Utilizing Community Based Participatory Research Methods in Black/African American and Hispanic/Latinx Communities in the US: The CDC Minority HIV Research Initiative (MARI-Round 4)

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.

"They should've talked to us more": lay health advisors' experiences with community-engaged hypertension research

BACKGROUND

Lay health advisors (LHAs) are increasingly being used to increase patient and public involvement in research, disseminate health information, and work toward preventing health disparities within communities at risk. This research explored LHAs' experiences with training and recruiting for a hypertension research project which ended due to minimal enrollment.

METHODS

The methodological design was qualitative description. One face-to-face semi-structured focus group was held with eight African American LHAs in Cleveland, Ohio, in the fall of 2019. The focus group was digitally recorded and transcribed by a professional transcriptionist and thematically analyzed.

RESULTS

Trainees reflected on how much they learned from the training and described feeling passionate and excited about their community work for the project. We identified three key themes from the data: (1) Systemic and Institutional Factors Affected LHAs' Experiences (subthemes: Unnecessarily Burdensome Requirements and Exploitation of Community Members for Research Gain; (2) Feeling Used Yet Unseen: Exclusion from Decision-Making Processes; (3) Worrying that Project Termination Damaged their Reputation; and (4) Disengaging from Research. We share lessons learned, including the need for LHAs' expertise to be integrated into research studies, and for projects to establish clear communication and expectations regarding research rigor and requirements.

CONCLUSION

Our results have implications for future studies attempting to build equitable and strong academic-community relationships to yield rigorous and useful research to reduce health disparities.

Comparing Safety and Effectiveness of Antiretroviral Therapy in a Diverse Population of Older People With HIV

Background Advances in antiretroviral therapy (ART) enable people with HIV to live longer, healthier lives. However, older people with HIV (OPWH) are more susceptible to long-term toxicity and drug interactions associated with ART. Racial and ethnic minorities have specific social determinants of health, which increase their risks of negative outcomes. Objective To determine if there were differences in the safety and effectiveness of ART in White, Black, and Hispanic OPWH. Methods A retrospective observational study was conducted on patients receiving care between January 1, 2017, and December 31, 2022, at two affiliated HIV clinics in South Florida. The primary effectiveness endpoint was the percentage of OPWH with undetectable viral load (< 50 copies/mL) throughout the study. Secondary safety endpoints were changes in median metabolic, hepatic, and renal parameters. A two-way analysis of variance or the Chi-square test was used to determine differences between groups. Results A total of 116 White, 42 Black, and 40 Hispanic OPWH were included. Upon enrollment, most patients (90.7%) were receiving ART. Of these, the percentage with undetectable viral load was lower among Black (61.8%) compared with White (85.8%; P < 0.01) or Hispanic (83.3%; P < 0.05) patients. Similarly, throughout the study after the first visit, the percentage with undetectable viral load was lower among Black (61.6%) compared with White (84.7%; P < 0.05) or Hispanic (83.3%; P = 0.12) patients. However, there were no significant differences in the percentage of virally suppressed (< 200 copies/mL) participants throughout the study after the first visit between Black (88.5%), White (94.9%), and Hispanic (96.7%) patients. Additionally, no significant changes in safety endpoints were observed among the groups throughout the study. Conclusion Fewer Black OPWH had undetectable viral load upon enrollment and throughout the study compared with White or Hispanic OPWH, suggesting the need to provide more targeted interventions for Black patients.