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Martin K, Peh RWC, Tembo M, Mavodza CV, Doyle AM, Dziva Chikwari C, Dauya E, Bandason T, Azizi S, Simms V, Ferrand RA. Factors Associated With the Use of Digital Technology Among Youth in Zimbabwe: Findings From a Cross-Sectional Population-Based Survey. J Med Internet Res 2024; 26:e52670. [PMID: 39312390 DOI: 10.2196/52670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/18/2024] [Accepted: 07/08/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Globally, the increasing use of digital technologies such as mobile phones and the internet has allowed for the development of innovative mobile health interventions, particularly for reaching and engaging with youth. However, there is a risk that using such technologies may exclude those who lack access to them. OBJECTIVE In this study, we investigated the sociodemographic factors associated with mobile phone ownership, internet use, and social media use among youth in Zimbabwe. METHODS A population-based prevalence survey was conducted in 24 urban and periurban communities across 3 provinces of Zimbabwe (Harare, Mashonaland East, and Bulawayo). Youths aged 18 to 24 years resident in randomly selected households in the study communities completed an interviewer-administered questionnaire. The primary outcomes were mobile phone ownership and current internet and social media use. A household wealth indicator was developed using principal components analysis, based on household asset ownership. Multivariable logistic regression was used to investigate the factors associated with each primary outcome. Age, sex, and province were considered a priori confounders. Household wealth, marital status, education level, employment status, time lived at current address, and HIV status were included in the final multivariable model if there was an age-, sex-, and province-adjusted association with a primary outcome on univariable analysis at a significance level of P<.10. RESULTS Of the 17,636 participants assessed for the primary outcome, 16,370 (92.82%) had access to a mobile phone, and 15,454 (87.63%) owned a mobile phone. Among participants with access to a mobile phone, 58.61% (9594/16,370) and 57.79% (9460/16,370), respectively, used internet and social media at least weekly. Older age (adjusted odds ratio [aOR] 1.76, 95% CI 1.55-2.00), increasing wealth (ranging from aOR 1.85, 95% CI 1.58-2.16, for wealth quintile 2 to aOR 3.80, 95% CI 3.00-4.80, for wealth quintile 5, with quintile 1 as reference), and higher education level (secondary: aOR 1.96, 95% CI 1.60-2.39; tertiary: aOR 8.36, 95% CI 5.29-13.20) were associated with mobile phone ownership. Older age, male sex, increasing wealth, having never been married, higher education level, being in education or formal employment, and having lived at the same address for ≥2 years were associated with higher levels of internet and social media use. CONCLUSIONS While mobile phone ownership was near-universal, over one-third of youths in urban and periurban settings did not have access to the internet and social media. Access to the internet and social media use were strongly associated with household wealth and education level. Mobile health interventions must ensure that they do not amplify existing inequalities in access to health care. Such interventions must be accompanied by alternative strategies to engage and enroll individuals without internet or social media access to prevent the exclusion of young people by sex and socioeconomic status.
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Affiliation(s)
- Kevin Martin
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rachel Wei Chun Peh
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mandikudza Tembo
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Constancia Vimbayi Mavodza
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aoife M Doyle
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chido Dziva Chikwari
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ethel Dauya
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Steven Azizi
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Victoria Simms
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rashida A Ferrand
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
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Velloza J, Liu AY, Katz AWK, van der Straten A, Siegler AJ, Scott H, Wilde G, Lockard A, Christie RH, Buchbinder SP. Acceptability of an automated directly observed therapy (DOT) application for PrEP adherence support among young men who have sex with men: a qualitative exploration. AIDS Care 2024:1-15. [PMID: 39222964 DOI: 10.1080/09540121.2024.2397133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
Pre-exposure prophylaxis (PrEP) adherence remains a challenge among young men who have sex with men (MSM). We developed and tested a smartphone application ("app"), "DOT Diary", which combines automated directly observed therapy (DOT) with information about PrEP protection levels, pill-taking reminders, a sexual behavior diary, and a PrEP dosing calendar. To contextualize trial results, we qualitatively explored participants' app experiences. The trial enrolled 100 young MSM in San Francisco and Atlanta. Participants were randomized 2:1 to DOT Diary versus standard-of-care and followed for 24 weeks. Interviews were conducted with 24 intervention participants. Data were analyzed using a memo-writing approach. Most expressed overall satisfaction with the app ("it was good for its purpose"), despite concerns about technical glitches. The most popular app features were the monthly calendar showing days PrEP was taken and information about level of protection based on pills taken. The DOT component helped participants establish PrEP routines. The reminders were "annoying but effective" at motivating dosing. Opinions about the sexual behavior diary varied. Overall, DOT Diary was acceptable; participants were willing to use it daily to record pill-taking. Critical components included the information about PrEP protection levels and calendar, while others may be modified to improve future success.Trial registration: ClinicalTrials.gov identifier: NCT03771638.
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Affiliation(s)
- Jennifer Velloza
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Ariana W K Katz
- RTI International, Women's Global Health Imperative, Berkeley, CA, USA
| | - Ariane van der Straten
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- ASTRA Consulting, Kensington, CA, USA
| | - Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Gretchen Wilde
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Annie Lockard
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Susan P Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
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Shi H, Du J, Jin G, Yang H, Guo H, Yuan G, Zhu Z, Xu W, Wang S, Guo H, Jiang K, Hao J, Sun Y, Su P, Zhang Z. Effectiveness of eHealth interventions for HIV prevention, testing and management: An umbrella review. Int J STD AIDS 2024; 35:752-774. [PMID: 38733263 DOI: 10.1177/09564624241252457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection has become a major contributor to the global burden of disease. Globally, the number of cases of HIV continues to increase. Electronic health (eHealth) interventions have emerged as promising tools to support disease self-management among people living with HIV. The purpose of this umbrella review is to systematically evaluate and summarize the evidence and results of published systematic reviews and meta-analyses on the effectiveness of eHealth interventions for HIV prevention, testing and management. METHODS PubMed, Embase and the Cochrane Library were searched for reviews. The methodological quality of the included studies was assessed using AMSTAR-2. RESULTS A total of 22 systematic reviews were included. The methodological quality of the reviews was low or critically low. EHealth interventions range from Internet, computer, or mobile interventions to websites, programs, applications, email, video, games, telemedicine, texting, and social media, or a combination of them. The majority of the reviews showed evidence of effectiveness (including increased participation in HIV management behaviours, successfully changed HIV testing behaviours, and reduced risk behaviours). EHealth interventions were effective in the short term. CONCLUSIONS Ehealth interventions have the potential to improve HIV prevention, HIV testing and disease management. Due to the limitations of the low methodological quality of the currently available systematic reviews, more high-quality evidence is needed to develop clear and robust recommendations.
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Affiliation(s)
- Haiyan Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Jun Du
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Guifang Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Huayu Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Haiyun Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Guojing Yuan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhihui Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Wenzhuo Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Sainan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Hao Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Kele Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Jiahu Hao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Ying Sun
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Puyu Su
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhihua Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
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Ibeneme SC, Mah J, Omeje C, Fortwengel G, Nwosu AO, Irem FO, Ibeneme GC, Myezwa H, Nweke M. Effectiveness of pedometer-based walking programmes in improving some modifiable risk factors of stroke among community-dwelling older adults: a systematic review, theoretical synthesis and meta-analysis. BMC Geriatr 2024; 24:516. [PMID: 38872081 PMCID: PMC11177376 DOI: 10.1186/s12877-024-05069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Pedometer-based walking programs hold promise as a health promotion strategy for stroke prevention in community-dwelling older adults, particularly when targeted at physical activity-related modifiable risk factors. The question arises: What is the effectiveness of pedometer-based walking program interventions in improving modifiable stroke risk factors among community-dwelling older adults? METHOD Eight databases were searched up to December 2nd, 2023, following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Inclusion criteria focused on randomized controlled trials (RCTS) involving community-dwelling older adults and reported in English. Two independent reviewers utilized Physiotherapy Evidence Database (PEDro) tool to extract data, assess eligibility, evaluate study quality, and identify potential bias. Standardized mean difference (SMD) was employed as summary statistics for primary -physical activity level -and secondary outcomes related to cardiovascular function (blood pressure) and metabolic syndrome, including obesity (measured by body mass index and waist circumference), fasting blood sugar, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), and triglycerides. A random-effects model was used to generate summary estimates of effects. RESULTS The review analyzed eight studies involving 1546 participants aged 60-85 years, with 1348 successfully completing the studies. Across these studies, pedometer-based walking programs were implemented 2-3 times per week, with sessions lasting 40-60 minutes, over a duration of 4-26 weeks. The risk of bias varied from high to moderate. Our narrative synthesis revealed positive trends in HDL-C levels, fasting blood sugar, and glycated hemoglobin, suggesting improved glycemic control and long-term blood sugar management. However, the impact on triglycerides was only marginal. Primary meta-analysis demonstrated significantly improved physical activity behavior (SMD=0.44,95%CI:0.26, 0.61,p=<0.00001;I2=0%;4 studies; 532 participants) and systolic blood pressure (SMD=-0.34,95%CI:-0.59,-0.09;p=<0.008;I2=65%,2 studies;249 participants), unlike diastolic blood pressure (SMD=0.13,95%CI:-0.13,-0.38,p=0.33; I2=91%; 2 studies; 237 participants). Interventions based on social cognitive, self-efficacy, and self-efficiency theory(ies), and social cognitive theory applied in an ecological framework, were linked to successful physical activity behavior outcomes. CONCLUSION Pedometer-based walking programs, utilizing interpersonal health behavior theory/ecological framework, enhance physical activity behavior and have antihypertensive effects in community-dwelling older adults. While they do not significantly affect diastolic blood pressure, these programs potentially serve as a primary stroke prevention strategy aligning with global health goals. TRIAL REGISTRATION Registration Number: INPLASY202230118.
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Affiliation(s)
- Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria.
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies,University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa.
- Department of Physiotherapy, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria.
- Department of physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Juliet Mah
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
- Department of Physiotherapy, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Enugu, Nigeria
| | - Chidimma Omeje
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
| | - Gerhard Fortwengel
- Faculty III, Hochschule Hannover University of Applied Sciences & Arts, 30159, Hannover, Lower Saxony, Germany
| | - Akachukwu Omumuagwula Nwosu
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
| | - Frank Onyemaechi Irem
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
| | - Georgian Chiaka Ibeneme
- Department of Nursing Sciences, Faculty of Health Sciences & Technology, College of Health Sciences, Ebonyi State University, Ebonyi State, Abakaliki, Nigeria
- Department of Nursing Science, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies,University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa
| | - Martins Nweke
- Department of Physiotherapy, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
- Department of physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Redfern J, Tu Q, Hyun K, Hollings MA, Hafiz N, Zwack C, Free C, Perel P, Chow CK. Mobile phone text messaging for medication adherence in secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2024; 3:CD011851. [PMID: 38533994 PMCID: PMC10966941 DOI: 10.1002/14651858.cd011851.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the leading cause of death globally, accounting for almost 18 million deaths annually. People with CVDs have a five times greater chance of suffering a recurrent cardiovascular event than people without known CVDs. Although drug interventions have been shown to be cost-effective in reducing the risk of recurrent cardiovascular events, adherence to medication remains suboptimal. As a scalable and cost-effective approach, mobile phone text messaging presents an opportunity to convey health information, deliver electronic reminders, and encourage behaviour change. However, it is uncertain whether text messaging can improve medication adherence and clinical outcomes. This is an update of a Cochrane review published in 2017. OBJECTIVES To evaluate the benefits and harms of mobile phone text messaging for improving medication adherence in people with CVDs compared to usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases, and two trial registers. We also checked the reference lists of all primary included studies and relevant systematic reviews and meta-analyses. The date of the latest search was 30 August 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) with participants with established arterial occlusive events. We included trials investigating interventions using short message service (SMS) or multimedia messaging service (MMS) with the aim of improving adherence to medication for the secondary prevention of cardiovascular events. The comparator was usual care. We excluded cluster-RCTs and quasi-RCTs. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were medication adherence, fatal cardiovascular events, non-fatal cardiovascular events, and combined CVD event. Secondary outcomes were low-density lipoprotein cholesterol for the effect of statins, blood pressure for antihypertensive drugs, heart rate for the effect of beta-blockers, urinary 11-dehydrothromboxane B2 for the antiplatelet effects of aspirin, adverse effects, and patient-reported experience. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 18 RCTs involving a total of 8136 participants with CVDs. We identified 11 new studies in the review update and seven studies in the previous version of the review. Participants had various CVDs including acute coronary syndrome, coronary heart disease, stroke, myocardial infarction, and angina. All studies were conducted in middle- and high-income countries, with no studies conducted in low-income countries. The mean age of participants was 53 to 64 years. Participants were recruited from hospitals or cardiac rehabilitation facilities. Follow-up ranged from one to 12 months. There was variation in the characteristics of text messages amongst studies (e.g. delivery method, frequency, theoretical grounding, content used, personalisation, and directionality). The content of text messages varied across studies, but generally included medication reminders and healthy lifestyle information such as diet, physical activity, and weight loss. Text messages offered advice, motivation, social support, and health education to promote behaviour changes and regular medication-taking. We assessed risk of bias for all studies as high, as all studies had at least one domain at unclear or high risk of bias. Medication adherence Due to different evaluation score systems and inconsistent definitions applied for the measurement of medication adherence, we did not conduct meta-analysis for medication adherence. Ten out of 18 studies showed a beneficial effect of mobile phone text messaging for medication adherence compared to usual care, whereas the other eight studies showed either a reduction or no difference in medication adherence with text messaging compared to usual care. Overall, the evidence is very uncertain about the effects of mobile phone text messaging for medication adherence when compared to usual care. Fatal cardiovascular events Text messaging may have little to no effect on fatal cardiovascular events compared to usual care (odds ratio 0.83, 95% confidence interval (CI) 0.47 to 1.45; 4 studies, 1654 participants; low-certainty evidence). Non-fatal cardiovascular events We found very low-certainty evidence that text messaging may have little to no effect on non-fatal cardiovascular events. Two studies reported non-fatal cardiovascular events, neither of which found evidence of a difference between groups. Combined CVD events We found very low-certainty evidence that text messaging may have little to no effect on combined CVD events. Only one study reported combined CVD events, and did not find evidence of a difference between groups. Low-density lipoprotein cholesterol Text messaging may have little to no effect on low-density lipoprotein cholesterol compared to usual care (mean difference (MD) -1.79 mg/dL, 95% CI -4.71 to 1.12; 8 studies, 4983 participants; very low-certainty evidence). Blood pressure Text messaging may have little to no effect on systolic blood pressure (MD -0.93 mmHg, 95% CI -3.55 to 1.69; 8 studies, 5173 participants; very low-certainty evidence) and diastolic blood pressure (MD -1.00 mmHg, 95% CI -2.49 to 0.50; 5 studies, 3137 participants; very low-certainty evidence) when compared to usual care. Heart rate Text messaging may have little to no effect on heart rate compared to usual care (MD -0.46 beats per minute, 95% CI -1.74 to 0.82; 4 studies, 2946 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Due to limited evidence, we are uncertain if text messaging reduces medication adherence, fatal and non-fatal cardiovascular events, and combined cardiovascular events in people with cardiovascular diseases when compared to usual care. Furthermore, text messaging may result in little or no effect on low-density lipoprotein cholesterol, blood pressure, and heart rate compared to usual care. The included studies were of low methodological quality, and no studies assessed the effects of text messaging in low-income countries or beyond the 12-month follow-up. Long-term and high-quality randomised trials are needed, particularly in low-income countries.
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Affiliation(s)
- Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Sydney , Australia
| | - Qiang Tu
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Cardiology, Concord Hospital, Sydney , Australia
| | - Matthew A Hollings
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nashid Hafiz
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Clara Zwack
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Pablo Perel
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
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Rao A, Mhlophe H, Pretorius A, Mcingana M, Mcloughlin J, Shipp L, Baral S, Hausler H, Schwartz S, Lesko C. Effect of implementation strategies on pre-exposure prophylaxis persistence among female sex workers in South Africa: an interrupted time series study. Lancet HIV 2023; 10:e807-e815. [PMID: 38040479 PMCID: PMC10771038 DOI: 10.1016/s2352-3018(23)00262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND A disproportionate number of new HIV infections in South Africa are among female sex workers; pre-exposure prophylaxis (PrEP) for HIV prevention is freely available to female sex workers in the country, but unique barriers challenge PrEP persistence. TB HIV Care, a large South African non-profit organisation that provides daily oral PrEP (tenofovir disoproxil fumarate and emtricitabine), has implemented multiple strategies to improve PrEP persistence. We aimed to evaluate the effect of different implementation strategies on PrEP persistence in a large-scale real-world setting. METHODS In this interrupted time series study, we estimated level changes in 1-month oral PrEP persistence associated with roll-out of various implementation strategies among female sex workers across nine districts in South Africa. We used routinely collected data from TB HIV Care programme files from June 7, 2016, to April 30, 2021. Poisson regression of 1-month persistence was used to assess the effect of these strategies. In secondary analyses, we tested the association between each of the strategies and 4-month persistence. FINDINGS The median 1-month PrEP persistence for female sex workers was 33% (IQR 27-40). SMS support and refill reminders were associated with an 11% relative increase in 1-month persistence (risk ratio [RR] 1·11, 95% CI 1·02-1·26) and clinical mentoring for PrEP providers was associated with a 127% relative increase (RR 2·27, 95% CI 1·94-2·66) among female sex workers. The loyalty rewards programme was negatively associated with 1-month persistence (RR 0·71, 95% CI 0·67-0·83). Although clinical mentoring improved 4-month persistence, SMS support text messages had no significant effect. INTERPRETATION Identification and subsequent use of clinical mentoring for PrEP providers and SMS support and refill reminders might improve the usefulness of PrEP overall to prevent new HIV infections among female sex workers. PrEP persistence remains an important issue, and strategies to build on our findings are needed. FUNDING National Institute of Mental Health and National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | | | | | - Lillian Shipp
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Zhang L, Ni Z, Liu Y, Chen H. The effectiveness of e-health on reducing stigma, improving social support and quality of life among people living with HIV: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud 2023; 148:104606. [PMID: 37801937 DOI: 10.1016/j.ijnurstu.2023.104606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Many people living with HIV reported poor quality of life, which was primarily due to HIV-related stigma and the lack of social support. Compared with face-to-face interventions, e-health interventions are reported to have potential to help people living with HIV improve their adherence to antiretroviral therapy, promote their management of HIV and depressive symptoms. However, in the literature, the effectiveness of e-health interventions in helping people living with HIV reduce stigma, improve social support and quality of life is unclear. OBJECTIVE To examine the effectiveness of e-health interventions in reducing stigma and improving social support and quality of life among people living with HIV. DESIGN This study is a systematic review and meta-analysis of randomized controlled trials following the Cochrane Handbook guidelines and PRISMA2020. METHODS A comprehensive search was conducted from inception to 1st December 2022 in six databases: PubMed, CINAHL Plus with Full Text, PsycINFO (Ovid), Embase, Web of Science, and CENTRAL (Ovid), and an updated search took place on 11st June 2023. Two authors independently screened the studies and extracted the data. Cochrane's bias risk tool for randomized controlled trials was used to examine the methodological quality of the included studies. The intervention effect was estimated by calculating the standardized mean difference (SMD) and 95 % confidence interval (CI) using Review Manager 5.3. A sensitivity analysis was conducted to test the rigor of the pooled results using one-study-out method. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS Nine studies met eligibility criteria and were included in this review. The results of the meta-analysis showed that e-health interventions could statistically significantly reduce stigma (SMD: -0.29, 95 % CI: [-0.48, -0.10], p = 0.002) and improve quality of life (SMD = 0.49, 95 % CI: [0.30, 0.68], P < 0.001), but had no significant effects on social support (SMD = -0.01, 95 % CI: [-0.48, 0.46] P = 0.96). CONCLUSIONS E-health interventions could reduce stigma and improve quality of life among people living with HIV. More studies are needed to further explore if e-health interventions can improve the social support for people living with HIV and investigate how to integrate e-health interventions into the existing health models to help people living with HIV treat and manage HIV/AIDS. REGISTRATION The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42022373299).
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Affiliation(s)
- Liao Zhang
- Department of Nursing, West China Hospital/West China School of Nursing, Sichuan University, PR China
| | - Zhao Ni
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, CT, USA; School of Nursing, Yale University, New Haven, CT, USA
| | - Ying Liu
- Department of Nursing, West China Hospital/West China School of Nursing, Sichuan University, PR China
| | - Hong Chen
- Department of Nursing, West China Hospital/West China School of Nursing, Sichuan University, PR China.
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8
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Kalichman SC, Kalichman MO, Eaton LA. Phone-Delivered Intervention to Improve HIV Care for Young People Living With HIV: Trial to Inform Implementation and Utility. J Acquir Immune Defic Syndr 2023; 94:227-234. [PMID: 37643392 PMCID: PMC10578518 DOI: 10.1097/qai.0000000000003279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Phone-delivered counseling has demonstrated improved health outcomes for people living with HIV. However, counseling is hampered by a lack of guidance on the frequency and duration of intervention in relation to clinical benefits. The added benefits of bidirectional (ie, interactive) vs. unidirectional (ie, passive) text messages to augment counseling are also unknown. We conducted a clinical trial of adaptive phone counseling along with either bidirectional or unidirectional text messaging for people living with HIV. METHODS A community sample of 425 young people (aged 16-36 years) living with HIV in Georgia, USA, received weekly phone counseling sessions with the number of sessions determined by the participant and their counselor. Participants were subsequently randomized to either (1) weekly bidirectional text messages with their counselor or (2) weekly automated unidirectional text message reminders. Participants were followed for 16 months to assess 3 primary outcomes: antiretroviral therapy (ART) adherence, HIV care engagement, and HIV suppression. RESULTS Participants demonstrated improved clinical outcomes over the follow-up period, with 74% of those who were not taking ART initiating treatment, 65% of those on ART improving adherence, and 47% who had detectable viral loads at baseline attaining viral suppression. The number of sessions completed predicted improved ART adherence, greater care engagement, and HIV suppression over follow-ups. Bidirectional text messages impacted care engagement by moderating the effects of counseling sessions on HIV suppression. CONCLUSIONS Phone counseling augmented by bidirectional text messages has the potential to improve HIV care for young adults living with HIV.
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Affiliation(s)
- Seth C. Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT
| | - Moira O. Kalichman
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT
| | - Lisa A. Eaton
- Institute for Collaboration on Health Intervention and Policy, University of Connecticut, Storrs, CT
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Swai IU, ten Bergen LL, Mtenga A, Maro R, Ngowi K, Mtesha B, Lekashingo N, Msosa T, Rinke de Wit TF, Aarnoutse R, Sumari-de Boer M. Developing contents for a digital adherence tool: A formative mixed-methods study among children and adolescents living with HIV in Tanzania. PLOS DIGITAL HEALTH 2023; 2:e0000232. [PMID: 37851616 PMCID: PMC10584100 DOI: 10.1371/journal.pdig.0000232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/26/2023] [Indexed: 10/20/2023]
Abstract
Optimal adherence (>95%) to antiretroviral treatment (ART) remains a challenge among children and adolescents living with HIV (CALHIV). Digital adherence tools (DAT) with reminder cues have proven feasible among adult people living with HIV (PLHIV), with some concerns about the risk of HIV status disclosure. We aimed to assess the needs, contents and acceptability of an SMS-based DAT among CALHIV. We first conducted a survey to understand potential barriers to using DAT among CALHIV, then tested the DAT intervention among purposively selected participants. The DAT intervention included using the Wisepill device, receiving daily reminder SMS and receiving adherence reports on how they had taken medication in the past month. The content of the reminder SMS differed over time from asking if the medication was taken to a more neutral SMS like "take care". Afterwards, we conducted exit interviews, in-depth interviews, and focus-group discussions. We analysed quantitative findings descriptively and used thematic content analysis for qualitative data. We included 142 children and 142 adolescents in the survey, and 20 of each used the intervention. Eighty-five percent (121/142) of surveyed participants indicated they would like to receive reminder SMS. Most of them (97/121-80%) of children and 94/121(78%) of adolescents would prefer to receive daily reminders. Participants who used the DAT mentioned to be happy to use the device. Ninety percent of them had good experience with receiving reminders and agreed that the SMS made them take medication. However, 25% experienced network problems. Participants preferred neutral reminder SMSs that did not mention the word 'medication', but preserved confidentiality. The provided adherence reports inspired participants to improve their adherence. None of the participants experienced unwanted disclosure or stigmatisation due to DAT. However, 5% of adolescents were concerned about being monitored daily. This study showed that DAT is acceptable and provided insight of the needed SMS content for a customized DAT for CALHIV.
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Affiliation(s)
- Iraseni Ufoo Swai
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- UMC Amsterdam, Location AMC, Amsterdam, the Netherlands
| | - Lisa Lynn ten Bergen
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alan Mtenga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Rehema Maro
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- UMC Amsterdam, Location AMC, Amsterdam, the Netherlands
| | - Benson Mtesha
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Takondwa Msosa
- UMC Amsterdam, Location AMC, Amsterdam, the Netherlands
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Tobias F. Rinke de Wit
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- PharmAccess Foundation, Amsterdam, the Netherlands
| | - Rob Aarnoutse
- Radboud university medical center, Department of Pharmacy, Research Institute for Medical Innovation, Nijmegen, the Netherlands
| | - Marion Sumari-de Boer
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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10
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Wagner AD, Njuguna IN, Neary J, Lawley KA, Louden DKN, Tiwari R, Jiang W, Kalu N, Burke RM, Mangale D, Obermeyer C, Escudero JN, Bulterys MA, Waters C, Mollo B, Han H, Barr-DiChiara M, Baggaley R, Jamil MS, Shah P, Wong VJ, Drake AL, Johnson CC. Demand creation for HIV testing services: A systematic review and meta-analysis. PLoS Med 2023; 20:e1004169. [PMID: 36943831 PMCID: PMC10030044 DOI: 10.1371/journal.pmed.1004169] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/05/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND HIV testing services (HTS) are the first steps in reaching the UNAIDS 95-95-95 goals to achieve and maintain low HIV incidence. Evaluating the effectiveness of different demand creation interventions to increase uptake of efficient and effective HTS is useful to prioritize limited programmatic resources. This review was undertaken to inform World Health Organization (WHO) 2019 HIV testing guidelines and assessed the research question, "Which demand creation strategies are effective for enhancing uptake of HTS?" focused on populations globally. METHODS AND FINDINGS The following electronic databases were searched through September 28, 2021: PubMed, PsycInfo, Cochrane CENTRAL, CINAHL Complete, Web of Science Core Collection, EMBASE, and Global Health Database; we searched IAS and AIDS conferences. We systematically searched for randomized controlled trials (RCTs) that compared any demand creation intervention (incentives, mobilization, counseling, tailoring, and digital interventions) to either a control or other demand creation intervention and reported HTS uptake. We pooled trials to evaluate categories of demand creation interventions using random-effects models for meta-analysis and assessed study quality with Cochrane's risk of bias 1 tool. This study was funded by the WHO and registered in Prospero with ID CRD42022296947. We screened 10,583 records and 507 conference abstracts, reviewed 952 full texts, and included 124 RCTs for data extraction. The majority of studies were from the African (N = 53) and Americas (N = 54) regions. We found that mobilization (relative risk [RR]: 2.01, 95% confidence interval [CI]: [1.30, 3.09], p < 0.05; risk difference [RD]: 0.29, 95% CI [0.16, 0.43], p < 0.05, N = 4 RCTs), couple-oriented counseling (RR: 1.98, 95% CI [1.02, 3.86], p < 0.05; RD: 0.12, 95% CI [0.03, 0.21], p < 0.05, N = 4 RCTs), peer-led interventions (RR: 1.57, 95% CI [1.15, 2.15], p < 0.05; RD: 0.18, 95% CI [0.06, 0.31], p < 0.05, N = 10 RCTs), motivation-oriented counseling (RR: 1.53, 95% CI [1.07, 2.20], p < 0.05; RD: 0.17, 95% CI [0.00, 0.34], p < 0.05, N = 4 RCTs), short message service (SMS) (RR: 1.53, 95% CI [1.09, 2.16], p < 0.05; RD: 0.11, 95% CI [0.03, 0.19], p < 0.05, N = 5 RCTs), and conditional fixed value incentives (RR: 1.52, 95% CI [1.21, 1.91], p < 0.05; RD: 0.15, 95% CI [0.07, 0.22], p < 0.05, N = 11 RCTs) all significantly and importantly (≥50% relative increase) increased HTS uptake and had medium risk of bias. Lottery-based incentives and audio-based interventions less importantly (25% to 49% increase) but not significantly increased HTS uptake (medium risk of bias). Personal invitation letters and personalized message content significantly but not importantly (<25% increase) increased HTS uptake (medium risk of bias). Reduced duration counseling had comparable performance to standard duration counseling (low risk of bias) and video-based interventions were comparable or better than in-person counseling (medium risk of bias). Heterogeneity of effect among pooled studies was high. This study was limited in that we restricted to randomized trials, which may be systematically less readily available for key populations; additionally, we compare only pooled estimates for interventions with multiple studies rather than single study estimates, and there was evidence of publication bias for several interventions. CONCLUSIONS Mobilization, couple- and motivation-oriented counseling, peer-led interventions, conditional fixed value incentives, and SMS are high-impact demand creation interventions and should be prioritized for programmatic consideration. Reduced duration counseling and video-based interventions are an efficient and effective alternative to address staffing shortages. Investment in demand creation activities should prioritize those with undiagnosed HIV or ongoing HIV exposure. Selection of demand creation interventions must consider risks and benefits, context-specific factors, feasibility and sustainability, country ownership, and universal health coverage across disease areas.
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Affiliation(s)
- Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Irene N. Njuguna
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Kendall A. Lawley
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Diana K. N. Louden
- University Libraries, University of Washington, Seattle, Washington, United States of America
| | - Ruchi Tiwari
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Wenwen Jiang
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Ngozi Kalu
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rachael M. Burke
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Dorothy Mangale
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Chris Obermeyer
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Jaclyn N. Escudero
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Michelle A. Bulterys
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Chloe Waters
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Bastien Mollo
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Hannah Han
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | | | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S. Jamil
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Purvi Shah
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
- UNAIDS, Asia Pacific, Regional Support Team, Bangkok, Thailand
| | - Vincent J. Wong
- USAID, Division of HIV Prevention, Care and Treatment, Office of HIV/AIDS, Washington DC, United States of America
| | - Alison L. Drake
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Cheryl C. Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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11
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Buchbinder SP, Siegler AJ, Coleman K, Vittinghoff E, Wilde G, Lockard A, Scott H, Anderson PL, Laborde N, van der Straten A, Christie RH, Marlborough M, Liu AY. Randomized Controlled Trial of Automated Directly Observed Therapy for Measurement and Support of PrEP Adherence Among Young Men Who have Sex with Men. AIDS Behav 2023; 27:719-732. [PMID: 35984607 PMCID: PMC9908647 DOI: 10.1007/s10461-022-03805-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/26/2022]
Abstract
Measurement of adherence to oral pre-exposure prophylaxis (PrEP) in real-time has been challenging. We developed DOT Diary, a smartphone application that combines automated directly observed therapy with a PrEP adherence visualization toolkit, and tested its ability to measure PrEP adherence and to increase adherence among a diverse cohort of young men who have sex with men (MSM). We enrolled 100 MSM in San Francisco and Atlanta and randomly assigned them 2:1 to DOT Diary versus standard of care. Concordance between DOT Diary measurement and drug levels in dried blood spots was substantial, with 91.0% and 85.3% concordance between DOT Diary and emtricitabine-triphosphate and tenofovir-diphosphate, respectively. There was no significant difference in the proportion of participants with detectable PrEP drug levels at 24 weeks between study arms. These results suggest DOT Diary is substantially better than self-reported measures of adherence, but additional interventions are needed to improve PrEP adherence over time.
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Affiliation(s)
- Susan P Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA.
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA.
| | - Aaron J Siegler
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Kenneth Coleman
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Gretchen Wilde
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Annie Lockard
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Ariane van der Straten
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- ASTRA Consulting, Kensington, CA, USA
| | | | | | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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12
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Aung ET, Fairley CK, Ong JJ, Phillips TP, Tran J, Chen MY, Maddaford K, Chow EPF. Adherence to weekly anal self-examination among men who have sex with men for detection of anal syphilis. Front Med (Lausanne) 2022; 9:941041. [PMID: 35979212 PMCID: PMC9376231 DOI: 10.3389/fmed.2022.941041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Men who have sex with men (MSM) practicing exclusively receptive anal sex are more likely to present with secondary than primary syphilis, implying primary anorectal lesions may be missed. If men could detect anorectal lesions by regular anal self-examination, the duration of infectiousness could be reduced. This study aimed to examine adherence to weekly anal self-examination. Method We conducted a longitudinal feasibility study examining the adherence to weekly anal self-examinations among MSM attending a sexual health clinic in Melbourne, Australia between December 2020 and June 2021. Adherence to weekly anal self-examinations over 12 weeks was assessed from a logbook and 4-weekly surveys. Participants who identified abnormalities in their anus were recommended to seek medical review. Results Of the 30 men who completed the study, anal self-examination was performed at least weekly for 308 of 360 person-weeks (86% of the weeks, 95% CI: 82–89). The mean adherence was 3.6 (95% CI: 3.3–3.9) examinations per 4-weeks per person in Weeks 1–4, 3.5 (95% CI: 3.1–3.8) in Weeks 5–8 and 3.3 (95% CI: 2.9–3.7) in Weeks 9–12 (Ptrend = 0.06). Six men (20%, 6/30) were seen for medical review after they identified abnormalities, whilst eight men (27%, 8/30) reported abnormalities, but did not seek medical review. No participants were diagnosed with syphilis during the study period. Conclusion We conclude that men adhered well to weekly anal self-examination. Therefore, it is feasible to trial this as a routine practice among MSM. Future studies should investigate possible reductions in adherence over time and ways to increase medical review for abnormalities that men find.
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Affiliation(s)
- Ei T. Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- *Correspondence: Ei T. Aung
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jason J. Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Tiffany P. Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Julien Tran
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Marcus Y. Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Eric P. F. Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Eric P. F. Chow
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13
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Chan NPT, Lai AYK, Choy HK, Cheung DYT, Wan ANT, Cheng VYH, Chan KY, Lau YK, Yung CY, Cheung GOC, Lam TH. Feasibility and Potential Effectiveness of a Smartphone Zero-Time Exercise Intervention for Promoting Physical Activity and Fitness in Patients With Coronary Heart Disease: A Pilot Randomized Controlled Trial. Front Public Health 2022; 10:865712. [PMID: 35910893 PMCID: PMC9330491 DOI: 10.3389/fpubh.2022.865712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Zero-time Exercise (ZTEx), a simple strength- and stamina-enhancing physical activity (PA) requiring no extra equipment, can potentially increase PA and fitness. This pilot trial examined the feasibility and potential effectiveness of a smartphone ZTEx intervention to promote PA and fitness in patients with coronary heart disease (CHD). Methods A parallel-group assessor-blinded pilot randomized controlled trial was conducted on Chinese patients with stable coronary heart disease (CHD) in three cardiology clinics. The experimental group received a 15-min brief individual face-to-face session and a 12-week ZTEx instant messaging with 28 picture e-messages and a smartphone ZTEx application (ZTExApp). The control group received the same duration of individual session and number and format of e-messages, but the content was healthy eating and breathing exercise. The feasibility was assessed based on: attrition rate, usage, response rate and perception of the intervention. The outcome evaluation included primary outcome (PA), fitness, exercise self-efficacy and intention, perceived happiness and health, and quality of life. A linear mixed model was used with intention-to-treat analysis adjusting for sex, age and baseline values. A semi-structured interview was conducted to collect feedback from the experiment group. Results One hundred thirty-nine patients (mean age 59.8 ± 6.6; 71.2% male) were randomized to the experimental group (n = 70) or control group (n = 69), and 80% (56/70) and 82% (57/69) of patients completed the 12-week follow-up assessment, respectively. The attrition rate was 18.7%. The experimental group reported that ZTEx was feasible to integrate PA into their daily life and appreciated the picture e-messages, and 95% of them sent feedback to us, but only 19.6% (13/70) of the participants entered their PA information into the e-diary of the ZTExApp. The experimental group had a significantly greater increase in time spent walking [mean difference (95% CI): 155.3 (10.1, 300.4), P = 0.04, Cohen's d = 0.34] than the control group. Conclusions This pilot study showed using a brief ZTEx face-to-face session with picture e-messages empowered patients with CHD to integrate PA into daily life. Future definitive trials with a longer follow-up and a more user-friendly ZTExApp interface are necessary to determine the effectiveness of the smartphone ZTEx intervention in enhancing PA and related outcomes. Trial Registration The research protocol was registered at the Hong Kong University Clinical Trials Registry (HKUCTR) on 22 Jul 2016 (Study identifier: HKUCTR-2165) and was also retrospectively registered at the National Institutes of Health (identifier number: NCT03464331) on 14 March 2018.
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Affiliation(s)
- Noel P. T. Chan
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, Hong Kong SAR, China
| | - Agnes Y. K. Lai
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- *Correspondence: Agnes Y. K. Lai
| | - Hau K. Choy
- Faculty of Medicine, Poznon University of Medical Sciences, Poznan, Poland
| | - Derek Y. T. Cheung
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Alice N. T. Wan
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Aberdeen Kai Fong Welfare Association Services Centre, Aberdeen, Hong Kong SAR, China
| | - Victor Y. H. Cheng
- Division of Cardiology, Department of Medicine and Geriatrics, Pok Oi Hospital, New Territories, Hong Kong SAR, China
| | - Ka Y. Chan
- Intensive Care Unit, Hong Kong Sanatorium Hospital, Happy Valley, Hong Kong SAR, China
| | - Yuk K. Lau
- Private Practice, Hong Kong, Hong Kong SAR, China
| | - Chi Y. Yung
- Division of Cardiology, Department of Medicine, Ruttonjee and Tang Shiu Kin Hospitals, Wan Chai, Hong Kong SAR, China
| | - George O. C. Cheung
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - T. H. Lam
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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