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Ostermann J, Njau B, van Zwetselaar M, Yamanis T, McClimans L, Mwangi R, Beti M, Hobbie A, Gass SJ, Mtuy T, Thielman N. Mobile Phone-Based Confidential Social Network Referrals for HIV Testing (CONSORT): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55068. [PMID: 38814692 PMCID: PMC11176874 DOI: 10.2196/55068] [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: 12/01/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Critical to efforts to end the HIV epidemic is the identification of persons living with HIV who have yet to be diagnosed and engaged in care. Expanded HIV testing outreach efforts need to be both efficient and ambitious, targeting the social networks of persons living with HIV and those at above-average risk of undiagnosed HIV infection. The ubiquity of mobile phones across many high HIV prevalence settings has created opportunities to leverage mobile health (mHealth) technologies to engage social networks for HIV testing outreach, prevention, and treatment. OBJECTIVE The purpose of this study is to evaluate the acceptability and efficacy of a novel mHealth intervention, "Confidential Social Network Referrals for HIV Testing (CONSORT)," to nudge at-risk individuals to test for HIV using SMS text messages. METHODS We will conduct the CONSORT study in Moshi, Tanzania, the commercial center and administrative capital of the Kilimanjaro Region in northern Tanzania. After qualitative formative work and pilot testing, we will enroll 400 clients presenting for HIV counseling and testing and 200 persons living with HIV and receiving care at HIV care and treatment centers as "inviters" into a randomized controlled trial. Eligible participants will be aged 18 years or older and live, work, or regularly receive care in Moshi. We will randomize inviters into 1 of 2 study arms. All inviters will be asked to complete a survey of their HIV testing and risk behaviors and to think of social network contacts who would benefit from HIV testing. They will then be asked to whom they would prefer to extend an HIV testing invitation in the form of a physical invitation card. Arm 1 participants will also be given the opportunity to extend CONSORT invitations in the form of automated confidential SMS text messages to any of their social network contacts or "invitees." Arm 2 participants will be offered physical invitation cards alone. The primary outcome will be counselor-documented uptake of HIV testing by invitees within 30 days of inviter enrollment. Secondary outcomes will include the acceptability of CONSORT among inviters, the number of new HIV diagnoses, and the HIV risk of invitees who present for testing. RESULTS Enrollment in the randomized controlled trial is expected to start in September 2024. The findings will be disseminated to stakeholders and published in peer-reviewed journals. CONCLUSIONS If CONSORT is acceptable and effective for increasing the uptake of HIV testing, given the minimal costs of SMS text reminders and the potential for exponential but targeted growth using chain referrals, it may shift current practices for HIV testing programs in the area. TRIAL REGISTRATION ClincalTrials.gov NCT05967208; https://clinicaltrials.gov/study/NCT05967208. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/55068.
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Affiliation(s)
- Jan Ostermann
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, United States
| | - Bernard Njau
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | | | - Thespina Yamanis
- School of International Service, American University, Washington, DC, United States
| | - Leah McClimans
- Department of Philosophy, University of South Carolina, Columbia, SC, United States
| | - Rose Mwangi
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Melkiory Beti
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Amy Hobbie
- Center for Health Policy and Inequalities Research, Duke University, Durham, SC, United States
| | - Salomé-Joelle Gass
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, United States
| | - Tara Mtuy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nathan Thielman
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
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Pak SHL, Wang MP, Teitelman AM, Wong JYH, Fong DYT, Choi EPH. Nurse-Led Brief Intervention for Enhancing Safe Sex Practice Among Emerging Adults in Hong Kong Using Instant Messaging: Feasibility Study. JMIR Form Res 2024; 8:e52695. [PMID: 38506897 PMCID: PMC10993122 DOI: 10.2196/52695] [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: 09/12/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The incidence of sexually transmitted infections has been increasing throughout the world. Additionally, substantial changes in emerging adults' attitudes toward sex and the popularization of premarital sex could further affect the diagnosis and treatment of sexually transmitted infections. With the high acceptability and effectiveness of instant messaging (IM) interventions for health promotion, there is potential for such interventions to improve condom use knowledge and promote safer sex practice. OBJECTIVE The study evaluates the feasibility of a nurse-led IM intervention to promote safer sex practices in emerging adults. METHODS A 30-minute adaptive IM intervention and a 5-day booster dose of daily messages after 2 weeks through WhatsApp (Meta Platforms, Inc) were conducted with emerging adults in local universities in Hong Kong aged between 18 and 29 years with previous sexual experience. A questionnaire was distributed 1 week after the intervention that measured the consistency in condom use, the change in condom use knowledge and attitudes, and the acceptability of the intervention. The feasibility of the intervention was assessed by Bowen's feasibility framework. RESULTS A total of 20 participants completed the intervention and questionnaire. Results showed (1) high satisfaction level (mean satisfaction score: 9.10/10), (2) high demand of the intervention (retention rate: 95%), (3) smooth implementation of the intervention, (4) high practicality (13/20, 65% of the participants viewed IM to be an effective means of intervention), (5) potential integration of the intervention, and (6) significant mean increase in condom use knowledge and attitudes (mean increase 9.05; t19=3.727; 95% CI 3.97-14.13; P=.001). CONCLUSIONS The IM intervention was feasible, acceptable, and had potential impacts on improving safer sex practices. These findings will support the future development of IM interventions in the arena of sexual health promotion.
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Affiliation(s)
- Sharon Hoi Lam Pak
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Man Ping Wang
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Anne M Teitelman
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- College of Nursing, Thomas Jefferson University, Philadelphia, PA, United States
| | - Janet Yuen Ha Wong
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China (Hong Kong)
| | - Daniel Yee Tak Fong
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Edmond Pui Hang Choi
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Swendeman D, Rotheram-Borus MJ, Arnold EM, Fernández MI, Comulada WS, Lee SJ, Ocasio MA, Ishimoto K, Gertsch W, Duan N, Reback CJ, Murphy DA, Lewis KA. Optimal strategies to improve uptake of and adherence to HIV prevention among young people at risk for HIV acquisition in the USA (ATN 149): a randomised, controlled, factorial trial. Lancet Digit Health 2024; 6:e187-e200. [PMID: 38395539 DOI: 10.1016/s2589-7500(23)00252-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/22/2023] [Accepted: 12/05/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP), condom use, post-exposure prophylaxis (PEP), and sexual partner reduction help to prevent HIV acquisition but have low uptake among young people. We aimed to assess the efficacy of automated text messaging and monitoring, online peer support, and strengths-based telehealth coaching to improve uptake of and adherence to PrEP, condom use, and PEP among adolescents aged 12-24 years at risk of HIV acquisition in Los Angeles, CA, USA, and New Orleans, LA, USA. METHODS We conducted a four-arm randomised controlled factorial trial, assessing interventions designed to support uptake and adherence of HIV prevention options (ie, PrEP, PEP, condom use, and sexual partner reduction). We recruited young people aged 12-24 years who were at risk of HIV acquisition from 13 community-based organisations, adolescent medicine clinics, and organisations serving people who are unstably housed, people who were previously incarcerated, and other vulnerable young people, and through dating apps, peer referrals, and social venues and events in Los Angeles, CA, USA, and New Orleans, LA, USA. Young people who tested seronegative and reported being gay, bisexual, or other men who have sex with men, transgender men or women, or gender diverse (eg. non-binary or genderqueer) were eligible for inclusion. Participants were randomly assigned to one of four intervention groups in a factorial design: automated text messaging and monitoring (AMMI) only, AMMI plus peer support via private social media, AMMI plus strengths-based telehealth coaching by near-peer paraprofessionals, or AMMI plus peer support and coaching. Assignment was further stratified by race or ethnicity and sexual orientation within each interviewer's group of participants. Participants were masked to intervention assignment until after baseline interviews when offered their randomly assigned intervention, and interviewers were masked throughout the study. Interventions were available throughout the 24-month follow-up period, and participants completed baseline and follow-up assessments, including rapid diagnostic tests for sexually transmitted infections, HIV, and substance use, at 4-month intervals over 24 months. The primary outcomes were uptake and adherence to HIV prevention options over 24 months, measured by self-reported PrEP use and adherence, consistent condom use with all partners, PEP prescription and adherence, and number of sexual partners in participants with at least one follow-up. We used Bayesian generalised linear modelling to assess changes in outcomes over time comparing the four study groups. This study is registered with ClinicalTrials.gov (NCT03134833) and is completed. FINDINGS We screened 2314 adolescents beginning May 1, 2017, to enrol 1037 participants (45%) aged 16-24 years between May 6, 2017, and Aug 30, 2019, of whom 895 (86%) had follow-up assessments and were included in the analytical sample (313 assigned to AMMI only, 205 assigned to AMMI plus peer support, 196 assigned to AMMI plus coaching, and 181 assigned to AMMI plus peer support and coaching). Follow-up was completed on Nov 8, 2021. Participants were diverse in race and ethnicity (362 [40%] Black or African American, 257 [29%] Latinx or Hispanic, 184 [21%] White, and 53 [6%] Asian or Pacific Islander) and other sociodemographic factors. At baseline, 591 (66%) participants reported anal sex without a condom in the past 12 months. PrEP use matched that in young people nationally, with 101 (11%) participants reporting current PrEP use at baseline, increasing at 4 months to 132 (15%) and continuing to increase in the AMMI plus peer support and coaching group (odds ratio 2·31, 95% CI 1·28-4·14 vs AMMI control). There was no evidence for intervention effect on condom use, PEP use (ie, prescription or adherence), PrEP adherence, or sexual partner numbers. No unanticipated or study-related adverse events occurred. INTERPRETATION Results are consistent with hypothesised synergistic intervention effects of evidence-based functions of informational, motivational, and reminder messaging; peer support for HIV prevention; and strengths-based, goal-focused, and problem-solving telehealth coaching delivered by near-peer paraprofessionals. These core functions could be flexibly scaled via combinations of technology platforms and front-line or telehealth HIV prevention workers. FUNDING Adolescent Medicine Trials Network for HIV/AIDS Interventions, US National Institutes of Health.
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Affiliation(s)
- Dallas Swendeman
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Mary Jane Rotheram-Borus
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | | | | | - Walter Scott Comulada
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Sung-Jae Lee
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Manuel A Ocasio
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kelsey Ishimoto
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - William Gertsch
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Naihua Duan
- Division of Mental Health Data Science, Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Debra A Murphy
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Katherine A Lewis
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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Huang F, Fairley CK, Lee DM, Rahman R, Ong JJ, Bradshaw CS, Chen MY, Phillips TR, Chow EPF. Factors Associated With Consenting to Receive an Automated Email Summary After a Sexual Health Clinic Visit. Sex Transm Dis 2023; 50:664-670. [PMID: 37432979 DOI: 10.1097/olq.0000000000001847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND Electronic health records allow for inexpensive communication with patients. In March 2021, the Melbourne Sexual Health Centre implemented an automated email summary ("Sexual Health Automated Visit Email" [SHAVE]) of a client's visit. This study evaluates the proportion of attendees at a sexual health service who opted in or out of SHAVE. METHODS This study was conducted at the Melbourne Sexual Health Centre in Australia between March 2021 and June 2022. Univariable and multivariable logistic regression analyses were used to examine the client characteristics associated with consenting to SHAVE. RESULTS There were 18,528 clients (men, 12,700; women, 5828) included in the final analysis and 55.2% (n = 10,233) consented to receiving SHAVE. Comparing with those who did not have a new sexually transmitted infection diagnosis, clients with a new diagnosis of a sexually transmitted infection, but not HIV, had lower odds of consenting to receiving SHAVE (chlamydia: adjusted odds ratio [aOR], 0.64 [95% confidence interval {CI}, 0.57-0.72]; gonorrhea: aOR, 0.71 [95% CI, 0.62-0.82]; syphilis: aOR, 0.75 [95% CI, 0.59-0.96]). Men had lower odds of consenting when compared with women (men who have sex with women only: aOR, 0.77 [95% CI, 0.71-0.84]; men who have sex with men: aOR, 0.68 [95% CI, 0.62-0.75]). Comparing with those born in Australia or Oceania, clients born in Europe had lower odds of consenting (aOR, 0.81; 95% CI, 0.70-0.94), whereas those born in Latin America or Caribbean had higher odds of consenting (aOR, 1.25; 95% CI, 1.04-1.51). CONCLUSIONS Email summaries may serve as a valuable strategy to improve health communication and record keeping for clients. Understanding the client characteristics associated with consenting SHAVE will allow for the implementation of strategies to better communicate with clients.
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Affiliation(s)
| | | | - David M Lee
- From the Melbourne Sexual Health Centre, Alfred Health
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Perinpanathan T, Maiya S, van Velthoven MHH, Nguyen AT, Free C, Smith C. Mobile phone-based interventions for improving contraception use. Cochrane Database Syst Rev 2023; 7:CD011159. [PMID: 37458240 PMCID: PMC10363274 DOI: 10.1002/14651858.cd011159.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: 07/20/2023]
Abstract
BACKGROUND Contraception provides significant benefits for women's and children's health, yet many women have an unmet need for contraception. Rapid expansion in the use of mobile phones in recent years has had a dramatic impact on interpersonal communication. Within the health domain text messages and smartphone applications offer means of communication between clients and healthcare providers. This review focuses on interventions delivered by mobile phone and their effect on use of contraception. OBJECTIVES To evaluate the benefits and harms of mobile phone-based interventions for improving contraception use. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was August 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) of mobile phone-based interventions to improve forms of contraception use amongst users or potential users of contraception. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. uptake of contraception, 2. uptake of a specific method of contraception, 3. adherence to contraception method, 4. safe method switching, 5. discontinuation of contraception and 6. pregnancy or abortion. Our secondary outcomes were 7. road traffic accidents, 8. any physical or psychological effect reported and 9. violence or domestic abuse. MAIN RESULTS Twenty-three RCTs (12,793 participants) from 11 countries met our inclusion criteria. Eleven studies were conducted in high-income resource settings and 12 were in low-income settings. Thirteen studies used unidirectional text messaging-based interventions, six studies used interactive text messaging, four used voice message-based interventions and two used mobile-phone apps to improve contraception use. All studies received funding from non-commercial bodies. Mobile phone-based interventions probably increase contraception use compared to the control (odds ratio (OR) 1.30, 95% confidence interval (CI) 1.06 to 1.60; 16 studies, 8972 participants; moderate-certainty evidence). There may be little or no difference in rates of unintended pregnancy with the use of mobile phone-based interventions compared to control (OR 0.82, 95% CI 0.48 to 1.38; 8 trials, 2947 participants; moderate-certainty evidence). Subgroup analysis assessing unidirectional mobile phone interventions versus interactive mobile phone interventions found evidence of a difference between the subgroups favouring interactive interventions (P = 0.003, I2 = 88.5%). Interactive interventions had an OR of 1.71 (95% CI 1.28 to 2.29; P = 0.0003, I2 = 63%; 8 trials, 3089 participants) whilst unidirectional interventions had an OR of 1.03 (95% CI 0.87 to 1.22; P = 0.72, I2 = 17%; 9 trials, 5883 participants). Subgroup analysis assessing high-income versus low-income trial settings found no difference between groups (subgroup difference test: P = 0.70, I2 = 0%). Only six trials reported on safety and unintended outcomes; one trial reported increased partner violence whilst another four trials reported no difference in physical violence rates between control and intervention groups. One trial reported no road traffic accidents with mobile phone intervention use. AUTHORS' CONCLUSIONS This review demonstrates there is evidence to support the use of mobile phone-based interventions in improving the use of contraception, with moderate-certainty evidence. Interactive mobile phone interventions appear more effective than unidirectional methods. The cost-effectiveness, cost benefits, safety and long-term effects of these interventions remain unknown, as does the evidence of this approach to support contraception use among specific populations. Future research should investigate the effectiveness and safety of mobile phone-based interventions with better quality trials to help establish the effects of interventions delivered by mobile phone on contraception use. This review is limited by the quality of the studies due to flaws in methodology, bias or imprecision of results.
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Affiliation(s)
- Tanaraj Perinpanathan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Shilpa Maiya
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, India
| | | | - Amy T Nguyen
- Department of Research, Darkness to Light, Baltimore, North Charleston, South Carolina, USA
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Stracker N, Williford SL, Gilliams E, Rives S, Page KR, Hamill MM, Greenbaum A, Schumacher CM. Factors Associated With Chlamydia and Gonorrhea Treatment Completion Among Sexual Health Clinic Patients, Baltimore City, Maryland; 2018 to 2019. Sex Transm Dis 2023; 50:265-273. [PMID: 36728272 DOI: 10.1097/olq.0000000000001770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prompt and appropriate treatment of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is critical to prevent transmission and serious sequelae. The objectives were to determine the prevalence of CT/NG treatment completion and identify demographic, behavioral, and clinical factors associated with treatment completion at sexual health clinics in Baltimore City, Maryland. METHODS Electronic health record data from patients diagnosed with CT/NG during 2018-2019 were analyzed. Treatment completion was defined as documentation of Centers for Disease Control and Prevention-recommended treatment ≤30 days after testing. Regression was used to assess differences in treatment completion across groups; analyses were stratified by birth sex. RESULTS Most of the 2426 male (86%) and 754 (72%) female patients diagnosed with CT/NG completed treatment in ≤30 days; 74% of male and 36% of female patients were treated same-day. Among 890 male patients not treated same-day, treatment completion was associated with other same-day antimicrobial treatments (adjusted prevalence ratio, 0.76 [95% confidence interval, 0.61-0.94]), longer test processing times (≥10 days; 0.78 [0.65-0.95]) infection at multiple anatomic sites (1.49 [1.25-1.76]), and patients with previous clinic visits (1.16 [1.03-1.31]). Among 483 female patients not treated same-day, treatment completion was associated with diagnosis year (2019 vs. 2018; 1.23 [1.05-1.43]) and residential addresses 2 to 5 miles (vs. <2 miles) from clinic (1.25 [1.02-1.53]). Demographic and behavioral characteristics were not associated with treatment completion. CONCLUSIONS Substantial proportions of male and female sexual health clinic patients did not complete treatment. Our findings underscore the need for implementation of highly sensitive and specific point-of-care (POC) CT/NG testing to improve treatment completion in this setting.
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Affiliation(s)
| | | | | | | | | | | | | | - Christina M Schumacher
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Beck EJ, Mandalia S, Yfantopoulos P, Leon A, Merino MJ, Garcia F, Wittevogel M, Apers L, Benkovic I, Zekan S, Begovac J, Cunha AS, Teofilo E, Rodrigues G, Borges MDF, Fatz D, Vera J, Whetham J. Efficiency of the EmERGE Pathway of Care in Five European HIV Centres. PHARMACOECONOMICS 2022; 40:1235-1246. [PMID: 36227463 DOI: 10.1007/s40273-022-01193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We aimed to calculate the efficiency of the EmERGE Pathway of Care in five European HIV clinics, developed and implemented for medically stable people living with HIV. METHODS Participants were followed up for 1 year before and after implementation of EmERGE, between April 2016 and October 2019. Micro-costing studies were performed in the outpatient services of the clinics. Unit costs for outpatient services were calculated in national currencies and converted to US$ 2018 OECD purchasing parity prices to enable between clinic comparisons in terms of outcomes and costs. Unit costs were linked to the mean use of services for medically stable people living with HIV, before and after implementation of EmERGE. Primary outcome measures were CD4 count and viral load; secondary outcomes were patient activation (PAM13) and quality of life (PROQOL-HIV). Out-of-pocket expenditure data were collected. RESULTS There were 2251 participants: 87-93% were male, mean age at entry was 41-47 years. Medically stable people living with HIV had outpatient visits in four sites which decreased by 9-31% and costs by 5-33%; visits and costs increased by 8% in one site, which had to revert back to face-to-face visits. Antiretroviral drugs comprised 83-91% of annual costs: the Portuguese site had the highest antiretroviral drug costs in US$ purchasing parity prices. Primary and secondary outcome measures of participants did not change during the study. CONCLUSIONS EmERGE is acceptable and provided cost savings in different socio-economic settings. Antiretroviral drug costs remain the main cost drivers in medically stable people living with HIV. While antiretroviral drug prices in local currencies did not differ that much between countries, conversion to US$ purchasing parity prices revealed antiretroviral drugs were more expensive in the least wealthy countries. This needs to be taken into consideration when countries negotiate drug prices with pharmaceutical vendors. Greater efficiencies can be anticipated by extending the use of the EmERGE Pathway to people with complex HIV infection or other chronic diseases. Extending such use should be systematically monitored, implementation should be evaluated and funding should be provided to monitor and evaluate future changes in service provision.
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Affiliation(s)
- Eduard J Beck
- NPMS-HHC CIC, 21 Bedford Square, London, WC1B 3HH, UK.
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - Agathe Leon
- Infectious Diseases Department, Hospital Clínic-IDIBAPS (HC-IDIBAPS), University of HC-IDIBAPS, Barcelona, Spain
| | - Marie J Merino
- Infectious Diseases Department, Hospital Clínic-IDIBAPS (HC-IDIBAPS), University of HC-IDIBAPS, Barcelona, Spain
| | - Felipe Garcia
- Infectious Diseases Department, Hospital Clínic-IDIBAPS (HC-IDIBAPS), University of HC-IDIBAPS, Barcelona, Spain
| | | | - Ludwig Apers
- Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Ivana Benkovic
- University Hospital for Infectious Diseases (UHID), Zagreb, Croatia
| | - Sime Zekan
- University Hospital for Infectious Diseases (UHID), Zagreb, Croatia
| | - Josip Begovac
- University Hospital for Infectious Diseases (UHID), Zagreb, Croatia
| | - Ana S Cunha
- Hospital Capuchos, Centro Hospitalar De Lisboa Central, EPE (HC-CHLC), Lisbon, Portugal
| | - Eugenio Teofilo
- Hospital Capuchos, Centro Hospitalar De Lisboa Central, EPE (HC-CHLC), Lisbon, Portugal
| | - Goncalo Rodrigues
- Hospital Capuchos, Centro Hospitalar De Lisboa Central, EPE (HC-CHLC), Lisbon, Portugal
| | - Margarida D F Borges
- Hospital Capuchos, Centro Hospitalar De Lisboa Central, EPE (HC-CHLC), Lisbon, Portugal
| | - Duncan Fatz
- Brighton and Sussex University Hospitals NHS Trust (BSUHT), Brighton, UK
| | - Jamie Vera
- Brighton and Sussex University Hospitals NHS Trust (BSUHT), Brighton, UK
| | - Jennifer Whetham
- Brighton and Sussex University Hospitals NHS Trust (BSUHT), Brighton, UK
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8
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The efficiency of the EmERGE platform for medically stable people living with HIV in Portugal. Porto Biomed J 2022; 7:e191. [DOI: 10.1097/j.pbj.0000000000000191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/27/2022] [Indexed: 11/22/2022] Open
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Beck EJ, Mandalia S, Yfantopoulos P, Jones CI, Bremner S, Whetham J, Etcheverry F, Moreno L, Gonzalez E, Merino MJ, Leon A, Garcia F. Efficiency of the EmERGE Pathway to provide continuity of care for Spanish people living with medically stable HIV. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:388-395. [PMID: 35906033 DOI: 10.1016/j.eimce.2020.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/23/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Calculate the efficiency of the EmERGE Pathway of Care for medically stable people living with HIV at the Hospital Clínic-IDIBAPS, Barcelona, Spain. METHODS 546 study participants were followed between 1st July 2016 and 30th October 2019 across three HIV outpatient clinics, but the virtual clinic was closed during the second year. Unit costs were calculated, linked to mean use outpatient services per patient year, one-year before and after the implementation of EmERGE. Costs were combined with primary and secondary outcomes. RESULTS Annual costs across HIV-outpatient services increased by 8%: €1073 (95%CI €999-€1157) to €1158 (95%CI €1084-€1238). Annual cost of ARVs was €7,557; total annual costs increased by 1% from €8430 (95%CI €8356-8514) to €8515 (95%CI €8441-8595). Annual cost for 433 participants managed in face-to-face (F2F) clinics decreased by 5% from €958 (95%CI 905-1018) to €904 (95%CI 863-945); participants transferred from virtual to F2F outpatient clinics (V2F) increased their annual cost by a factor of 2.2, from €115 (95%CI 94-139) to €251 (95%CI 219-290). No substantive changes were observed in primary and secondary outcomes. CONCLUSION EmERGE Pathway is an efficient and acceptable intervention. Increases in costs were caused by internal structural changes. The cost reduction observed in F2F clinics were off-set by the transfer of participants from the virtual to the F2F clinics due to the closure of the virtual clinic during the second year of the Study. Greater efficiencies are likely to be achieved by extending the use of the Pathway to other PLHIV.
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Affiliation(s)
- E J Beck
- NPMS-HHC CIC, London, UK; Department of Health Services Research and Policy, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - C I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - S Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - J Whetham
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - F Etcheverry
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - L Moreno
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - E Gonzalez
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - M J Merino
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - A Leon
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - F Garcia
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
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10
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Xu X, Fairley CK, Chow EPF, Lee D, Aung ET, Zhang L, Ong JJ. Using machine learning approaches to predict timely clinic attendance and the uptake of HIV/STI testing post clinic reminder messages. Sci Rep 2022; 12:8757. [PMID: 35610227 PMCID: PMC9128330 DOI: 10.1038/s41598-022-12033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/07/2022] [Indexed: 11/09/2022] Open
Abstract
Timely and regular testing for HIV and sexually transmitted infections (STI) is important for controlling HIV and STI (HIV/STI) among men who have sex with men (MSM). We established multiple machine learning models (e.g., logistic regression, lasso regression, ridge regression, elastic net regression, support vector machine, k-nearest neighbour, naïve bayes, random forest, gradient boosting machine, XGBoost, and multi-layer perceptron) to predict timely (i.e., within 30 days) clinic attendance and HIV/STI testing uptake after receiving a reminder message via short message service (SMS) or email). Our study used 3044 clinic consultations among MSM within 12 months after receiving an email or SMS reminder at the Melbourne Sexual Health Centre between April 11, 2019, and April 30, 2020. About 29.5% [899/3044] were timely clinic attendance post reminder messages, and 84.6% [761/899] had HIV/STI testing. The XGBoost model performed best in predicting timely clinic attendance [mean [SD] AUC 62.8% (3.2%); F1 score 70.8% (1.2%)]. The elastic net regression model performed best in predicting HIV/STI testing within 30 days [AUC 82.7% (6.3%); F1 score 85.3% (1.8%)]. The machine learning approach is helpful in predicting timely clinic attendance and HIV/STI re-testing. Our predictive models could be incorporated into clinic websites to inform sexual health care or follow-up service.
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Affiliation(s)
- Xianglong Xu
- Central Clinical School, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, The Alfred, Melbourne, 3053, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, The Alfred, Melbourne, 3053, Australia
| | - Eric P F Chow
- Central Clinical School, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, The Alfred, Melbourne, 3053, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - David Lee
- Melbourne Sexual Health Centre, The Alfred, Melbourne, 3053, Australia
| | - Ei T Aung
- Central Clinical School, Monash University, Melbourne, Australia.,Melbourne Sexual Health Centre, The Alfred, Melbourne, 3053, Australia
| | - Lei Zhang
- Central Clinical School, Monash University, Melbourne, Australia. .,Melbourne Sexual Health Centre, The Alfred, Melbourne, 3053, Australia. .,China Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, China. .,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia. .,Melbourne Sexual Health Centre, The Alfred, Melbourne, 3053, Australia. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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11
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Beck EJ, Mandalia S, Yfantopoulos P, Jones CI, Bremner S, Fatz D, Vera J, Whetham J. The efficiency of the EmERGE pathway of care for people living with HIV in England. AIDS Care 2022; 35:899-908. [PMID: 35348411 DOI: 10.1080/09540121.2022.2040723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study estimated the efficiency of implementing the EmERGE Pathway of Care for people living with medically stable HIV in Brighton, UK; an App enables individuals to communicate with caregivers via their smart-phone. Individual data on the use of HIV outpatient services were collected one-year pre- and post-implementation of EmERGE. Unit costs of HIV outpatient services were calculated and linked with mean use of services per patient year. Primary outcomes were CD4 count and viral load; patient activation and quality-of-life measures were secondary outcomes. 565 participants were followed up April 2017 - October 2018: 93% men, mean age at recruitment 47.0 years (95%CI:46.2-47.8). Outpatient visits decreased by 9% from 5.6 (95%CI:5.4-5.8) to 5.1 (95%CI:4.9-5.3). Face-to-face visits decreased and virtual visits increased. Annual costs decreased by 9% from £751 (95%CI: £722-£780) to £678 (95%CI: £653-£705). Including anti-retroviral drugs, total annual cost decreased from £7,343 (95%CI: £7,314-7,372) to £7,270 (95%CI: £7,245-7,297): ARVs costs comprised 90%. EmERGE was a cost-saving intervention, patients remained engaged and clinically stable. Annual costs were reduced, but ARVs continue to dominate costs. Extension of EmERGE to other people with chronic conditions, could produce greater efficiencies but these needs to be evaluated and monitored over time.
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Affiliation(s)
- E J Beck
- NPMS-HHC CIC, London, UK.,Department of Health Services Research and Policy, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - C I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - S Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - D Fatz
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - J Vera
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - J Whetham
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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12
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Beck EJ, Mandalia S, Yfantopoulos P, Jones CI, Bremner S, Whetham J, Wittevrongel M, Apers L. The efficiency of the EmERGE pathway to provide continuity of care for medically stable people living with HIV in Belgium. Acta Clin Belg 2021; 77:915-924. [PMID: 34802399 DOI: 10.1080/17843286.2021.2004697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Perdomo-Pantoja A, Alomari S, Lubelski D, Liu A, DeMordaunt T, Bydon A, Witham TF, Theodore N. Implementation of an Automated Text Message-Based System for Tracking Patient-Reported Outcomes in Spine Surgery: An Overview of the Concept and Our Early Experience. World Neurosurg 2021; 158:e746-e753. [PMID: 34800733 DOI: 10.1016/j.wneu.2021.11.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Text message-based interventions have been demonstrated to be a valuable monitoring tool across various conditions. Here, we aimed to describe our early experience using a newly developed text message-based platform designed to track symptoms in spine surgery patients. METHODS We used the Informed Mindset Medical (IMM) platform to automatically send text messages with secure and encrypted hyperlinks to enrolled patients. Patient symptoms were monitored using well-standardized functional assessments. Limited patient data and responses were stored on a Health Insurance Portability and Accountability Act-compliant SQL cloud-based server database. RESULTS In 3 months, 101 patients scheduled for elective spine surgery accepted participation in our pilot study. Overall, 71.2% of the enrolled patients responded to at least 1 preoperative baseline questionnaire. The response rates were similar across attendings, questionnaire bundles (cervical vs. thoracolumbar), genders, and age groups. The overall preoperative IMM pain scores were found to correlate positively with the preoperative electronic medical record pain rates. Similarly, the overall preoperative IMM and electronic medical record pain scores correlated positively with the IMM-collected Neck Disability Index/Oswestry Disability Index scores. From an initial 71.2%, the response rate decreased to 54.9% for the 6-week follow-up questionnaires. CONCLUSIONS Our preliminary findings support the reliability of this text message-based strategy to monitor symptoms in spine surgery patients. Further studies are warranted to explore strategies to increase the response rate and expand this platform's clinical and research applicability.
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Affiliation(s)
| | - Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Trevor DeMordaunt
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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14
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Whiteley LB, Olsen EM, Haubrick KK, Odoom E, Tarantino N, Brown LK. A Review of Interventions to Enhance HIV Medication Adherence. Curr HIV/AIDS Rep 2021; 18:443-457. [PMID: 34152554 DOI: 10.1007/s11904-021-00568-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Adherence to antiretroviral treatment (ART) is crucial for the successful treatment of HIV. Unfortunately, it is estimated that 45% of persons living with HIV (PLWH) have poor adherence to ART. To provide health care professionals and PLWH with effective tools for supporting adherence, researchers have investigated the effectiveness of psychosocial interventions to enhance adherence to ART. In this paper, interventional studies, systematic reviews, and meta-analyses that examine ART adherence interventions for PLWH are reviewed. RECENT FINDINGS There is great variability among interventions in terms of quality, sample, measures, and outcome characteristics. Despite a diverse and wide-ranging assortment of ART adherence interventions, consistent lessons have been learned. Interventions that focus on individual and interpersonal factors have been effective for improving ART adherence; however, the improvement in adherence tends to be short-lived. Additionally, interventions are most successful when tailored to those at risk for poor adherence. Finally, theory-based interventions are more likely to be effective than non-theory-based interventions. A variety of individual-level psychological interventions have been shown to be effective in improving ART adherence in the short term. Digital and mobile interventions have the potential to improve dissemination and implementation of these evidence-based interventions and could be used to extend intervention effects. Future interventions that address issues of accessibility, inequality, structural and institutional barriers to ART adherence should also be tested and prioritized. Implementation science frameworks can be used to assess and address issues of accessibility and systematic barriers to care.
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Affiliation(s)
- Laura B Whiteley
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Elizabeth M Olsen
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kayla K Haubrick
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Enyonam Odoom
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | | | - Larry K Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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15
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Lockhart E, Turner D, Ficek J, Livingston T, Logan RG, Marhefka SL. Understanding Technology Fit Among People with HIV Based on Intersections of Race, Sex, and Sexual Behavior: An Equitable Approach to Analyzing Differences Across Multiple Social Identities. AIDS Behav 2021; 25:2618-2629. [PMID: 33751311 PMCID: PMC7982513 DOI: 10.1007/s10461-021-03223-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
HIV disproportionately impacts individuals based on intersecting categories (e.g. gender, race/ethnicity, behavior), with groups most at-risk deemed priority populations. Using weighted effects coding to account for differential group sizes, this study used multilevel mixed logistic models to investigate differences in eHealth use and willingness to use eHealth for HIV-related information among priority populations. Compared to the sample average, Black men who had sex with women were less likely to use all technologies except cellphones with text-messaging and less likely to be willing to use computers and tablets. White and Hispanic men who had sex with men were more likely to use all technologies. No significant differences existed for use or willingness to use cellphones with text-messaging. Future research should consider approaches used here to account for equity and multiple intersecting social identities; practitioners may use these findings or similar local data to ensure fit between eHealth programs and priority populations.
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Affiliation(s)
- Elizabeth Lockhart
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | - DeAnne Turner
- Yale AIDS Prevention Training Program (Y-APT), Center for Interdisciplinary Research On AIDS (CIRA), Yale University, 135 College St. Suite 200, New Haven, CT, 06510, USA
| | - Joseph Ficek
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | - Taylor Livingston
- University of Nebraska-Lincoln, 816 Oldfather Hall, Lincoln, NE, 68588-0368, USA
| | | | - Stephanie L Marhefka
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL, 33612, USA.
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16
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Duthely LM, Sanchez-Covarrubias AP, Brown MR, Thomas TE, Montgomerie EK, Dale S, Safren SA, Potter JE. Pills, PrEP, and Pals: Adherence, Stigma, Resilience, Faith and the Need to Connect Among Minority Women With HIV/AIDS in a US HIV Epicenter. Front Public Health 2021; 9:667331. [PMID: 34235129 PMCID: PMC8255796 DOI: 10.3389/fpubh.2021.667331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Ending HIV/AIDS in the United States requires tailored interventions. This study is part of a larger investigation to design mCARES, a mobile technology-based, adherence intervention for ethnic minority women with HIV (MWH). Objective: To understand barriers and facilitators of care adherence (treatment and appointment) for ethnic MWH; examine the relationship between these factors across three ethnic groups; and, explore the role of mobile technologies in care adherence. Methods: Cross-sectional, mixed-methods data were collected from a cohort of African-American, Hispanic-American and Haitian-American participants. Qualitative data were collected through a focus group (n = 8) to assess barriers and facilitators to care adherence. Quantitative data (n = 48) surveyed women on depressive symptomology (PHQ-9), HIV-related stigma (HSS) and resiliency (CD-RISC25). We examined the relationships between these factors and adherence to treatment and care and across groups. Findings: Qualitative analyses revealed that barriers to treatment and appointment adherence were caregiver-related stressors (25%) and structural issues (25%); routinization (30%) and religion/spirituality (30%) promoted adherence to treatment and care. Caregiver role was both a hindrance (25%) and promoter (20%) of adherence to treatment and appointments. Quantitatively, HIV-related stigma differed by ethnic group; Haitian-Americans endorsed the highest levels while African-Americans endorsed the lowest. Depression correlated to stigma (R = 0.534; p < 0.001) and resiliency (R = −0.486; p < 0.001). Across ethnic groups, higher depressive symptomology and stigma were related to viral non-suppression (p < 0.05)—a treatment adherence marker; higher resiliency was related to viral suppression. Among Hispanic-Americans, viral non-suppression was related to depression (p < 0.05), and among African-Americans, viral suppression was related to increased resiliency (p < 0.04). Conclusion: Multiple interrelated barriers to adherence were identified. These findings on ethnic group-specific differences underscore the importance of implementing culturally-competent interventions. While privacy and confidentiality were of concern, participants suggested additional intervention features and endorsed the use of mCARES as a strategy to improve adherence to treatment and appointments.
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Affiliation(s)
- Lunthita M Duthely
- Obstetrics, Gynecology and Reproductive Sciences, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Alex P Sanchez-Covarrubias
- Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Megan R Brown
- Medical Education, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Tanya E Thomas
- Medical Education, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Emily K Montgomerie
- Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sannisha Dale
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - JoNell E Potter
- Obstetrics, Gynecology and Reproductive Sciences, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, United States
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17
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Muhindo R, Mujugira A, Castelnuovo B, Sewankambo NK, Parkes-Ratanshi R, Kiguli J, Tumwesigye NM, Nakku-Joloba E. Text message reminders and peer education increase HIV and Syphilis testing among female sex workers: a pilot quasi-experimental study in Uganda. BMC Health Serv Res 2021; 21:436. [PMID: 33962611 PMCID: PMC8103763 DOI: 10.1186/s12913-021-06461-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/29/2021] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Globally, female sex workers (FSW) are disproportionately affected by HIV and other sexually transmitted infections (STIs). However, uptake of STI and HIV testing services among FSW in sub-Saharan Africa remains low. We aimed to assess the effect of FSW-led peer education and text message reminders on 3-monthly syphilis and HIV testing among FSW in Uganda. METHODS Between September 2019 and February 2020, we implemented weekly peer education sessions and bi-monthly SMS reminders for FSW in Mbarara (intervention city). Peer education sessions were implemented by 20 FSW, who received five days of basic training as peer educators. We held monthly meetings with peer educators throughout the six-month implementation period. FSW in Mbale (control city) continued to receive standard of care consisting of HIV testing outreach campaigns, and facility-based testing. Using a quasi-experimental design in one intervention city, and one control city, we conducted pre- and post- questionnaire-based surveys on recent syphilis and HIV testing behavior among FSW in July-October 2018, and March 2020. We compared proportions and prevalence ratios at baseline and follow-up using chi-square tests and negative binomial regression. RESULTS We conducted 436 interviews (200 before/236 after) with FSW. At baseline similar proportions reported taking an HIV test (57 % vs. 54 %; p = 0.72), and a syphilis serology test (35 % vs. 39 %; p = 0.67) in the intervention and control cities, respectively, in the prior three months. After the intervention, this proportion increased to 82 % (95 % confidence interval [CI] 74.0-88.2) for HIV, and 81 % (95 % CI: 73.0-87.0) for syphilis in the intervention city. Relative to baseline in the control city, the proportion testing for HIV was unchanged (52 %) but decreased for syphilis (26 %). CONCLUSIONS Bi-monthly text message reminders with weekly peer education sessions increased uptake of 3-monthly syphilis and HIV testing in a Ugandan female sex work population and could help increase sex worker engagement in HIV/STI services in line with World Health Organization recommendations.
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Affiliation(s)
- Richard Muhindo
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Andrew Mujugira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson K Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rosalind Parkes-Ratanshi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Juliet Kiguli
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Edith Nakku-Joloba
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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18
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Opportunities to Harness Technology to Deliver HIV Prevention / Healthy Sexuality Programming to Sexual and Gender Minority Adults Living in East Africa. AIDS Behav 2021; 25:1120-1128. [PMID: 33123824 PMCID: PMC10184554 DOI: 10.1007/s10461-020-03059-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
Because of stigmatization of and discrimination against lesbian, gay, bisexual, transgender, and other sexual and gender minority (SGM) people in East Africa, there is paucity of SGM-focused sexual health research. Technology-based outreach efforts may represent a feasible way to reach and engage this population. They also may be a way to deliver important yet sensitive sexual health information in a stigma-free, anonymous atmosphere. We explored the feasibility of recruiting and surveying East African SGM adults online, and examined their interest in technology-based sexual health programming. Over a 14-month period, 2451 respondents were surveyed. They were, on average, 26.7 years of age. Fifty-four percent identified as lesbian, gay, and/or bisexual (LGB); a similar percentage (49%) reported having sex with a same-sex partner. Sixteen percent identified as gender minority (i.e. transgender or non-binary); and 29% were assigned female at birth. Almost half (48%) of SGM adults expressed interest in an SGM-focused healthy sexuality program delivered online. Enthusiasm also was noted for email (43%) and text messaging (41%). Compared to face-to-face settings, technology-based settings were more commonly appraised as the safest mode through which one could engage in sexual health programming. People who had a same sex partner and those who identified as sexual minority were especially likely to want to engage in technology-based programs. Interest in technology-based programming was similar for adults across gender identities, sex assigned at birth, and age however. Findings suggest that technology may be an underutilized opportunity to reach and engage SGM East Africans in a safe and private manner. Given levels of acceptability indicated by SGM adults across age, sex assigned at birth, and gender and sexual identities in this study, it seems possible that technology-based sexual health and HIV prevention and intervention programs could have the potential to be transformative in East Africa.
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19
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Beck EJ, Mandalia S, Yfantopoulos P, Jones CI, Bremner S, Whetham J, Etcheverry F, Moreno L, Gonzalez E, Merino MJ, Leon A, Garcia F. Efficiency of the EmERGE Pathway to provide continuity of care for Spanish people living with medically stable HIV. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(20)30422-5. [PMID: 33549335 DOI: 10.1016/j.eimc.2020.11.018] [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: 08/21/2020] [Revised: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Calculate the efficiency of the EmERGE Pathway of Care for medically stable people living with HIV at the Hospital Clínic-IDIBAPS, Barcelona, Spain. METHODS 546 study participants were followed between 1st July 2016 and 30th October 2019 across three HIV outpatient clinics, but the virtual clinic was closed during the second year. Unit costs were calculated, linked to mean use outpatient services per patient year, one-year before and after the implementation of EmERGE. Costs were combined with primary and secondary outcomes. RESULTS Annual costs across HIV-outpatient services increased by 8%: €1073 (95%CI €999-€1157) to €1158 (95%CI €1084-€1238). Annual cost of ARVs was €7,557; total annual costs increased by 1% from €8430 (95%CI €8356-8514) to €8515 (95%CI €8441-8595). Annual cost for 433 participants managed in face-to-face (F2F) clinics decreased by 5% from €958 (95%CI 905-1018) to €904 (95%CI 863-945); participants transferred from virtual to F2F outpatient clinics (V2F) increased their annual cost by a factor of 2.2, from €115 (95%CI 94-139) to €251 (95%CI 219-290). No substantive changes were observed in primary and secondary outcomes. CONCLUSION EmERGE Pathway is an efficient and acceptable intervention. Increases in costs were caused by internal structural changes. The cost reduction observed in F2F clinics were off-set by the transfer of participants from the virtual to the F2F clinics due to the closure of the virtual clinic during the second year of the Study. Greater efficiencies are likely to be achieved by extending the use of the Pathway to other PLHIV.
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Affiliation(s)
- E J Beck
- NPMS-HHC CIC, London, UK; Department of Health Services Research and Policy, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - C I Jones
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - S Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, UK
| | - J Whetham
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - F Etcheverry
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - L Moreno
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - E Gonzalez
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - M J Merino
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - A Leon
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
| | - F Garcia
- Fundació Clínic per a la Recerca Biomèdica, University of Barcelona, Barcelona, Spain
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20
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Berendes S, Gubijev A, McCarthy OL, Palmer MJ, Wilson E, Free C. Sexual health interventions delivered to participants by mobile technology: a systematic review and meta-analysis of randomised controlled trials. Sex Transm Infect 2021; 97:190-200. [PMID: 33452130 DOI: 10.1136/sextrans-2020-054853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The use of mobile technologies to prevent STIs is recognised as a promising approach worldwide; however, evidence has been inconclusive, and the field has developed rapidly. With about 1 million new STIs a day globally, up-to-date evidence is urgently needed. OBJECTIVE To assess the effectiveness of mobile health interventions delivered to participants for preventing STIs and promoting preventive behaviour. METHODS We searched seven databases and reference lists of 49 related reviews (January 1990-February 2020) and contacted experts in the field. We included randomised controlled trials of mobile interventions delivered to adolescents and adults to prevent sexual transmission of STIs. We conducted meta-analyses and assessed risk of bias and certainty of evidence following Cochrane guidance. RESULTS After double screening 6683 records, we included 22 trials into the systematic review and 20 into meta-analyses; 18 trials used text messages, 3 used smartphone applications and 1 used Facebook messages as delivery modes. The certainty of evidence regarding intervention effects on STI/HIV occurrence and adverse events was low or very low. There was moderate certainty of evidence that in the short/medium-term text messaging interventions had little or no effect on condom use (standardised mean differences (SMD) 0.02, 95% CI -0.09 to 0.14, nine trials), but increased STI/HIV testing (OR 1.83, 95% CI 1.41 to 2.36, seven trials), although not if the standard-of-care control already contained an active text messaging component (OR 1.00, 95% CI 0.68 to 1.47, two trials). Smartphone application messages also increased STI/HIV testing (risk ratio 1.40, 95% CI 1.22 to 1.60, subgroup analysis, two trials). The effects on other outcomes or of social media or blended interventions is uncertain due to low or very low certainty evidence. CONCLUSIONS Text messaging interventions probably increase STI/HIV testing but not condom use in the short/medium term. Ongoing trials will report the effects on biological and other outcomes.
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Affiliation(s)
- Sima Berendes
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anasztazia Gubijev
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ona L McCarthy
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa J Palmer
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma Wilson
- Population, Policy & Practice Department, Faculty of Population Health Sciences, University College London GOS Institute of Child Health, London, UK
| | - Caroline Free
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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21
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Duthely LM, Sanchez-Covarrubias AP. Digitized HIV/AIDS Treatment Adherence Interventions: A Review of Recent SMS/Texting Mobile Health Applications and Implications for Theory and Practice. FRONTIERS IN COMMUNICATION 2020; 5:530164. [PMID: 33644162 PMCID: PMC7909469 DOI: 10.3389/fcomm.2020.530164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Mobile health technologies (mHealth) are efficacious along the continuum of HIV/AIDS-from prevention of HIV transmission to those at the highest risk of acquiring infection, to adherence to HIV medical care, for those living with the disease-decreasing the public health burden of the disease. HIV/AIDS is a complex condition, as certain population subgroups are disproportionately affected. Furthermore, barriers experienced at the individual level (e.g., HIV stigma) and at the systems level (i.e., access to care) contribute to these disparities. Low cost, high penetration rates and ease of use mean mHealth SMS/texting solutions hold the biggest promise for curbing the global HIV/AIDS epidemic; yet these technologies have their own challenges. Our primary objective was to assess interventions that promote adherence, which are delivered via SMS/texting, and important design and ethical considerations of these technologies. Specifically, we evaluated the underlying frameworks underpinning intervention design, strategies to safeguard privacy and confidentiality, and measures taken to ensure equity and equitable access across different subgroups of persons living with HIV (PLWH). We also synthesized study outcomes, barriers/facilitators to adherence, and barriers/facilitators of technology to support HIV adherence. METHODS A scoping review methodology was utilized, searching the Medline database for recently published articles (January 2017 to June 2019). Two reviewers independently screened titles and abstracts for relevancy using the following eligibility criteria: (a) original research or protocol; (b) inclusion of persons living with HIV; (c) intervention delivery via SMS/text messaging; and, (d) intervention included HIV care adherence. RESULTS Seven (7) of the 134 articles met full criteria. The great majority (n = 6) did not report whether the interventions were developed under established behavioral change models or frameworks. Strategies to address privacy, confidentiality and equity/equitable access were taken in four (n = 4) studies. CONCLUSION Our mixed methods review determined that privacy and confidentiality remain a concern for PLWH. Provisions to accommodate literacy, infrastructure, technology and other challenges (e.g., access to smartphones and Wifi) are important ethical considerations that guarantee equity and equitable access. Further investigation will determine the contexts within which theoretical models and frameworks remain relevant in the rapidly evolving field of digitized interventions that support adherence.
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Affiliation(s)
- Lunthita M. Duthely
- Obstetrics, Gynecology and Reproductive Sciences, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, United States
- Correspondence: Lunthita M. Duthely,
| | - Alex P. Sanchez-Covarrubias
- Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, United States
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22
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Utility of Short Message Service (SMS) for Remote Data Collection for HIV in Low- and Middle-Income Countries. Curr HIV/AIDS Rep 2020; 17:654-662. [PMID: 33010003 PMCID: PMC7532340 DOI: 10.1007/s11904-020-00534-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Short message system (SMS) communication is widespread in low- and middle-income countries (LMICs), and may be a viable approach to address challenges with in-person data collection for HIV-related research and monitoring and evaluation. We reviewed the literature to characterize potential benefits and challenges with using SMS for remote data capture, including examples from HIV and sexual and reproductive health. RECENT FINDINGS In our review, we found that studies that have used SMS to capture sensitive, self-reported data found this was an acceptable and feasible strategy, and may reduce social desirability bias of self-reported data; but studies are limited. Shared phones and privacy concerns have been described as challenges, but can be addressed with enhanced security features. Response rates to SMS surveys varied significantly by topic, population, and setting. SMS may improve generalizability and precision of health and behavior data for HIV in research and programs, but use in LMICs is limited. SMS systems should be carefully designed to overcome potential implementation hurdles.
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23
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McMahan VM, Frank N, Buckler S, Violette LR, Baeten JM, Banta-Green CJ, Barnabas RV, Simoni J, Stekler JD. Protocol Development for HMU! (HIV Prevention for Methamphetamine Users), a Study of Peer Navigation and Text Messaging to Promote Pre-Exposure Prophylaxis Adherence and Persistence Among People Who Use Methamphetamine: Qualitative Focus Group and Interview Study. JMIR Form Res 2020; 4:e18118. [PMID: 32924952 PMCID: PMC7522731 DOI: 10.2196/18118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/24/2020] [Accepted: 07/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cisgender men who have sex with men (MSM) and transgender people (TGP) who use methamphetamine are disproportionately impacted by HIV acquisition. Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV, and interventions that support PrEP persistence and adherence should be evaluated among MSM and TGP who use methamphetamine. OBJECTIVE We conducted formative work to inform the development of text messaging and peer navigation interventions to support PrEP persistence and adherence among MSM and TGP who use methamphetamine. In this paper, we describe how the findings from these focus groups and interviews were used to refine the study interventions and protocol for the Hit Me Up! study (HMU!; HIV Prevention in Methamphetamine Users). METHODS Between October 2017 and March 2018, we conducted two focus groups and three in-depth interviews with MSM and TGP who use methamphetamine or who have worked with people who use methamphetamine. During these formative activities, we asked participants about their opinions on the proposed interventions, education and recruitment materials, and study design. We focused on how we could develop peer navigation and text messaging interventions that would be culturally appropriate and acceptable to MSM and TGP who use methamphetamine. Transcripts were reviewed by two authors who performed a retrospective content analysis to describe which specific opinions and recommendations influenced protocol development and the refinement of the interventions. RESULTS Overall, participants thought that MSM and TGP would be interested in participating in the study, although they expected recruitment and retention to be challenging. Participants thought that the peer navigator should be someone who is nonjudgmental, has experience with people who use methamphetamine, and is patient and flexible. There was consensus that three text messages per day were appropriate, adherence reminders should be straightforward, all messages should be nonjudgmental, and participants should be able to tailor the timing and content of the text messages. These suggestions were incorporated into the study interventions via the hiring and training process and into the development of the text library, platform selection, and customizability of messages. CONCLUSIONS It is important to include the opinions and insights of populations most impacted by HIV to develop PrEP interventions with the greatest chance of success. Our formative work generated several recommendations that were incorporated into the interventions and protocol development for our ongoing study. TRIAL REGISTRATION ClinicalTrials.gov NCT03584282; https://clinicaltrials.gov/ct2/show/NCT03584282.
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Affiliation(s)
- Vanessa M McMahan
- San Francisco Department of Public Health, Center on Substance Use and Health, San Francisco, CA, United States.,Department of Health Services, University of Washington, Seattle, WA, United States
| | - Noah Frank
- San Francisco Department of Public Health, Center on Substance Use and Health, San Francisco, CA, United States
| | - Smitty Buckler
- San Francisco Department of Public Health, Center on Substance Use and Health, San Francisco, CA, United States
| | - Lauren R Violette
- San Francisco Department of Public Health, Center on Substance Use and Health, San Francisco, CA, United States
| | - Jared M Baeten
- San Francisco Department of Public Health, Center on Substance Use and Health, San Francisco, CA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Caleb J Banta-Green
- Department of Health Services, University of Washington, Seattle, WA, United States.,Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA, United States
| | - Ruanne V Barnabas
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Joanne D Stekler
- San Francisco Department of Public Health, Center on Substance Use and Health, San Francisco, CA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Epidemiology, University of Washington, Seattle, WA, United States
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24
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Smith C, van Velthoven MH. Best practices in digital health to improve antiretroviral treatment adherence. BMJ Health Care Inform 2020; 27:e100215. [PMID: 32907827 PMCID: PMC7481084 DOI: 10.1136/bmjhci-2020-100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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25
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Iterative Development of In This toGether, the First mHealth HIV Prevention Program for Older Adolescents in Uganda. AIDS Behav 2020; 24:2355-2368. [PMID: 32072385 DOI: 10.1007/s10461-020-02795-4] [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: 10/25/2022]
Abstract
In Uganda, HIV prevention programming for older adolescents is noticeably lacking, even though HIV incidence rates increase dramatically from adolescence into young adulthood. Here we describe the development of In This toGether (ITG), the first-of-its-kind, comprehensive text messaging-based HIV prevention program for both sexually active and abstinent 18- to 22-year-old Ugandans. Five iterative development activities are described: (1) conducting focus groups (FGs) to better understand the sexual decision-making of older adolescents across Uganda and to gain 'voice' of older adolescents; (2) the drafting of intervention content based on FG data; (3) testing of the drafted content with two Content Advisory Teams (CATs) that reviewed and provided feedback on the messages; (4) alpha-testing the program among the research team; and (5) beta-testing the intervention and protocol with people in the target population. Participants were recruitment nationally via Facebook and Instagram, and enrolled over the telephone by research staff. Results suggest that men were easier to reach and engage across all intervention development steps. As such, specific efforts to enroll women were made to ensure that feedback from both sexes was taken into account. FG participants said they were interested in learning more about sexual positions, how to prepare for sex, the consequences of unprotected sex, benefits of protected sex, masturbation, and how to be a good sexual partner. In both the FGs (n = 202) and CATs (n = 143) however, some noted that masturbation, oral sex, and anal sex were particularly sensitive topics. These messages were rewritten to address the cultural sensitivity. Feedback from beta test participants (n = 34) suggested that text messaging-based HIV prevention programming that is intense (e.g., 5-11 messages per day) and extends for two months, is both feasible and acceptable. In conclusion, the engagement of older adolescents at each step of the iterative intervention development process increased the likelihood that the final product would resonate with 18- to 22-year-old Ugandan youth across the country. Furthermore, social media appears to be a feasible method for recruiting national samples of Ugandan older adolescents into HIV-focused research.
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26
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Badawy SM, Radovic A. Digital Approaches to Remote Pediatric Health Care Delivery During the COVID-19 Pandemic: Existing Evidence and a Call for Further Research. JMIR Pediatr Parent 2020; 3:e20049. [PMID: 32540841 PMCID: PMC7318926 DOI: 10.2196/20049] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/15/2022] Open
Abstract
The global spread of the coronavirus disease (COVID-19) outbreak poses a public health threat and has affected people worldwide in various unprecedented ways, both personally and professionally. There is no question that the current global COVID-19 crisis, now more than ever, is underscoring the importance of leveraging digital approaches to optimize pediatric health care delivery in the era of this pandemic. In this perspective piece, we highlight some of the available digital approaches that have been and can continue to be used to streamline remote pediatric patient care in the era of the COVID-19 pandemic, including but not limited to telemedicine. JMIR Pediatrics and Parenting is currently publishing a COVID-19 special theme issue in which investigators can share their interim and final research data related to digital approaches to remote pediatric health care delivery in different settings. The COVID-19 pandemic has rapidly transformed health care systems worldwide, with significant variations and innovations in adaptation. There has been rapid expansion of the leveraging and optimization of digital approaches to health care delivery, particularly integrated telemedicine and virtual health. Digital approaches have played and will play major roles as invaluable and reliable resources to overcome restrictions and challenges imposed during the COVID-19 pandemic and to increase access to effective, accessible, and consumer-friendly care for more patients and families. However, a number of challenges remain to be addressed, and further research is needed. Optimizing digital approaches to health care delivery and integrating them into the public health response will be an ongoing process during the current COVID-19 outbreak and during other possible future pandemics. Regulatory changes are essential to support the safe and wide adoption of these approaches. Involving all relevant stakeholders in addressing current and future challenges as well as logistical, technological, and financial barriers will be key for success. Future studies should consider evaluating the following research areas related to telemedicine and other digital approaches: cost-effectiveness and return on investment; impact on quality of care; balance in use and number of visits needed for the management of both acute illness and chronic health conditions; system readiness for further adoption in other settings, such as inpatient services, subspecialist consultations, and rural areas; ongoing user-centered evaluations, with feedback from patients, families, and health care providers; strategies to optimize health equity and address disparities in access to care related to race and ethnicity, socioeconomic status, immigration status, and rural communities; privacy and security concerns for protected health information with Health Insurance Portability and Accountability Act (HIPAA)-secured programs; confidentiality issues for some specific populations, especially adolescents and those in need of mental health services; early detection of exposure to violence and child neglect; and integration of training into undergraduate and graduate medical education and subspecialty fellowships. Addressing these research areas is essential to understanding the benefits, sustainability, safety, and optimization strategies of telemedicine and other digital approaches as key parts of modern health care delivery. These efforts will inform long-term adoption of these approaches with expanded dissemination and implementation efforts.
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Affiliation(s)
- Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ana Radovic
- Department of Pediatrics, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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27
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Adebayo OW, Williams JR, Garcia A. "The right place and the right time": A qualitative study of the decision-making process of self-initiated HIV testing among young adults. Res Nurs Health 2020; 43:186-194. [PMID: 32048749 DOI: 10.1002/nur.22015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/25/2020] [Indexed: 11/08/2022]
Abstract
Young adults continue to have very low rates of human immunodeficiency virus (HIV) testing, which contribute to transmission, late diagnoses, and poor health outcomes. The access and uptake of HIV testing among young adults can be improved by promoting self-initiated testing (i.e., testing without the immediate recommendation of a clinician). Little is known, however, about how young adults self-initiate HIV testing. The purpose of this study was to explore the decision-making process of young adults who self-initiated HIV testing. A qualitative descriptive study was conducted with 30 young adults aged 18-24 years. The findings from this study describe how young adults acknowledge their vulnerability to HIV infection and navigate the process of deciding to self-initiate testing. Some subcategories include Self-Convincing, Conversation Prompts, and The Right Place and Right Time. Findings from this study are pivotal for subsequent studies to further understand self-initiated HIV testing among young adults and design targeted interventions that will improve testing uptake.
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Affiliation(s)
| | - Jessica R Williams
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina
| | - Ana Garcia
- University of Miami, Miller School of Medicine, Miami, Florida
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28
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Demena BA, Artavia-Mora L, Ouedraogo D, Thiombiano BA, Wagner N. A Systematic Review of Mobile Phone Interventions (SMS/IVR/Calls) to Improve Adherence and Retention to Antiretroviral Treatment in Low-and Middle-Income Countries. AIDS Patient Care STDS 2020; 34:59-71. [PMID: 32049555 DOI: 10.1089/apc.2019.0181] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The use of mobile health technologies (mHealth) to ameliorate HIV care has considerably risen in low- and middle-income countries (LMICs) since 2010. Yet, the discrepancies in the results of accompanying studies warrant an updated and systematic consolidation of all available evidence. We report a systematic review of studies testing whether text/image messages, interactive voice response reminders, or calls promote adherence and retention to antiretroviral therapy (ART) in LMICs. We systematically compiled studies published in English until June 2018 from PubMed/Medline, Web of Science, WHO database, ProQuest Dissertations and Theses, and manual search. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 and used frequency analysis to assess reported findings. In total, we compiled 35 published articles: 27 completed studies and 8 protocols. Among the main 27 studies, 17 examine adherence, 5 retention, and 5 both measures. Results indicate that 56% report positive and statistically significantly impacts of mHealth on primary outcomes, the remaining 44% report insignificant results. While 41% of studies found a positive and significant effect for adherence, only 12% improved retention. The evidence shows ambiguous results (with high variability) about the effectiveness of mobile phone-assisted mHealth interventions to boost adherence and retention to ART. The literature also points to short follow-up periods, small samples, and limited geographical coverage. Hence, future research should focus on evaluating longer interventions with more patients spread across wider areas to address whether mHealth can be effectively used in LMICs.
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Affiliation(s)
- Binyam Afewerk Demena
- Institute of Social Studies, Erasmus University Rotterdam, The Hague, The Netherlands
| | - Luis Artavia-Mora
- Institute of Social Studies, Erasmus University Rotterdam, The Hague, The Netherlands
| | - Dénis Ouedraogo
- Institut du Développement Rural, Université Nazi Boni (Former Université Polytechnique de Bobo-Dioulasso), Bobo-Dioulasso, Burkina Faso
| | - Boundia Alexandre Thiombiano
- Institut du Développement Rural, Université Nazi Boni (Former Université Polytechnique de Bobo-Dioulasso), Bobo-Dioulasso, Burkina Faso
| | - Natascha Wagner
- Institute of Social Studies, Erasmus University Rotterdam, The Hague, The Netherlands
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29
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Evans W, Harrington C, Patchen L, Andrews V, Gaminian A, Ellis L, Napolitano M. Design of a novel digital intervention to promote healthy weight management among postpartum African American women. Contemp Clin Trials Commun 2019; 16:100460. [PMID: 31650078 PMCID: PMC6804615 DOI: 10.1016/j.conctc.2019.100460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/21/2019] [Accepted: 09/28/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Excess weight retention among postpartum women is a risk factor for long term obesity, and African American women are at heightened risk. New solutions, including digital technologies and community-based approaches are needed. Digital platforms, like social media, provide opportunity for participant co-creation (i.e., content co-generated by users and investigators) of health messages and may allow for adaptation of evidence-based weight management interventions to reduce participant burden. The BeFAB intervention, a branded, digital weight management program, tests this hypothesis. METHODS BeFAB content comprises culturally-specific nutrition, physical activity, stress management, health information seeking and related weight management messages and content designed for African American women. The intervention is 12 weeks in duration, delivered through a mobile phone app, and is designed to target specific behavioral predictor beliefs and attitudinal measures (e.g., self-efficacy to achieve weight management goals) based on the culturally-specific content. Use of personal, culturally-specific video-based narratives in the app, and through a secret Facebook group, are included to help model HEAL behaviors and brand BeFAB. Intervention development consisted of iterative formative research steps to engage African American women. The program will be evaluated in a small randomized trial among patients recruited at a clinical facility. CONCLUSIONS BeFAB applies evidence-based content using a promising digital approach. It is novel in its use of branding, culturally-tailored content, and digital technology for behavior change.Evaluation of BeFAB will contribute to the growing literature on digital health behavior change interventions for weight management.
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Affiliation(s)
- W.D. Evans
- The George Washington University, United States
| | | | - L. Patchen
- Medstar Health Research Institute, United States
| | - V. Andrews
- The George Washington University, United States
| | - A. Gaminian
- The George Washington University, United States
| | - L.P. Ellis
- Medstar Health Research Institute, United States
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