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Aunon FM, Wanje G, Richardson BA, Masese L, Odeny TA, Kinuthia J, Mandaliya K, Jaoko W, Simoni JM, McClelland RS. Randomized controlled trial of a theory-informed mHealth intervention to support ART adherence and viral suppression among women with HIV in Mombasa, Kenya: preliminary efficacy and participant-level feasibility and acceptability. BMC Public Health 2023; 23:837. [PMID: 37158872 PMCID: PMC10169479 DOI: 10.1186/s12889-023-15638-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 04/10/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Mobile Health ("mHealth") interventions have shown promise in improving HIV treatment outcomes for stigmatized populations. This paper presents the findings from a randomized controlled trial to assess the efficacy, participant-level feasibility and acceptability of a theory-informed mHealth intervention, Motivation Matters!, designed to improve viral suppression and ART adherence among HIV-seropositive women who engage in sex work in Mombasa, Kenya. METHODS A total of 119 women were randomized between the intervention and standard of care control. The primary outcome examined viral suppression (≤ 30 copies/mL) six months following ART initiation. ART adherence was assessed monthly using a visual analogue scale. Participant-level feasibility was measured through response rates to study text messages. Acceptability was assessed through qualitative exit interviews. RESULTS Six months following treatment initiation, 69% of intervention and 63% of control participants were virally suppressed (Risk Ratio [RR] = 1.09, 95% Confidence Interval [95% CI] (0.83, 1.44). Among women who were viremic at baseline and endorsed engagement in sex work, 74% of women in the intervention arm compared with 46% of women in the control arm achieved viral suppression at month six RR = 1.61, 95% CI (1.02, 2.55). Adherence was higher in intervention versus control participants every month. All participants responded to at least one message, and there was a 55% overall response rate to intervention text messages. Qualitative exit interviews suggested high acceptability and perceived impact of the intervention. CONCLUSION The improvements in ART adherence and viral suppression, combined with encouraging data on feasibility and acceptability, provides preliminary evidence that Motivation Matters! could support ART adherence and viral suppression in women who engage in sex work. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov (NCT02627365, 10/12/2015; http://clinicaltrials.gov ).
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Affiliation(s)
- Frances M Aunon
- Department of Psychology, University of Washington, Seattle, WA, United States of America.
- VA Connecticut Healthcare System, West Haven, CT, United States of America.
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America.
| | - George Wanje
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Barbra A Richardson
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Linnet Masese
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Thomas A Odeny
- Department of Medicine, University Washington in St. Louis, St. Louis, MO, United States of America
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Kishorchandra Mandaliya
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Gender, Women and Sexuality Studies, University of Washington, Seattle, WA, United States of America
| | - R Scott McClelland
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
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Addotey-Delove M, Scott RE, Mars M. Healthcare Workers' Perspectives of mHealth Adoption Factors in the Developing World: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1244. [PMID: 36673995 PMCID: PMC9858911 DOI: 10.3390/ijerph20021244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND mHealth applications provide health practitioners with platforms that enable disease management, facilitate drug adherence, facilitate drug adherence, speed up diagnosis, monitor outbreaks, take and transfer medical images, and provide advice. Many developing economies are investing more in mobile telecommunication infrastructure than in road transport and electric power generation. Despite this, mHealth has not seen widespread adoption by healthcare workers in the developing world. This study reports a scoping review of factors that impact the adoption of mHealth by healthcare workers in the developing world, and based on these findings, a framework is developed for enhancing mHealth adoption by healthcare workers in the developing world. METHODS A structured literature search was performed using PubMed and Scopus, supplemented by hand searching. The searches were restricted to articles in English during the period January 2009 to December 2019 and relevant to the developing world that addressed: mobile phone use by healthcare workers and identified factors impacting the adoption of mHealth implementations. All authors reviewed selected papers, with final inclusion by consensus. Data abstraction was performed by all authors. The results were used to develop the conceptual framework using inductive iterative content analysis. RESULTS AND DISCUSSION Of 919 articles, 181 met the inclusion criteria and, following a review of full papers, 85 reported factors that impact (promote or impede) healthcare worker adoption of mHealth applications. These factors were categorised into 18 themes and, after continued iterative review and discussion were reduced to 7 primary categories (engagement/funding, infrastructure, training/technical support, healthcare workers' mobile-cost/ownership, system utility, motivation/staffing, patients' mobile-cost/ownership), with 17 sub-categories. These were used to design the proposed framework. CONCLUSIONS Successful adoption of mHealth by healthcare workers in the developing world will depend on addressing the factors identified in the proposed framework. They must be assessed in each specific setting prior to mHealth implementation. Application of the proposed framework will help shape future policy and practice of mHealth implementation in the developing world and increase adoption by health workers.
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Affiliation(s)
- Michael Addotey-Delove
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Richard E. Scott
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Maurice Mars
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia
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Aboye GT, Vande Walle M, Simegn GL, Aerts JM. mHealth in sub-Saharan Africa and Europe: A systematic review comparing the use and availability of mHealth approaches in sub-Saharan Africa and Europe. Digit Health 2023; 9:20552076231180972. [PMID: 37377558 PMCID: PMC10291558 DOI: 10.1177/20552076231180972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Background mHealth can help with healthcare service delivery for various health issues, but there's a significant gap in the availability and use of mHealth systems between sub-Saharan Africa and Europe, despite the ongoing digitalization of the global healthcare system. Objective This work aims to compare and investigate the use and availability of mHealth systems in sub-Saharan Africa and Europe, and identify gaps in current mHealth development and implementation in both regions. Methods The study adhered to the PRISMA 2020 guidelines for article search and selection to ensure an unbiased comparison between sub-Saharan Africa and Europe. Four databases (Scopus, Web of Science, IEEE Xplore, and PubMed) were used, and articles were evaluated based on predetermined criteria. Details on the mHealth system type, goal, patient type, health concern, and development stage were collected and recorded in a Microsoft Excel worksheet. Results The search query produced 1020 articles for sub-Saharan Africa and 2477 articles for Europe. After screening for eligibility, 86 articles for sub-Saharan Africa and 297 articles for Europe were included. To minimize bias, two reviewers conducted the article screening and data retrieval. Sub-Saharan Africa used SMS and call-based mHealth methods for consultation and diagnosis, mainly for young patients such as children and mothers, and for issues such as HIV, pregnancy, childbirth, and child care. Europe relied more on apps, sensors, and wearables for monitoring, with the elderly as the most common patient group, and the most common health issues being cardiovascular disease and heart failure. Conclusion Wearable technology and external sensors are heavily used in Europe, whereas they are seldom used in sub-Saharan Africa. More efforts should be made to use the mHealth system to improve health outcomes in both regions, incorporating more cutting-edge technologies like wearables internal and external sensors. Undertaking context-based studies, identifying determinants of mHealth systems use, and considering these determinants during mHealth system design could enhance mHealth availability and utilization.
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Affiliation(s)
- Genet Tadese Aboye
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
- School of Biomedical Engineering, Jimma University, Jimma, Ethiopia
| | - Martijn Vande Walle
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
| | | | - Jean-Marie Aerts
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
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McCreesh-Toselli S, Torline J, Gouse H, Robbins RN, Mellins CA, Remien RH, Rowe J, Peton N, Rabie S, Joska JA. Staff Perceptions of Preimplementation Barriers and Facilitators to a Mobile Health Antiretroviral Therapy Adherence Counseling Intervention in South Africa: Qualitative Study. JMIR Mhealth Uhealth 2021; 9:e23280. [PMID: 33821806 PMCID: PMC8058692 DOI: 10.2196/23280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/04/2021] [Accepted: 02/23/2021] [Indexed: 12/03/2022] Open
Abstract
Background South Africa adopted a universal test and treatment program for HIV infection in 2015. The standard of care that people living with HIV receive consists of 3 sessions of readiness counseling delivered by lay counselors (LCs). In the largest antiretroviral therapy (ART) program worldwide, effective and early HIV and ART education and support are key for ensuring ART adoption, adherence, and retention in care. Having LCs to deliver readiness counseling allows for the wide task-sharing of this critical activity but carries the risks of loss of standardization, incomplete content delivery, and inadequate monitoring and supervision. Systems for ensuring that a minimum standard of readiness counseling is delivered to the growing number of people living with HIV are essential in the care cascade. In resource-constrained, high-burden settings, mobile health (mHealth) apps may potentially offer solutions to these treatment gaps by providing content structure and delivery records. Objective This study aims to explore, at a large Cape Town–based nonprofit HIV care organization, the staff’s perceived preimplementation barriers and facilitators of an mHealth intervention (Masivukeni) developed as a structured app for ART readiness counseling. Methods Masivukeni is a laptop-based app that incorporates written content, graphics, short video materials, and participant activities. In total, 20 participants were included in this study. To explore how an mHealth intervention might be adopted across different staff levels within the organization, we conducted 7 semistructured interviews (participants: 7/20, 35%) and 3 focus groups (participants in 2 focus groups: 4/20, 20%; participants in 1 focus group: 3/20, 15%) among LCs, supervisors, and their managers. In total, 20 participants were included in this study. Interviews lasted approximately 60 minutes, and focus groups ranged from 90 to 120 minutes. The Consolidated Framework for Implementation Research was used to explore the perceived implementation barriers and facilitators of the Masivukeni mHealth intervention. Results Several potential facilitators of Masivukeni were identified. Multimedia and visual elements were generally regarded as aids in content delivery. The interactive learning components were notably helpful, whereas facilitated updates to the adherence curriculum were important to facilitators and managers. The potential to capture administrative information regarding LC delivery and client logging was regarded as an attractive feature. Barriers to implementation included security risks and equipment costs, the high volume of clients to be counseled, and variable computer literacy among LCs. There was uncertainty about the app’s appeal to older clients. Conclusions mHealth apps, such as Masivukeni, were perceived as being well placed to address some of the needs of those who deliver ART adherence counseling in South Africa. However, the successful implementation of mHealth apps appeared to be dependent on overcoming certain barriers in this setting.
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Affiliation(s)
- Siobhan McCreesh-Toselli
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
| | - John Torline
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
| | - Hetta Gouse
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States
| | - Jessica Rowe
- The Columbia Center for New Media Teaching and Learning, Columbia University, New York, NY, United States
| | - Neshaan Peton
- City of Cape Town Metropolitan Municipality, Cape Town, South Africa
| | - Stephan Rabie
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
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Hickson W, Mayers PM. Understanding how young people become motivated to take their human immunodeficiency virus medication (antiretroviral therapy) and how the need for adherence is communicated. Health SA 2021; 25:1458. [PMID: 33391827 PMCID: PMC7756603 DOI: 10.4102/hsag.v25i0.1458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/13/2020] [Indexed: 11/20/2022] Open
Abstract
Background Antiretroviral therapy (ART), the only effective treatment for human immunodeficiency virus (HIV), requires excellent long-term compliance. Poor levels of adherence to ART, especially amongst adolescents and young adults in South Africa, have been reported. Aim This study aimed to explore how young people become motivated to take their HIV medication (ART) and how the need for adherence is communicated. Setting The study was conducted in a peri-urban township in the Western Cape, South Africa. Methods A qualitative grounded theory approach was employed. Eighty young people were purposively recruited. Participant observation, focus groups and semi-structured interviews were utilised to explore how effective ART adherence messages are in motivating adherence amongst young people and how they would like ART adherence to be communicated to them. All interviews and focus groups were transcribed and analysed by using cross-comparison analysis. Measures to ensure trustworthiness were established and ethical considerations were adhered to. Results Young people’s adherence motivation was an outcome of reconnecting to one or more trusted significant other(s) from within their belonging group, who accepted and supported them, which in turn affirmed their prior belonging identities of son, daughter, other family member or close friend. This facilitated reconnection to their present and future hopes, which in turn increased their motivation to live and to adhere to treatment. Conclusion The findings highlight the need for the development of more effective communication strategies, which facilitate and support young people’s reconnection to trusted members of their belonging groups, and also help belonging group members to accept, affirm and support adherence.
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Affiliation(s)
- Warren Hickson
- Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Pat M Mayers
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Davis A, Pala AN, Nguyen N, Robbins RN, Joska J, Gouse H, Mellins CA, Myer L, Henry M, Leu CS, Remien RH. Sociodemographic and psychosocial predictors of longitudinal antiretroviral therapy (ART) adherence among first-time ART initiators in Cape Town, South Africa. AIDS Care 2020; 33:1394-1403. [PMID: 32698680 DOI: 10.1080/09540121.2020.1798336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
First-time antiretroviral therapy (ART) initiators may be more vulnerable to poor ART adherence because they may be coping with a new HIV diagnosis, facing logistical challenges to accessing and adhering to ART for the first time, and have not yet developed support networks or the skills to support long-term adherence. We recruited 324 participants in two HIV clinics near Cape Town, South Africa. Sociodemographic/psychosocial factors were measured at baseline and self-reported adherence at the 6 month follow-up. We conducted multivariable regression to determine which baseline factors were associated with 6-month adherence. A better patient-clinic relationship score (OR: 1.08 [95% CI: 1.05-1.11]) was associated with higher adherence. A drug use problem (0.51 [0.29-0.87]), higher social isolation (0.93 [0.87-0.99]), and greater number of years living with HIV before initiating ART (0.92 [0.86-1.00]) were associated with adherence levels below 90%. Patient-clinic relationships and social support are key psycho-social factors in early adherence behavior. Reducing drug use problems through targeted screening and early intervention may improve ART adherence.
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Affiliation(s)
- Alissa Davis
- School of Social Work, Columbia University, New York, NY, USA
| | | | - Nadia Nguyen
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - John Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Hetta Gouse
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Landon Myer
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Michelle Henry
- Numeracy Centre, Centre for Higher Education Development, University of Cape Town, Cape Town, South Africa
| | - Cheng Shiun Leu
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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Ortblad KF, Baeten JM, Cherutich P, Wamicwe JN, Wasserheit JN. The arc of HIV epidemics in sub-Saharan Africa: new challenges with concentrating epidemics in the era of 90-90-90. Curr Opin HIV AIDS 2019; 14:354-365. [PMID: 31343457 PMCID: PMC6669088 DOI: 10.1097/coh.0000000000000569] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to examine the emerging results from the HIV universal test and treat (UTT) cluster-randomized trials in sub-Saharan Africa, discuss how expanding access to HIV clinical services is likely to reshape the arc of HIV epidemics, and consider implications for HIV prevention and control strategies in the coming decade. RECENT FINDINGS The effect of universal HIV testing followed by immediate antiretroviral treatment (ART) on community-level HIV incidence remains unclear upon completion of five randomized trials. Only two of the four trials that measured HIV incidence found significant reductions in community-level incidence. Even in these trials, HIV incidence remained above levels required for epidemic control (≤1 case per 1000 person-years) despite high levels of ART coverage and viral suppression. These findings may indicate that community-delivered HIV services are not reaching the high-frequency transmitters who sustain HIV epidemics and are likely members of marginalized or hard to engage core groups. SUMMARY With expanded access to HIV services in sub-Saharan Africa, HIV epidemics are transitioning from hyperendemic to declining/endemic epidemic phases, characterized increasingly by the reconcentration of HIV in marginalized or hard to engage core groups. To move toward epidemic control, novel HIV service delivery models and technologies are needed to engage those who continue to drive HIV incidence in this new epidemic phase.
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Affiliation(s)
| | - Jared M Baeten
- Department of Global Health
- Department of Medicine
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | | | | | - Judith N Wasserheit
- Department of Global Health
- Department of Medicine
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
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Magidson JF, Joska JA, Regenauer KS, Satinsky E, Andersen LS, Seitz-Brown CJ, Borba CPC, Safren SA, Myers B. "Someone who is in this thing that I am suffering from": The role of peers and other facilitators for task sharing substance use treatment in South African HIV care. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 70:61-69. [PMID: 31082664 PMCID: PMC6679990 DOI: 10.1016/j.drugpo.2018.11.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/07/2018] [Accepted: 11/19/2018] [Indexed: 11/20/2022]
Abstract
South Africa is home to the largest number of people living with HIV/AIDS in the world. Alongside the HIV/AIDS epidemic, problematic alcohol and other drug (AOD) use is prevalent and associated with poor HIV treatment and secondary HIV prevention outcomes. International guidelines and local policy both support the integration of mental health care and AOD treatment into HIV care, yet barriers exist to implementation. This study aimed to explore patient and provider perspectives on the integration of HIV and AOD treatment services in Cape Town, South Africa. This included barriers and facilitators to task sharing AOD treatment in HIV care and preferences for a task shared approach to integrating AOD treatment in HIV care, including who should deliver the behavioural intervention. We conducted thirty semi-structured qualitative interviews with HIV and AOD treatment staff, providers, and people living with HIV/AIDS (PLWH) with moderate, problematic AOD use and difficulties (personal or structural) adhering to HIV treatment. Findings illustrated several key themes: (1) the separation between AOD and HIV services (a "siloed treatment experience"), even in the context of geographic co-location; (2) low AOD treatment literacy among HIV patients and providers, including a low awareness of existing AOD use services, even when co-located; (3) substance use stigma as a barrier to HIV and AOD treatment integration; (4) a strong patient preference for peer interventionists; and (5) the role of community health workers (CHWs) in detecting AOD use among some PLWH who had not followed up in HIV care. These findings will inform a future type 1 hybrid effectiveness-implementation trial, guided by the RE-AIM framework, to evaluate a task shared, evidence-based intervention to address problematic AOD use and improve HIV medication adherence in this setting.
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Affiliation(s)
- Jessica F Magidson
- University of Maryland, College Park, 4094 Campus Drive, College Park, MD, USA.
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Anzio Road, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa.
| | | | - Emily Satinsky
- University of Maryland, College Park, 4094 Campus Drive, College Park, MD, USA.
| | - Lena S Andersen
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Anzio Road, Groote Schuur Hospital, Observatory, University of Cape Town, Cape Town, South Africa.
| | - C J Seitz-Brown
- University of Maryland, College Park, 4094 Campus Drive, College Park, MD, USA.
| | - Christina P C Borba
- Boston University/Boston Medical Center, 85 E. Newton St., Fuller Building, Boston, MA, USA.
| | - Steven A Safren
- University of Miami, Clinical Research Building, Miller School of Medicine, 1120 NW 14th St., Suite, 787, Miami, FL, USA.
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council Francie Van Zyl Drive, Parow, 7505, South Africa; Division of Addiction Psychiatry, Department of Psychiatry, and Mental Health, University of Cape Town, Cape Town, South Africa.
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