A proof-of-concept feasibility trial testing a multi-component App-based intervention for improving smoking cessation and adherence to treatment in low-income HIV patients.

Abstract

Introduction: Low-income people living with HIV (PLWH) in the US encounter several behavioral challenges. Multiple-behavior interventions targeting multiple risks are promising. Cigarette smoking remains high among PLWH (47%), and smokers have low adherence to anti-retroviral therapies (ART). This study explores the feasibility of a smartphone app-based intervention combining Mindfulness Training (MT) for smoking cessation with Video Directly Observed Therapy (vDOT) for ART monitoring among minority and low-income PLWH.

Methods: We conducted a proof-of-concept feasibility 3-arm randomized controlled trial among PLWH (n=39; 53.8% males) to test 3 treatment groups (Gs): G1) usual care (UC; brief advice to quit and ART adherence); G2) MT app plus brief advice to ART adherence; and G3) MT plus vDOT apps. The primary outcomes were intervention feasibility, acceptability, app usability, smoking cessation, and ART adherence improvement.

Results: Enrollment rate was low (37%) due to low access to technology and language barriers. Retention rates were high (UC: 92.3%, G2: 84.6%, G3: 100.0%). The MT app usability was higher (G2: 72.8%, G3: 69.2%) than the vDOT app (G3: 23.1%). G2 participants were more satisfied with treatment than G3 (p<0.04). Smoking abstinence rates in G2 and G3 were double that in UC (UC: 25.0%, G2: 45.5%, G3: 53.8%). ART adherence improved by 53.0% in G2 and G3 compared to 30.7% in UC.

Conclusions: The combined intervention was promising. However, the app-based intervention feasibility was low, and vDOT for ART monitoring was unacceptable. These results will inform the optimization and further testing of the multi-component intervention.

Implication: Disparities in HIV persist among minority and low-income groups who face several behavioral challenges. The current proof-of-concept trial indicated that the multiple-behavior intervention targeting smoking cessation and adherence to ART in minority and low-income PLWH is promising. However, given the low access to technology and the language barrier in this group, the feasibility of the app-based intervention was low. Video-based strategy to monitor ART adherence was not acceptable due to privacy concerns. As healthcare becomes more reliant on technology-based tools, research is needed to address the digital divide among this group to prevent the exacerbation of existing healthcare access disparities.