A Multi-Site Study of Social Cognitive Factors Related to Adherence Among Youth Living With HIV in the New Era of Antiretroviral Medication

Background In the United States, adolescents and young adults are disproportionately affected by HIV and have poorer HIV-related health outcomes than adults. Health care transition (HCT) from pediatric or adolescent to adult-oriented HIV care is associated with disruptions to youths’ care retention, medication adherence, and viral suppression. However, no evidence-based interventions exist to improve HCT outcomes for youth living with HIV. Objective There are 2 phases of this project. Phase 1 involves the iterative development and usability testing of a Social Cognitive Theory–based mobile health (mHealth) HIV HCT intervention (iTransition). In phase 2, we will conduct a pilot implementation trial to assess iTransition’s feasibility and acceptability and to establish preliminary efficacy among youth and provider participants. Methods The iterative phase 1 development process will involve in-person and virtual meetings and a design team comprising youth living with HIV and health care providers. The design team will both inform the content and provide feedback on the look, feel, and process of the iTransition intervention. In phase 2, we will recruit 100 transition-eligible youth across two clinical sites in Atlanta, Georgia, and Philadelphia, Pennsylvania, to participate in the historical control group (n=50; data collection only) or the intervention group (n=50) in a pilot implementation trial. We will also recruit 28 provider participants across the pediatric or adolescent and adult clinics at the two sites. Data collection will include electronic medical chart abstraction for clinical outcomes as well as surveys and interviews related to demographic and behavioral characteristics; Social Cognitive Theory constructs; and intervention feasibility, acceptability, and use. Analyses will compare historical control and intervention groups in terms of HCT outcomes, including adult care linkage (primary), care retention, and viral suppression (secondary). Interview data will be analyzed using content analysis to understand the experience with use and acceptability. Results Phase 1 (development) of iTransition research activities began in November 2019 and is ongoing. The data collection for the phase 2 pilot implementation trial is expected to be completed in January 2023. Final results are anticipated in summer 2023. Conclusions The development and pilot implementation trial of the iTransition intervention will fill an important gap in understanding the role of mHealth interventions to support HCT outcomes for youth living with HIV. International Registered Report Identifier (IRRID) DERR1-10.2196/24565

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Qualitative Comparison of Barriers to Antiretroviral Medication Adherence Among Perinatally and Behaviorally HIV-Infected Youth

Qualitative Health Research ◽

10.1177/1049732317697674 ◽

2017 ◽

Vol 27 (8) ◽

pp. 1177-1189 ◽

Cited By ~ 19

Author(s):

Errol L. Fields ◽

Laura M. Bogart ◽

Idia B. Thurston ◽

Caroline H. Hu ◽

Margie R. Skeer ◽

...

Keyword(s):

Medication Adherence ◽

Comparative Method ◽

Qualitative Comparison ◽

Antiretroviral Medication ◽

Antiretroviral Medication Adherence ◽

Constant Comparative Method ◽

Perinatally Infected ◽

Youth Living With Hiv ◽

Living With Hiv ◽

Common Barriers

Medication adherence among youth living with HIV (28%–69%) is often insufficient for viral suppression. The psychosocial context of adherence barriers is complex. We sought to qualitatively understand adherence barriers among behaviorally infected and perinatally infected youth and develop an intervention specific to their needs. We conducted in-depth interviews with 30 youth living with HIV (aged 14–24 years) and analyzed transcripts using the constant comparative method. Barriers were influenced by clinical and psychosocial factors. Perinatally infected youth barriers included reactance, complicated regimens, HIV fatigue, and difficulty transitioning to autonomous care. Behaviorally infected youth barriers included HIV-related shame and difficulty initiating medication. Both groups reported low risk perception, medication as a reminder of HIV, and nondisclosure, but described different contexts to these common barriers. Common and unique barriers emerged for behaviorally infected and perinatally infected youth reflecting varying HIV experiences and psychosocial contexts. We developed a customizable intervention addressing identified barriers and their psychosocial antecedents.

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Cognitive factors in an organization-A new era in emergence

PsycEXTRA Dataset ◽

10.1037/e520782009-001 ◽

1969 ◽

Author(s):

Kersey Antia

Keyword(s):

Cognitive Factors ◽

New Era

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Faculty Opinions recommendation of Health care transition for youth living with HIV/AIDS.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13357047.14726338 ◽

2011 ◽

Author(s):

Lynne Mofenson

Keyword(s):

Health Care ◽

Care Transition ◽

Health Care Transition ◽

Youth Living With Hiv ◽

Living With Hiv ◽

Hiv Aids

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Adolescent Trials Network for HIV-AIDS Scale It Up Program: Protocol for a Rational and Overview (Preprint)

10.2196/preprints.11204 ◽

2018 ◽

Author(s):

Sylvie Naar ◽

Jeffrey T Parsons ◽

Bonita F Stanton

Keyword(s):

Implementation Science ◽

Large Body ◽

Hiv Infections ◽

Self Management ◽

Management Interventions ◽

Hiv Research ◽

The Individual ◽

Youth Living With Hiv ◽

Living With Hiv ◽

Hiv Aids

BACKGROUND The past 30 years have witnessed such significant progress in the prevention and treatment of HIV/AIDS that an AIDS-free generation and the end to the global AIDS epidemic are ambitious, but achievable, national and global goals. Despite growing optimism, globally, youth living with HIV are markedly less likely to receive antiretroviral therapy than adults (23% vs 38%). Furthermore, marked health disparities exist regarding HIV infection risk, with young men of color who have sex with men disproportionately affected. A large body of research has identified highly impactful facilitators of and barriers to behavior change. Several efficacious interventions have been created that decrease the rate of new HIV infections among youth and reduce morbidity among youth living with HIV. However, full benefits that should be possible based on the tools and interventions currently available are yet to be realized in youth, in large part, because efficacious interventions have not been implemented in real-world settings. Scale It Up (SIU) primarily aims to assemble research teams that will ultimately bring to practice evidence-based interventions that positively impact the youth HIV prevention and care cascades, and in turn, advance the fields of implementation science and self-management science. OBJECTIVE This paper aims to describe the structure of the U19-SIU and the effectiveness-implementation hybrid trials, as well as other center-wide protocols and initiatives, implemented within SIU. METHODS SIU will achieve its aims through 4 individual primary protocols, 2 center-wide protocols, and 3 cross-project initiatives. RESULTS SIU was funded by National Institute for Child Health and Human Development (U19HD089875) and began in October 2016. As of November 2018, 6 SIU protocols have launched at least the first phase of work (ATN 144 SMART: Sequential Multiple Assignment Randomized Trial; ATN 145 YMHP: Young Men’s Health Project; ATN 146 TMI: Tailored Motivational Interviewing Intervention; ATN 153 EPIS: Exploration, Preparation, Implementation, Sustainment model; ATN 154 CM: Cascade Monitoring; ATN 156 We Test: Couples' Communication and HIV Testing). Further details can be found in the individual protocol papers. CONCLUSIONS To date, the youth HIV research portfolio has not adequately advanced the important care area of self-management. SIU protocols and initiatives address this broad issue by focusing on evaluating the effectiveness and implementation of self-management interventions. SIU is highly innovative for 5 primary reasons: (1) our research framework expands the application of “self-management”; (2) the 4 primary protocols utilize innovative hybrid designs; (3) our Analytic Core will conduct cost-effectiveness analyses of each intervention; (4) across all 4 primary protocols, our Implementation Science Core will apply implementation scales designed to assess inner and outer context factors; and (5) we shall advance understanding of the dynamics between provider and patient through analysis of recorded interactions. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11204

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Care and support for youth living with HIV/AIDS in secondary schools: perspectives of school stakeholders in western Uganda

BMC Public Health ◽

10.1186/s12889-020-10143-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Emmanuel Kimera ◽

Sofie Vindevogel ◽

Didier Reynaert ◽

Anne-Mie Engelen ◽

Kintu Mugenyi Justice ◽

...

Keyword(s):

Secondary Schools ◽

Qualitative Inquiry ◽

Resource Limited ◽

Care And Support ◽

Gradual Process ◽

Youth Living With Hiv ◽

Living With Hiv ◽

Western Uganda ◽

Hiv Aids ◽

School Stakeholders

Abstract Background Although schools have been identified as significant settings in the response to the HIV/AIDS pandemic, limited research is available on how they can accommodate Youth Living with HIV/AIDS (YLWHA), especially in resource limited countries. In this study, we explored strategies by school stakeholders (school staff, parents/caretakers, and students) in western Uganda to care for and support YLWHA in their schools. Methods The article utilizes data collected between May and October, 2019 from a qualitative inquiry based on focus group discussions and interviews with 88 school stakeholders purposively selected from 3 secondary schools in western Uganda. Textual data was analyzed thematically involving both inductive and deductive coding. Results We identified 7 overarching interrelated themes in which participants reported strategies to care for and support YLWHA: counselling and guidance; social support networks and linkages; knowledge and skills; anti-stigma and anti-discrimination measures; disclosure of HIV status; treatment and management of HIV/AIDS; and affirmative actions for YLWHA. Stakeholders’ strategies often differed regarding what was considered appropriate, the approach and who to take lead in supporting YLWHA. Conclusions Despite the limited care and support strategies specific for YLWHA currently available in schools, our study points to optimism and high potential given stakeholders’ identified avenues for improvement. We posit that promoting HIV/AIDS-care and support in schools is a gradual process requiring each school to develop a strong knowledge base about HIV/AIDS and support needs of YLWHA, develop a coherent and school-wide approach, and collaborate extensively with external stakeholders who are significant in supporting YLWHA.

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To sext or not to sext. The role of social-cognitive processes in the decision to engage in sexting

Journal of Social and Personal Relationships ◽

10.1177/0265407521995884 ◽

2021 ◽

Vol 38 (4) ◽

pp. 1410-1429

Author(s):

Claire Wilson ◽

Tommy van Steen ◽

Christabel Akinyode ◽

Zara P. Brodie ◽

Graham G. Scott

Keyword(s):

Cognitive Processes ◽

Self Efficacy ◽

Social Cognitive ◽

Cognitive Factors ◽

Relationship Status ◽

Injunctive Norm ◽

The Social ◽

And Behavior ◽

Insight Into

Technology has given rise to online behaviors such as sexting. It is important that we examine predictors of such behavior in order to understand who is more likely to sext and thus inform intervention aimed at sexting awareness. We used the Theory of Planned Behavior (TPB) to examine sexting beliefs and behavior. Participants (n = 418; 70.3% women) completed questionnaires assessing attitudes (instrumental and affective), subjective norms (injunctive and descriptive), control perceptions (self-efficacy and controllability) and intentions toward sexting. Specific sexting beliefs (fun/carefree beliefs, perceived risks and relational expectations) were also measured and sexting behavior reported. Relationship status, instrumental attitude, injunctive norm, descriptive norm and self-efficacy were associated with sexting intentions. Relationship status, intentions and self-efficacy related to sexting behavior. Results provide insight into the social-cognitive factors related to individuals’ sexting behavior and bring us closer to understanding what beliefs predict the behavior.

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