Adherence Connection for Counseling, Education, and Support: Research Protocol for a Proof-of-Concept Study

The development of social capital in a peer-led mHealth cognitive behavioral antiretroviral therapy adherence intervention for HIV + adolescents and young adults

Adherence Connection for Counseling, Education, and Support (ACCESS)-I is a peer-led mHealth antiretroviral therapy adherence intervention for adolescents and young adults living with HIV who are in treatment but have detectable viral loads. Participants received five online sessions with peer health coaches who followed a structured intervention manual. Peers maintained intervention fidelity but also engaged in casual discussion that was not directly related to ART adherence or HIV. We conducted a qualitative analysis of the casual interactions that occurred during the ACCESS I intervention. Sessions were transcribed and coded, and these casual interactions were then coded into 10 subcodes to document their content, and also coded for three types of social capital - emotional, informational, and instrumental. Emotional and Informational social capital codes were the most common, while instrumental codes were rare. Activities was the most common topic overall, while encouragement was more common in emotional social capital narratives and personal experience was more common in informational social capital narratives. These casual interactions may strengthen peer-participant relationships, building social capital that could then be used to encourage positive behavior change. Although social capital was not directly measured, these analyses illustrate the value of attending to seemingly casual interactions in peer-led interventions.

Trends in U.S. HIV Peer Health Worker Training Strategies and Approaches: A Scoping Review of the Literature

ABSTRACT

Peer health workers (peers) are commonly engaged interventionists in the HIV care spectrum. The objective of this scoping review was to examine the range of evidence on training strategies and approaches for peer-led HIV behavioral interventions in the United States. Four electronic databases (Medline, CINAHL, EMBASE, and PsycINFO) were searched for peer-reviewed published literature (2010-2021) of peer-led HIV behavioral interventions directed to improving antiretroviral therapy adherence and/or retention in care. Eighteen studies met the inclusion criteria. Eleven studies referenced manualized training materials, and nine used role-play as part of their curricula. Peer training content and duration varied across studies, as well as evaluation of intervention fidelity, and peer competency. Findings highlight heterogeneity in peer training strategies and approaches. The expansion and sustainability of peer engagement in the HIV care continuum will require greater consensus among members of the research community on best practices for training.

Feasibility and Acceptability of the Adherence Connection Counseling, Education, and Support (ACCESS) Proof of Concept: A Peer-Led, Mobile Health (mHealth) Cognitive Behavioral Antiretroviral Therapy (ART) Adherence Intervention for HIV-Infected (HIV+) Adolescents and Young Adults (AYA)

Effective antiretroviral therapy (ART) adherence strategies for HIV+ adolescents and young adults (AYA) are needed to prevent HIV-related morbidity, mortality, and onward transmission. In the Adherence Connection for Counseling, Education, and Support (ACCESS) pilot, an exploratory sequential mixed-methods design was used to develop and test a peer-led, mobile health (mHealth) cognitive behavioral ART adherence intervention. HIV+ AYA (ages 16-29 years) with unsuppressed plasma HIV RNA (HIV viral load) were eligible for this five-session intervention directed to improving ART adherence and HIV viral load. A total of 78 peer-led remote videoconferencing sessions (via WebEx) were delivered to 16 participants. High completion rates (97.5%) and client satisfaction scores (mean = 29.13 of 32; SD = 2.45) were observed. Self-reported ART adherence improved (32% increase in doses taken; 95th CI 11.2-53.3) with an annualized average rate of 47.5% (0.28 log10) reduction in HIV viral load. We established proof of concept for the ACCESS peer-led, mHealth cognitive behavioral ART adherence intervention, with promising adherence and virologic outcome data.

Internet-based peer support interventions for people living with HIV: A scoping review

Peer support interventions for people living with HIV and AIDS (PLWHA) are effective, but their associated time and material costs for the recipient and the health system make them reachable for only a small proportion of PLWHA. Internet-based interventions are an effective alternative for delivering psychosocial interventions for PLWHA as they are more accessible. Currently, no reviews are focusing on internet-based interventions with peer support components. This scoping review aims to map the existing literature on psychosocial interventions for PLWHA based on peer support and delivered through the internet. We conducted a systematic scoping review of academic literature following methodological guidelines for scoping reviews, and 28 articles met our criteria. We summarized the main characteristics of the digital peer support interventions for PLWHA and how they implemented peer support in a virtual environment. Overall the reported outcomes appeared promising, but more robust evidence is needed.

Analysis of Continuous Nursing Intervention on Aplastic Anemia Patients Based on the "Information-Motivation-Behavioral Skills Model"

Objective

To explore the effect of continuous nursing care based on the “information-motivation-behavioral skills model” (IMB) in the intervention of patients with aplastic anemia.

Methods

A total of 90 patients with aplastic anemia who were admitted to our hospital from June 2019 to January 2021 were included in the study. The patients were divided into an observation group and a control group according to the random number table, with 45 patients in each group. The control group received routine nursing care, while the observation group received continuous nursing care based on IMB on the basis of the control group. Patients were followed up for 3 months, and their health knowledge was assessed with our self-made health knowledge rating scale. Patients' medication compliance was assessed using the Morisky medication compliance questionnaire. The self-care ability was assessed with the self-made self-care ability scale in our hospital. The comprehensive quality of life assessment questionnaire (GQOLI-74) was used to assess the quality of life of patients. A self-prepared nursing satisfaction questionnaire was used to score patients' nursing satisfaction. The total effective rate of nursing was evaluated.

Results

The awareness scores of basic disease knowledge, medication knowledge, and daily self-care knowledge in the observation group were higher than those in the control group (P < 0.05). The scores of medication compliance in the observation group were higher than those in the control group (P < 0.05). The self-care abilities such as healthy diet, psychological adjustment, self-care skills, oral care, and perianal care in the observation group were higher than those in the control group (P < 0.05). The quality of life scores of patients in the two groups in the 3 months of nursing were higher than those when they were discharged from hospital (P < 0.05). The GQOLI-74 score of 3 months' nursing care in the observation group was higher than that in the control group (P < 0.05). The nursing satisfaction degree of the observation group (97.78%) was higher than that of the control group (82.23%) (P < 0.05). The total effective rate of nursing care in the observation group (97.78%) was higher than that in the control group (77.78%) (P < 0.05).

Conclusion

IMB-based continuous nursing care can significantly increase the awareness of health knowledge in patients with aplastic anemia, effectively improve medication compliance, significantly enhance self-care ability, and thus, improve the quality of life.

Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus

BACKGROUND

Maintaining adherence to antiretroviral therapy (ART) is a significant challenge for human immunodeficiency virus (HIV)-infected racial and ethnic minority adolescents and young adults (youth). Given the consequences of suboptimal ART adherence, there is a pressing need for an expanded understanding of adherence behavior in this cohort.

OBJECTIVES

As part of an exploratory sequential, mixed-methods study, we used qualitative inquiry to explore adherence information, motivation, and behavioral skills among HIV-infected racial and ethnic minority youth. Our secondary aim was to gain an understanding of the contextual factors surrounding adherence behavior.

METHODS

The information-motivation-behavioral skills model (IMB model) was applied to identify the conceptual determinants of adherence behavior in our target population, along with attention to emergent themes. In-depth, individual, semistructured interviews, including open-ended questions with probes, were conducted with a convenience sample of HIV-infected racial and ethnic minority youth (ages 16-29 years), receiving ART and with evidence of virologic failure (i.e., detectable HIV viral load). New participants were interviewed until information redundancy was reached. Qualitative interviews were digitally recorded, transcribed verbatim, and analyzed using Atlas.ti (v8). Directed content analysis was performed to generate categories and broad themes. Coding was initially conceptually driven (IMB model) and shifted to a data-driven approach, allowing for the discovery of key contextual factors that influence adherence behavior in this population. Methodological rigor was ensured by member checks, an audit trail, thick descriptive data, and triangulation of data sources.

RESULTS

Twenty racial and ethnic minority participants (mean age = 24.3 years, 55.0% male) completed interviews. We found adherence information was understood in relation to HIV biomarkers; adherence motivation and behavioral skills were influenced by stigma and social context. We identified five primary themes regarding ART self-management: (a) emerging adulthood with a chronic illness, (b) stigma and disclosure concerns, (c) support systems and support deficits, (d) mental and behavioral health risks and challenges, and (e) mode of HIV transmission and perceptions of power and control.

DISCUSSION

Key constructs of the IMB model were applicable to participating HIV-infected youth yet did not fully explain the essence of adherence behavior. As such, we recommend expansion of current adherence models and frameworks to include known contextual factors associated with ART self-management among HIV-infected racial and ethnic minority youth.