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Li DH, Zamantakis A, Zapata JP, Danielson EC, Saber R, Benbow N, Smith JD, Swann G, Macapagal K, Mustanski B. A mixed-methods approach to assessing implementers' readiness to adopt digital health interventions (RADHI). Implement Sci Commun 2024; 5:91. [PMID: 39192345 PMCID: PMC11348516 DOI: 10.1186/s43058-024-00628-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 08/07/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Despite being the primary setting for HIV prevention among men who have sex with men (MSM) since the start of the epidemic, community-based organizations (CBOs) struggle to reach this historically stigmatized and largely hidden population with face-to-face interventions. HIV researchers have readily turned to the internet to deliver critical HIV education to this group, with evidence of high effectiveness and acceptability across studies. However, implementation outside of research contexts has been limited and not well studied. We aimed to assess HIV CBOs' readiness to adopt digital health interventions and identify contextual factors that may contribute to differing levels of readiness. METHODS We recruited 22 CBOs across the US through a pragmatic request-for-proposals process to deliver Keep It Up! (KIU!), an evidence-based eHealth HIV prevention program. We used mixed methods to examine CBO readiness to adopt digital health interventions (RADHI). Before implementation, CBO staff completed a 5-item RADHI scale (scored 0-4) that demonstrated concurrent and predictive validity. We interviewed CBO staff using semi-structured questions guided by the Consolidated Framework for Implementation Research and compared RADHI score groups on determinants identified from the interviews. RESULTS Eighty-five staff (range = 1-10 per CBO) completed the RADHI. On average, CBOs reported moderate-to-great readiness (2.74) to adopt KIU!. High RADHI CBOs thought KIU! was a top priority and an innovative program complementary to their existing approaches for their clients. Low RADHI CBOs expressed concerns that KIU! could be a cultural mismatch for their clients, was lower priority than existing programs and services, relied on clients' own motivation, and might not be suitable for clients with disabilities. Value, appeal, and limitations did not differ by RADHI group. CONCLUSIONS While HIV CBOs are excited for the opportunities and advantages of digital interventions, additional pre-implementation and implementation support may be needed to increase perceived value and usability for different client populations. Addressing these limitations is critical to effective digital prevention interventions for HIV and other domains such as mental health, chronic disease management, and transitions in care. Future research can utilize our novel, validated measure of CBOs' readiness to adopt digital health interventions. TRIAL REGISTRATION NCT03896776, clinicaltrials.gov, 1 April 2019.
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Affiliation(s)
- Dennis H Li
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Third Coast Center for AIDS Research, Northwestern University, Chicago, IL, USA
| | - Juan P Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Nanette Benbow
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Third Coast Center for AIDS Research, Northwestern University, Chicago, IL, USA
| | - Justin D Smith
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA
| | - Gregory Swann
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Kathryn Macapagal
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Third Coast Center for AIDS Research, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Third Coast Center for AIDS Research, Northwestern University, Chicago, IL, USA
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Rodriguez NM, Balian L, Tolliver C, Kataki I, Jesus JRD, Linnes JC. Human-centered design of a smartphone-based self-test for HIV viral load monitoring. J Clin Transl Sci 2023; 7:e262. [PMID: 38229894 PMCID: PMC10790236 DOI: 10.1017/cts.2023.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/18/2024] Open
Abstract
Background/Objective HIV viral load self-testing could enable people living with HIV (PLHIV) to monitor their viral suppression status more easily, potentially facilitating medication adherence and safe behavior decision-making. Smartphone-based viral load testing innovations have the potential to reach resource-limited and vulnerable communities to address inequities in access to HIV care. However, successful development and translation of these tests requires meaningful investigation of end-user contexts and incorporation of those context-specific needs early in the design process. The objective of this study is to engage PLHIV and HIV healthcare providers in human-centered design research to inform key design and implementation considerations for a smartphone-based HIV viral load self-testing device prototype in development. Methods Semi-structured in-depth interviews were conducted with PLHIV (n = 10) and HIV providers (n = 4) in Indiana, a state with suboptimal viral suppression rates and marked disparities in access to HIV care. Interview guides were developed based on contextual investigation and human-centered design frameworks and included a demonstration of the device prototype with feedback-gathering questions. Results Thematic analysis of interview transcripts revealed important benefits, concerns, and user requirements for smartphone-based HIV VL self-testing within the context of PLHIV lived experience, knowledge, and barriers to care in Indiana. Conclusion End-user needs and preferences were identified as key design specifications and implementation considerations to facilitate the acceptability and inform ongoing development and ultimately real-world translation of the HIV VL monitoring device prototype.
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Affiliation(s)
- Natalia M. Rodriguez
- Department of Public Health, College of Health and
Human Sciences, Purdue University, West Lafayette,
IN, USA
- Weldon School of Biomedical Engineering, College of
Engineering, Purdue University, West Lafayette,
IN, USA
| | - Lara Balian
- Department of Public Health, College of Health and
Human Sciences, Purdue University, West Lafayette,
IN, USA
| | - Cealia Tolliver
- Department of Public Health, College of Health and
Human Sciences, Purdue University, West Lafayette,
IN, USA
| | - Ishita Kataki
- Department of Public Health, College of Health and
Human Sciences, Purdue University, West Lafayette,
IN, USA
| | - Julio Rivera-De Jesus
- Weldon School of Biomedical Engineering, College of
Engineering, Purdue University, West Lafayette,
IN, USA
| | - Jacqueline C. Linnes
- Department of Public Health, College of Health and
Human Sciences, Purdue University, West Lafayette,
IN, USA
- Weldon School of Biomedical Engineering, College of
Engineering, Purdue University, West Lafayette,
IN, USA
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Dutta D, Liu J, Xiong H. The Impact of COVID-19 on People Living with HIV-1 and HIV-1-Associated Neurological Complications. Viruses 2023; 15:1117. [PMID: 37243203 PMCID: PMC10223371 DOI: 10.3390/v15051117] [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: 04/12/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen of the coronavirus disease 2019 (COVID-19) pandemic, a fatal respiratory illness. The associated risk factors for COVID-19 are old age and medical comorbidities. In the current combined antiretroviral therapy (cART) era, a significant portion of people living with HIV-1 (PLWH) with controlled viremia is older and with comorbidities, making these people vulnerable to SARS-CoV-2 infection and COVID-19-associated severe outcomes. Additionally, SARS-CoV-2 is neurotropic and causes neurological complications, resulting in a health burden and an adverse impact on PLWH and exacerbating HIV-1-associated neurocognitive disorder (HAND). The impact of SARS-CoV-2 infection and COVID-19 severity on neuroinflammation, the development of HAND and preexisting HAND is poorly explored. In the present review, we compiled the current knowledge of differences and similarities between SARS-CoV-2 and HIV-1, the conditions of the SARS-CoV-2/COVID-19 and HIV-1/AIDS syndemic and their impact on the central nervous system (CNS). Risk factors of COVID-19 on PLWH and neurological manifestations, inflammatory mechanisms leading to the neurological syndrome, the development of HAND, and its influence on preexisting HAND are also discussed. Finally, we have reviewed the challenges of the present syndemic on the world population, with a particular emphasis on PLWH.
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Affiliation(s)
- Debashis Dutta
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
| | | | - Huangui Xiong
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5880, USA
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Yang CWL, Wan ANT, Kwok MCW, Lam TH, Lai AYK. Implementation and evaluation of a model-based risk management process and service enhancement for home-based community care services amidst COVID-19 pandemic in Hong Kong: A mixed-method approach. Front Public Health 2023; 11:1070182. [PMID: 36891327 PMCID: PMC9986770 DOI: 10.3389/fpubh.2023.1070182] [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: 10/14/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
Background The COVID-19 pandemic has greatly challenged all public social services, particularly home-based community care services (HBCCS). Aberdeen Kai-fong Association (AKA) is a non-government organization (NGO) in Hong Kong that systematically manages the challenges to HBCCS. This paper presents a practical example of the implementation and evaluation of the risk management process for HBCCS. Methods Mixed-method design was used to evaluate the implementation of the risk management process in encountering the challenges from existing and potential problems to maintain and enhance HBCCS in four major areas amidst the pandemic. A cross-sectional questionnaire survey and three qualitative focus group interviews were conducted by AKA from 30 December 2021 to 12 March 2022 to collect staff feedback on the institutional risk management process in four areas. Results 109 HBCCS staff members (69% aged 40 years or above; 80% female) completed the questionnaire survey. For resource arrangement and staff training, over 90% of the participants agreed (including strongly agreed) that they had sufficient and reliable personal protective equipment and clear infection control guideline and effective training. Over 80% agreed they had safe working space and effective manpower allocation. However, only 75% agreed they had received emotional support from the organization. Over 90% agreed that the basic services were maintained for service continuation and enhancement, the service users and their families trusted the organization, and the provided services were adjusted according to users' needs. 88% agreed that the organization had obtained support from the neighborhood. For communication among stakeholders, over 80% agreed they had open discussions with the senior management team, and the senior management team was willing to listen. Twenty-six staff members joined the three focus group interviews. The qualitative findings corroborated the quantitative results. Staff appreciated the organisation's work to enhance staff safety and continue advancing services during this difficult period. Regular in-service training, updated information and guidelines to staff, and proactive phone calls to service users, especially the elderly, were suggested to enhance the quality of services. Conclusions The paper could help NGOs and others encountering management challenges in community social services in diverse settings amidst the pandemic and beyond.
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Affiliation(s)
- Caroline W L Yang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Alice N T Wan
- Aberdeen Kai-fong Welfare Association Social Service, Hong Kong, Hong Kong SAR, China
| | - Mable C W Kwok
- Aberdeen Kai-fong Welfare Association Social Service, Hong Kong, Hong Kong SAR, China
| | - Tai-Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Agnes Y K Lai
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Zhao T, Cao Z, Jiang Z, Bulloch G, Qiu Y, Liu L, Wang L, Li Y, Jia C, Guo L, Wu Z. Providing HIV testing in men who have sex with men through a gay social networking app in China: A qualitative interview study with multisectoral service providers. Front Public Health 2022; 10:1056720. [PMID: 36466506 PMCID: PMC9714668 DOI: 10.3389/fpubh.2022.1056720] [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: 10/13/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
Objective We explored the feasibility of app-based HIV testing services (AHTS) among men who have sex with men (MSM) according to the perspectives of testing service providers. Methods Twenty-one current or previous AHTS providers participated in a semi-structured interview which explored the facilitators and barriers to AHTS. Ten participants originating from the Center for Disease Control and Prevention (CDC) and 11 from the non-governmental organization (NGO) in Shijiazhuang, China took part in this study. Interviews was transcribed verbatim, and the socioecological model (SEM) was applied to thematic analysis. Results Twenty-one participants from AHTS services commented on the integration of online appointment schedules into HIV testing services. AHTS was deemed a convenient and efficient method for MSM and service providers to choose their preferred location and times. Moreover, it allowed for important HIV-related information to be accessed online and targeted toward at-risk individuals. Participants thought MSM may feel unsure about personal information security being stored within a privatized app and was considered a barrier to AHTS's usability. As such, they believed establishing a government-led national online platform for AHTS would allow for greater trust from MSM, rather than a social media app. Conclusion By linking booking services to an online platform, AHTS was deemed a convenient and efficient method for HIV testing services, especially for young MSM who are familiar with smartphone applications. To improve the use of these services, AHTS apps should focus on ensuring the confidentiality of personal information and internet security to build trust between MSM and service providers.
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Affiliation(s)
- Tianming Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China,National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhaobing Cao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China,National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhen Jiang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Gabriella Bulloch
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Yanchao Qiu
- Shijiazhuang Municipal Center for Disease Control and Prevention, Shijiazhuang, China
| | - Lihua Liu
- Shijiazhuang Municipal Center for Disease Control and Prevention, Shijiazhuang, China
| | - Lijing Wang
- Shijiazhuang Fifth Hospital, Shijiazhuang, China
| | - Yingxia Li
- Shijiazhuang Fifth Hospital, Shijiazhuang, China
| | - Ce Jia
- The “Tongxing” Non-Governmental Organization, Shijiazhuang, China
| | - Li Guo
- The “Tongxing” Non-Governmental Organization, Shijiazhuang, China
| | - Zunyou Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China,National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China,*Correspondence: Zunyou Wu
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