An Adaptive Antiretroviral Therapy Adherence Intervention for Youth with HIV Through Text Message and Cell Phone Support with and without Incentives: A Sequential Multiple Assignment Randomized Trial (SMART)

IF 2.7 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

AIDS and Behavior Pub Date : 2024-12-20 DOI:10.1007/s10461-024-04558-x

Marvin E. Belzer, Karen MacDonell, Demetria Cain, Samiran Ghosh, Richard Zhao, Julie McAvoy-Banerjea, Sitaji Gurung, Sylvie Naar

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Abstract

Youth living with HIV have low rates of medication adherence. Youth ages 15–24 years with adherence ≤ 80% or with HIV RNA PCRs (VL) ≥ 200 recruited through social media and clinical sites were randomized to brief weekday cell phone support (CPS) calls or daily, two-way, personalized text message (SMS) reminders for 3 months. Those with VL ≥ 200 or adherence ≤ 80% were rerandomized to receive SMS or CPS with monthly incentives for those utilizing the intervention at least 75% of days for 3 months. Those with VL < 200 or adherence > 80% after the initial 3 months were rerandomized to usual care or 3 months of tapered, 2x/week CPS or SMS. Self-reported adherence and VLs were collected every 3 months for one year. Eighty-three youth were recruited with 81% identifying as cisgender males, 55% Black, 22% Latine/x, and 76% gay, and 56% recruited from the Southern US. Both cohorts initially randomized to CPS and SMS demonstrated significant improvements in adherence over the 12-months (P <.001). Participants randomized to CPS had significant improvements in 7-day self-reported adherence over 12 months compared to those on SMS (P <.027). Those receiving a tapered intervention for an additional 3 months had improved self-reported adherence compared to those randomized to the standard of care arm (P <.001). Both SMS and CPS appear to be effective interventions for youth with poor antiretroviral adherence. Tapering the intervention for an additional 3 months is useful in maintaining adherence after the initial intervention. Additional research is required to determine how to best sequence these interventions, including the use of incentives.

Graphical Abstract

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通过短信和手机支持（有激励措施和无激励措施）对感染艾滋病病毒的青少年进行适应性抗逆转录病毒治疗干预：顺序多重分配随机试验》（SMART）。

感染艾滋病毒的青年坚持服药的比率很低。通过社交媒体和临床网站招募的依从性≤80%或HIV RNA pcr (VL)≥200的15-24岁青年被随机分配到工作日简短的手机支持（CPS）电话或每日双向个性化短信（SMS）提醒中，为期3个月。VL≥200或依从性≤80%的患者被重新随机分配，接受SMS或CPS，并对那些在3个月内使用干预措施至少75%天的患者进行每月奖励。在最初的3个月后，VL为80%的患者被重新随机分配到常规治疗组或3个月逐渐减少，每周2次CPS或SMS治疗组。自我报告的依从性和vl每3个月收集一次，持续一年。83名青年被招募，其中81%为顺性男性，55%为黑人，22%为拉丁裔，76%为同性恋，56%来自美国南部。最初随机分配到CPS和SMS的两个队列在12个月内的依从性都有显着改善(P

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来源期刊

AIDS and Behavior Multiple-

CiteScore

6.60

自引率

13.60%

发文量

382

期刊介绍： AIDS and Behavior provides an international venue for the scientific exchange of research and scholarly work on the contributing factors, prevention, consequences, social impact, and response to HIV/AIDS. This bimonthly journal publishes original peer-reviewed papers that address all areas of AIDS behavioral research including: individual, contextual, social, economic and geographic factors that facilitate HIV transmission; interventions aimed to reduce HIV transmission risks at all levels and in all contexts; mental health aspects of HIV/AIDS; medical and behavioral consequences of HIV infection - including health-related quality of life, coping, treatment and treatment adherence; and the impact of HIV infection on adults children, families, communities and societies. The journal publishes original research articles, brief research reports, and critical literature reviews. provides an international venue for the scientific exchange of research and scholarly work on the contributing factors, prevention, consequences, social impact, and response to HIV/AIDS. This bimonthly journal publishes original peer-reviewed papers that address all areas of AIDS behavioral research including: individual, contextual, social, economic and geographic factors that facilitate HIV transmission; interventions aimed to reduce HIV transmission risks at all levels and in all contexts; mental health aspects of HIV/AIDS; medical and behavioral consequences of HIV infection - including health-related quality of life, coping, treatment and treatment adherence; and the impact of HIV infection on adults children, families, communities and societies. The journal publishes original research articles, brief research reports, and critical literature reviews.5 Year Impact Factor: 2.965 (2008) Section ''SOCIAL SCIENCES, BIOMEDICAL'': Rank 5 of 29 Section ''PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH'': Rank 9 of 76