviral treatment (ART) adherence support among HIV+ adolescents and young adults (AYA) in a randomized controlled trial (RCT).

Methods

A seven-member multi-disciplinary team operationalized the flat, password protected, web-based platform. Manualized protocols guided the objectives and content for each of the eight web-based sessions. Team members evaluated usability and content validity. Client satisfaction and perceived ease of use was evaluated with the first ten HIV+ AYA participants.

Results

The web-based platform was developed, evaluated, refined, implemented and pilot tested between September 2020 to April 2022. Usability was rated as high; the evaluation of content validity showed an excellent fit between session content and objectives. HIV+ AYA participants (mean age = 24.2 years) were satisfied with the quality, type, and amount of support/education received, and found the platform easy to use, operate, and navigate. Average time spent per session was 6.5 min.

Conclusion

Findings support the usability, validity, acceptability, and feasibility of this web-based platform for ART adherence support among HIV+ AYA.

Innovation

Our research and findings are responsive to research gaps and the need for transparency in the methodological development and testing of web-based control arms for ART adherence support among HIV+ AYA.

Peer education as a strategy to promote vaccine acceptance: A randomized controlled trial within New York community healthcare practices

BACKGROUND

Effective strategies are needed to improve vaccine acceptance. This study sought to determine if a peer-led vaccine education intervention embedded within community medical practices increases parental acceptance of pediatric pneumococcal conjugate vaccination.

METHODS

From March 2022-July 2023, we conducted a randomized trial at three pediatric health practices in predominantly Hasidic Jewish neighborhoods in New York, where vaccine deferral is common. Parents of children up to 18 months due/overdue for routine pneumococcal vaccination were randomized (1:1) to receive routine care alone or routine care plus a peer educational intervention. Peer educators trained in motivational interviewing and vaccine science provided counseling at enrollment and follow-up telephone engagement in the intervention arm at day 30 and 60. Primary outcome was child's pneumococcal immunization status by allocation arm expressed as at least one dose received between enrollment and 90 days post-enrollment.

RESULTS

144 parent-child dyads were eligible for outcome analysis. Participants in the group receiving routine care along with peer-led vaccine counseling were significantly more likely to have their child receive at least 1 vaccine dose between enrollment and 90 days compared to the group who received routine care alone (28.4 % vs 12.9 %, risk ratio [RR] 2.21, confidence interval [CI] 1.09-4.49, p = 0.022). The effect of peer education was greatest in dyads with children less than 1 year old at enrollment (34 % vs 12.7 %, RR 2.67, CI (1.22-5.86), p = 0.009).

CONCLUSIONS

Peer vaccine education can increase vaccine acceptance compared to routine care alone and may be particularly valuable in decreasing vaccination delays for younger infants. (Funded by EGL Charitable Foundation, ClinicalTrials.gov NCT05875779).

A qualitative assessment of retention in HIV care among adolescents and young adults (AYA) living with HIV in New York City

Retention in HIV care is a critical precursor to ending the epidemic yet remains suboptimal in the United States. Gaining an understanding of the challenges faced by adolescents and young adults (AYA) living with HIV is essential to improving retention in HIV care. This study explored the barriers and facilitators to retention in care among Black and Hispanic AYA living with HIV. Audio-recorded semi-structured interviews were conducted with 20 AYA living with HIV ages 16-29 years in New York City. Our methods entailed an inductive content analysis to explore key concepts, reconcile codes, and identify a theme, categories, and subcategories. Bronfenbrenner's socioecological model evolved as an organizing framework around barriers and facilitators to retention in care at the individual, interpersonal, healthcare system, and structural level. Data analysis yielded one overarching theme-the influence of psychosocial factors on retention in HIV care. Psychological struggles, powerlessness, clinic-level characteristics, and socioeconomic struggles were barriers reported by participants. Self-responsibility, social support, patient-friendly healthcare services, and socioeconomic resources emerged as facilitators. Retention in HIV care among AYA living with HIV is a multifaceted and complex phenomenon that involves multiple systems. Strengthening patients, healthcare system, and community partnerships can help address some of the HIV-related health disparities.

Assessing the Validity of the Social Impact Scale Among a Longitudinal Cohort of Adolescents and Young Adults Living With Perinatally Acquired HIV

BACKGROUND

With few psychometrically evaluated HIV-related stigma measures for adolescents and young adults living with HIV, we examined the developmental applicability (ie, validity) of 2 subscales of the commonly used stigma measure, the Social Impact Scale, among a cohort of adolescents and young adults with perinatally acquired HIV.

SETTING

Data were obtained from a New York City longitudinal study (N = 340). This study primarily comprised Black and Latinx adolescents and young adults with either perinatally acquired HIV or those with perinatal exposure but who are uninfected. Data for this analysis were obtained from the population with perinatally acquired HIV and spanned approximately a 15-year survey period (2003-2018).

METHODS

A confirmatory factor analysis was used at 7 time points to assess whether the Social Rejection and Internalized Shame subscales were consistent in this cohort over time. Overall and individual Cronbach alphas were reported to show the strength of the internal consistency.

RESULTS

The mean age from baseline to follow-up 6 ranged from 12 to 23 years over the study period. The Social Rejection subscale was acceptably valid across follow-up periods with strong factor loadings and Cronbach alphas higher than 0.70. However, the Internalized Shame subscale was less valid among younger adolescents. Starting at follow-up 2, we observed better validity with the Internalized Shame subscale performance.

CONCLUSION

Future research must consider mechanisms for developing and adapting measures from a developmental perspective to best measure the experiences of HIV-related stigma among younger populations.

The development of social capital in a peer-led mHealth cognitive behavioral antiretroviral therapy adherence intervention for HIV + adolescents and young adults

Adherence Connection for Counseling, Education, and Support (ACCESS)-I is a peer-led mHealth antiretroviral therapy adherence intervention for adolescents and young adults living with HIV who are in treatment but have detectable viral loads. Participants received five online sessions with peer health coaches who followed a structured intervention manual. Peers maintained intervention fidelity but also engaged in casual discussion that was not directly related to ART adherence or HIV. We conducted a qualitative analysis of the casual interactions that occurred during the ACCESS I intervention. Sessions were transcribed and coded, and these casual interactions were then coded into 10 subcodes to document their content, and also coded for three types of social capital - emotional, informational, and instrumental. Emotional and Informational social capital codes were the most common, while instrumental codes were rare. Activities was the most common topic overall, while encouragement was more common in emotional social capital narratives and personal experience was more common in informational social capital narratives. These casual interactions may strengthen peer-participant relationships, building social capital that could then be used to encourage positive behavior change. Although social capital was not directly measured, these analyses illustrate the value of attending to seemingly casual interactions in peer-led interventions.

A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol

BACKGROUND

While there is no cure for HIV, adherence to antiretroviral therapy can extend the lifespan and improve the quality of life of people with HIV. Despite the global reduction of HIV infection rates in recent years, New York City and La Romana, Dominican Republic, continue to report high infection rates among Latino populations. Many people with HIV remain virally unsuppressed in these geographic hotspots, suggesting a need for additional interventions to overcome medication adherence barriers. Tailored and culturally appropriate mobile health (mHealth) technology can be an engaging way to improve adherence. The primary objective of this trial is to test the effectiveness of an mHealth tool to improve HIV medication adherence among Spanish-speaking people living in New York City and the Dominican Republic.

METHODS

The WiseApp study is a two-arm randomized controlled trial among 248 people with HIV across the New York and Dominican Republic sites over the course of 12 months. Participants are randomly assigned to either receive a CleverCap pill bottle that is linked to the WiseApp (intervention) or standard of care (control). All participants complete surveys at baseline, 3-month, 6-month, and 12-month follow-up visits and the study team obtains HIV-1 viral load and CD4 count results through blood draw at each study timepoint.

DISCUSSION

The use of mHealth technologies to improve medication adherence among people with HIV has been implemented in recent years. Although some studies have found improvement in adherence to antiretroviral therapy in the short term, there is limited information about how these interventions improve adherence among Spanish-speaking populations. Disproportionate rates of HIV infection among Latinos in New York City suggest an existing inequitable approach in reaching and treating this population. Due to a lack of mHealth studies with Latino populations, and apps tailored to Spanish-speakers, the WiseApp study will not only demonstrate the effectiveness of this particular mHealth app but will also contribute to the mHealth research community as a whole.

TRIAL REGISTRATION

This trial was registered with Clinicaltrials.gov (NCT05398185) on 5/31/2022.