scholarly journals Text Messaging to Improve Linkage, Retention, and Health Outcomes Among HIV-Positive Young Transgender Women: Protocol for a Randomized Controlled Trial (Text Me, Girl!)

10.2196/12837 ◽  
2019 ◽  
Vol 8 (7) ◽  
pp. e12837 ◽  
Author(s):  
Cathy J Reback ◽  
Jesse B Fletcher ◽  
Anne E Fehrenbacher ◽  
Kimberly Kisler
Keyword(s):  
Health Outcomes ◽  
Text Messaging ◽  
Text Message ◽  
Transgender Women ◽  
Text Messages ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Intervention Delivery ◽  
Living With Hiv

Background Transgender women in the United States experience numerous risk factors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, sex work, and nonprescribed hormone and soft tissue–filler injections. In addition, transgender women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically with young transgender women aged 35 years and younger, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older transgender women and nontransgender young adult counterparts. Young transgender women living with HIV experience a range of barriers that challenge their ability to be successfully linked and retained in HIV care. Objective The aim of this randomized controlled trial, Text Me, Girl!, is to assess the impact of a 90-day, theory-based, transgender-specific, text-messaging intervention designed to improve HIV-related health outcomes along the HIV care continuum among young (aged 18-34 years) transgender women (N=130) living with HIV/AIDS. Methods Participants were randomized into either Group A (immediate text message intervention delivery; n=61) or Group B (delayed text message intervention delivery whereby participants were delivered the text-messaging intervention after a 90-day delay period; n=69). Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized specifically for young transgender women living with HIV. Participants received 3 messages per day in real time within a 10-hour gradual and automated delivery system. The text-message content was scripted along the HIV care continuum and based on social support theory, social cognitive theory, and health belief model. The desired outcome of Text Me, Girl! was virological suppression. Results Recruitment began on November 18, 2016, and the first participant was enrolled on December 16, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations will conclude on August 31, 2019. Primary outcome analyses will begin immediately following the conclusion of the follow-up evaluations. Conclusions Text messaging is a communication platform well suited for engaging young transgender women in HIV care because it is easily accessible and widely used, as well as private, portable, and inexpensive. Text Me, Girl! aimed to improve HIV care continuum outcomes among young transgender women by providing culturally responsive text messages to promote linkage, retention, and adherence, with the ultimate goal of achieving viral suppression. The Text Me, Girl! text message library is readily scalable and can be adapted for other hard-to-reach populations. International Registered Report Identifier (IRRID) DERR1-10.2196/12837

scholarly journals Text Messaging to Improve Linkage, Retention, and Health Outcomes among HIV-positive Young Transgender Women: Protocol for a Randomized Controlled Trial (Text Me, Girl!) (Preprint)

2018 ◽  
Author(s):  
Cathy J. Reback ◽  
Jesse B. Fletcher ◽  
Anne E. Fehrenbacher ◽  
Kimberly Kisler
Keyword(s):  
Health Outcomes ◽  
Text Messaging ◽  
Text Message ◽  
Transgender Women ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Intervention Delivery ◽  
Trans Women ◽  
Living With Hiv

BACKGROUND Many transgender women in the U.S. experience numerous cofactors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, high rates of sex work, as well as non-prescribed hormone injections and/or medically unsupervised soft-tissue filler injections, HIV risk factors specific to this population. In addition, trans women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically on young trans women under the age of 35 years old, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older trans women and non-trans young adult counterparts. Young trans women living with HIV experience a range of barriers that challenge their ability to be successfully linked and retained in HIV care. OBJECTIVE Text Me, Girl! was a randomized controlled trial to assess the impact of a 90-day, theory-based, transgender-specific, text-messaging intervention designed to improve HIV-related health outcomes along the HIV Care Continuum among young (18 to 34 years) transgender women (N=130) living with HIV/AIDS. METHODS Participants were randomized into either Group A) Immediate Text Message Intervention Delivery (ID: n=61); or, Group B) Delayed Text Message Intervention Delivery (DD: n=69) whereby participants were delivered the text-messaging intervention after a 90-day delay period. Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized specifically for young transgender women living with HIV. Participants received three messages per day in real-time within a 10-hour gradual and automated delivery system. The text-message content was scripted along the HIV Care Continuum and based on Social Support Theory, Social Cognitive Theory, and Health Belief Model. The desired outcome of Text Me, Girl! was virological suppression. RESULTS Recruitment began on November 18, 2016 and the first participant was enrolled on December 16, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations concluded on August 31, 2019. Primary outcome analyses began immediately following the conclusion of the follow-up evaluations. CONCLUSIONS Text messaging is the ideal communication platform for engaging young trans women in HIV care because it is easily accessible, private, portable, and inexpensive. Text Me, Girl! aimed to improve HIV Care Continuum outcomes among young trans women by providing culturally responsive text messages to promote linkage, retention, and adherence with the ultimate goal of achieving viral suppression. The Text Me, Girl! text message library is readily scalable and can be adapted for other hard-to-reach populations.

scholarly journals Efficacy and Impact of Digital HIV Care Navigation in Young People Living With HIV in San Francisco, California: Prospective Study (Preprint)

2020 ◽  
Author(s):  
Sean Arayasirikul ◽  
Caitlin Turner ◽  
Dillon Trujillo ◽  
Victory Le ◽  
Erin C Wilson
Keyword(s):  
Primary Care ◽  
Young People ◽  
San Francisco ◽  
Text Messaging ◽  
Hiv Care ◽  
Computer Assisted ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Living With Hiv

BACKGROUND Young people are disproportionately impacted by HIV infection and exhibit poor HIV care continuum outcomes. Mobile health (mHealth) interventions are promising approaches to meet the unique needs of young people living with HIV. Youth-focused interventions are needed to improve HIV care continuum outcomes. OBJECTIVE This study assessed the preliminary efficacy and impact of a digital HIV care navigation intervention among young people living with HIV in San Francisco. Health electronic navigation (eNavigation or eNav) is a 6-month, text message–based, digital HIV care navigation intervention, in which young people living with HIV are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. METHODS This study had a single-arm, prospective, pre-post design. The analysis included 120 young men who have sex with men or transwomen living with HIV aged between 18 and 34 years. We analyzed self-reported sociobehavioral information pre- and postintervention at baseline and 6 months, which was collected using computer-assisted self-interviewing surveys. We characterized the sample and built generalized estimating equation (GEE) models to assess differences in HIV care continuum outcomes at baseline and 6 months. RESULTS The characteristics according to the intervention completion status were not different from those of the overall sample. The mean age of the participants was 27.75 years (SD 4.07). Most participants (103/120, 85.8%) identified as men, and the sample was racially/ethnically diverse. At baseline, majority (99/120, 82.5%) of the participants had recently received primary HIV care, yet this was more likely in those who completed the intervention than in those who did not (54/60, 90% vs 45/60, 75%; χ<sup>2</sup><sub>1</sub>=4.68, <i>P</i>=.03). More than half of the sample reported taking antiretroviral therapy (92/120, 76.7%) and having an undetectable viral load (65/120, 54.2%). The 6-month follow-up surveys were completed by 73.3% (88/120) of participants, and these participants were not characteristically different from the overall sample at baseline. GEE models indicated that participants had increased odds of viral suppression at 6 months as compared with baseline. No relevant additive or multiplicative interactions were noted on comparing outcome effects over time according to intervention completion. CONCLUSIONS Digital HIV care navigation fills a critical gap in public health and HIV care systems, making these systems more responsive and accountable to the needs of the most vulnerable individuals. Our intervention bridges the time between primary care visits with interactive, tailored, personalized, and peer-delivered social support; information; and motivational interviewing to scaffold behavioral change. This study is part of the next wave of system-informed mHealth intervention research that will offer potentially disruptive solutions to traditional in-person delivered interventions and improve the health of the most vulnerable individuals. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16406

scholarly journals 1312. Increasing Care Engagement Amongst People Living with HIV Through a Text Messaging Intervention at a Tertiary Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S473-S474
Author(s):  
Nupur Gupta ◽  
Sarah McBeth ◽  
Ella Kaplan ◽  
Greg Valdisera ◽  
Deborah McMahon
Keyword(s):  
Viral Load ◽  
Text Messaging ◽  
Chart Review ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Tertiary Center ◽  
Risk Patients ◽  
Living With Hiv

Abstract Background HIV has transitioned from an acute illness to a chronic disease due to potent antiretroviral therapy (ART). People living with HIV (PLWH) must be highly compliant which is difficult due to multiple barriers. The HIV care continuum was developed as a series of steps that PLWH take in their treatment cascade. At our HIV clinic, 90% of the patients are virally suppressed (viral load <200 copies/mL). Although this is higher than the national average, PLWH who are not virally suppressed and not retained in care carry the highest risk of transmission. We have several resources to engage patients, but text messaging has not been utilized for at-risk patients at the clinic or at the academic center. Methods The aim is to demonstrate that a pilot study of a text messaging-based intervention will increase the proportion of PLWH along the care continuum. The pre-intervention data consists of the clinic population with a viral load ≥200 copies/mL between July 1, 2017 and June 30, 2018. After chart review, eligible patients were consented to receive weekly text messages with content regarding appointment and medication reminders, and motivational messages. In the consented group, effectiveness of the intervention will be measured by tracking their appointments, viral loads, and ART prescriptions. Results After chart review, 80 patients were eligible, and 18 patients were consented for the intervention. In the eligible group, the average length of care is 8 years (range 0 to 26) and average number of years since initial ART prescription is 6.8 (range 0 to 20). The average viral load is 27,372 copies/mL. Amongst the consented group (n = 18), compared with the pre-intervention, there was a 6% increase in those who made an appointment, 33% increase in those who kept an appointment, 50% increase in those who had a viral load <200, and 62% increase in those who had ART dispensed post-intervention. Conclusion The intervention group is small due to difficulties in consenting this vulnerable population. This is an observational study that demonstrated the impact of text messaging a high-risk population with minimal harm that not only improved the local HIV care continuum, but also addressed the barriers to care. The next steps are to determine how this method can link other at-risk patients to care at a large HIV clinic at a tertiary center. Disclosures All authors: No reported disclosures.

scholarly journals Efficacy and Impact of Digital HIV Care Navigation in Young People Living With HIV in San Francisco, California: Prospective Study

10.2196/18597 ◽  
2020 ◽  
Vol 8 (5) ◽  
pp. e18597
Author(s):  
Sean Arayasirikul ◽  
Caitlin Turner ◽  
Dillon Trujillo ◽  
Victory Le ◽  
Erin C Wilson
Keyword(s):  
Primary Care ◽  
Young People ◽  
San Francisco ◽  
Text Messaging ◽  
Hiv Care ◽  
Computer Assisted ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Living With Hiv

Background Young people are disproportionately impacted by HIV infection and exhibit poor HIV care continuum outcomes. Mobile health (mHealth) interventions are promising approaches to meet the unique needs of young people living with HIV. Youth-focused interventions are needed to improve HIV care continuum outcomes. Objective This study assessed the preliminary efficacy and impact of a digital HIV care navigation intervention among young people living with HIV in San Francisco. Health electronic navigation (eNavigation or eNav) is a 6-month, text message–based, digital HIV care navigation intervention, in which young people living with HIV are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. Methods This study had a single-arm, prospective, pre-post design. The analysis included 120 young men who have sex with men or transwomen living with HIV aged between 18 and 34 years. We analyzed self-reported sociobehavioral information pre- and postintervention at baseline and 6 months, which was collected using computer-assisted self-interviewing surveys. We characterized the sample and built generalized estimating equation (GEE) models to assess differences in HIV care continuum outcomes at baseline and 6 months. Results The characteristics according to the intervention completion status were not different from those of the overall sample. The mean age of the participants was 27.75 years (SD 4.07). Most participants (103/120, 85.8%) identified as men, and the sample was racially/ethnically diverse. At baseline, majority (99/120, 82.5%) of the participants had recently received primary HIV care, yet this was more likely in those who completed the intervention than in those who did not (54/60, 90% vs 45/60, 75%; χ21=4.68, P=.03). More than half of the sample reported taking antiretroviral therapy (92/120, 76.7%) and having an undetectable viral load (65/120, 54.2%). The 6-month follow-up surveys were completed by 73.3% (88/120) of participants, and these participants were not characteristically different from the overall sample at baseline. GEE models indicated that participants had increased odds of viral suppression at 6 months as compared with baseline. No relevant additive or multiplicative interactions were noted on comparing outcome effects over time according to intervention completion. Conclusions Digital HIV care navigation fills a critical gap in public health and HIV care systems, making these systems more responsive and accountable to the needs of the most vulnerable individuals. Our intervention bridges the time between primary care visits with interactive, tailored, personalized, and peer-delivered social support; information; and motivational interviewing to scaffold behavioral change. This study is part of the next wave of system-informed mHealth intervention research that will offer potentially disruptive solutions to traditional in-person delivered interventions and improve the health of the most vulnerable individuals. International Registered Report Identifier (IRRID) RR2-10.2196/16406

scholarly journals Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Vasiliki Papageorgiou ◽  
Bethan Davies ◽  
Emily Cooper ◽  
Ariana Singer ◽  
Helen Ward
Keyword(s):  
Systematic Review ◽  
Social Determinants ◽  
Meta Analysis ◽  
Hiv Treatment ◽  
Material Deprivation ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Living With Hiv

AbstractDespite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.

Motivational Interviewing and the Adolescent/Young Adult HIV Care Continuum

2019 ◽  
pp. 37-46
Author(s):  
Sylvie Naar ◽  
Maurice Bulls
Keyword(s):  
Young Adult ◽  
Motivational Interviewing ◽  
Behavioral Therapy ◽  
Hiv Care ◽  
Behavior Changes ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Future Direction ◽  
Youth Living With Hiv ◽  
Living With Hiv

This chapter explores the HIV care continuum specifically with youth living with HIV (YLH). The authors review relevant HIV statistics, including the trends in YLH. The authors then examine the fit of motivational interviewing (MI) with adolescent development, arguing that it is an excellent strategy to include in promoting self-management of HIV. Multiple examples are also provided for programs and interventions using MI with youth. This chapter provides specific details on how MI can be leveraged in working with YLH, although many of these insights can generalize to adult populations. In the final section, the authors examine the future direction of MI in the care of YLH. They argue that once MI has helped to motivate YLH toward change, the substitution for or addition of cognitive-behavioral therapy (CBT) may be warranted. In this way, the more action-oriented strategies of CBT strengthen the behavior changes that MI has helped to put in motion.

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