Video-Counseling Intervention to Address HIV Care Engagement, Mental Health, and Substance Use Challenges: A Pilot Randomized Clinical Trial for Youth and Young Adults Living with HIV

Parya Saberi, Caravella McCuistian, Emily Agnew, Angie R Wootton, Dominique A Legnitto Packard, Carol Dawson-Rose, Mallory O Johnson, Valerie A Gruber, Torsten B Neilands, Parya Saberi, Caravella McCuistian, Emily Agnew, Angie R Wootton, Dominique A Legnitto Packard, Carol Dawson-Rose, Mallory O Johnson, Valerie A Gruber, Torsten B Neilands

Abstract

Background: Substance use and mental health are two barriers to engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV (YLWH). The consequences of suboptimal adherence in YLWH are increased risk of HIV transmission and a future generation of immunodeficient adults with drug-resistant virus. Methods: The Youth to Telehealth and Texting for Engagement in Care (Y2TEC) study was a pilot randomized crossover trial that examined the feasibility and acceptability of a novel video-counseling series and accompanying text messages aimed at mental health, substance use, and HIV care engagement for YLWH. The intervention consisted of twelve 20-30-min weekly video-counseling sessions focused on identifying and addressing barriers to HIV care, mental health, and substance use challenges. Participants completed quantitative surveys at baseline, 4 months, and 8 months. Feasibility and acceptability were evaluated using prespecified benchmarks. Results: Fifty YLWH aged 18-29 years living in the San Francisco Bay Area were enrolled. Eighty-six percent and 75% of participants were retained at 4 and 8 months, respectively. A total of 455 (76%) video-counseling sessions were completed. In 82% of sessions, participants responded that they strongly agreed/agreed with this statement: "I felt heard, understood, and respected by the counselor." In 81% of sessions, participants responded that they strongly agreed/agreed with this statement: "Overall, today's session was right for me." At baseline, among participants reporting mental health challenges, only 10% noted having ever received mental health services, and among those who reported substance use challenges, ∼19% reported ever receiving substance use services. After 4 months of the Y2TEC intervention, participants reported slightly higher ART adherence and HIV knowledge, decreased depression and anxiety, and reduced stigma related to mental health and substance use. Conclusions: The Y2TEC intervention using video-counseling and text messaging was feasible and acceptable for YLWH. ClinicalTrials.gov ID: NCT03681145.

Keywords: engagement in care; mental health; substance use; telehealth; video-counseling; youth living with HIV.

Conflict of interest statement

No competing financial interests exist.

© Parya Saberi et al., 2021; Published by Mary Ann Liebert, Inc.

References

    1. CDC. HIV in the United States and Dependent Areas. 2020. Available at Accessed January3, 2020
    1. Kim SH, Gerver SM, Fidler S, Ward H. Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis. AIDS 2014;28:1945–1956
    1. Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDs 2014;28:128–135
    1. Wood SM, Lowenthal E, Lee S, et al. . Longitudinal viral suppression among a cohort of adolescents and young adults with behaviorally acquired human immunodeficiency virus. Aids Patient Care STDS 2017;31:377–383
    1. Vreeman RC, Mccoy BM, Lee S. Mental health challenges among adolescents living with HIV. J Int AIDS Soc 2017;20(suppl 3):21497.
    1. Saberi P, Rose CD, Wootton AR, et al. . Use of technology for delivery of mental health and substance use services to youth living with HIV: a mixed-methods perspective. Aids Care 2019;32:931–939
    1. Krumme AA, Kaigamba F, Binagwaho A, et al. . Depression, adherence and attrition from care in HIV-infected adults receiving antiretroviral therapy. J Epidemiol Commun Health 2015;69:284–289
    1. Gonzalez JS, Batchelder AW, Psaros C, et al. . Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Def Syndr 2011;58:181–187
    1. Gamarel KE, Brown L, Kahler CW, et al. . Prevalence and correlates of substance use among youth living with HIV in clinical settings. Drug Alcohol Depen 2016;169:11–18
    1. Reeder C, Neilands TB, Palar K, et al. . Food insecurity and unmet needs among youth and young adults living with HIV in the San Francisco Bay Area. J Adolescent Health 2019;65:262–266
    1. Scott-Sheldon LAJ, Carey KB, Johnson BT, et al. . Behavioral interventions targeting alcohol use among people living with HIV/AIDS: a systematic review and meta-analysis. Aids Behav 2017;21:S126–S143
    1. van Luenen S, Garnefski N, Spinhoven P, et al. . The benefits of psychosocial interventions for mental health in people living with HIV: a systematic review and meta-analysis. Aids Behav 2018;22:9–42
    1. Wootton AR, Legnitto DA, Gruber VA, et al. . Telehealth and texting intervention to improve HIV care engagement, mental health and substance use outcomes in youth living with HIV: a pilot feasibility and acceptability study protocol. BMJ Open 2019;9:e028522
    1. Kempf MC, Huang CH, Savage R, et al. . Technology-delivered mental health interventions for people living with HIV/AIDS (PLWHA): a review of recent advances. Curr HIV/AIDS Rep 2015;12:472–480
    1. Cheng LJ, Kumar PA, Wong SN, et al. . Technology-delivered psychotherapeutic interventions in improving depressive symptoms among people with HIV/AIDS: a systematic review and meta-analysis of Randomised Controlled Trials. Aids Behav 2020;24:1663–1675
    1. Olson KE, O'Brien MA, Rogers WA, et al. . Diffusion of technology: frequency of use for younger and older adults. Ageing Int 2011;36:123–145
    1. Fiorillo A, Gorwood P. The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. Eur Psychiatry 2020;63:e32.
    1. Shachar C, Engel J, Elwyn G. Implications for telehealth in a postpandemic future regulatory and privacy issues. J Am Med Assoc 2020;323:2375–2376
    1. Fisher JD, Amico KR, Fisher WA, et al. . The information-motivation-behavioral skills model of antiretroviral adherence and its applications. Curr HIV/AIDS Rep 2008;5:193–203
    1. Amico KR, Toro-Alfonso J, Fisher JD. An empirical test of the information, motivation and behavioral skills model of antiretroviral therapy adherence. Aids Care 2005;17:661–673
    1. Fisher JD, Fisher WA, Misovich SJ, et al. . Changing AIDS risk behavior: effects of an intervention emphasizing AIDS risk reduction information, motivation, and behavioral skills in a college student population. Health Psychol 1996;15:114–123
    1. Duncan BL, Miller SD, Sparks JA, et al. . The Session Rating Scale: preliminary psychometric properties of a “Working” Alliance Measure. J Brief Ther 2003;3:3–12
    1. Johnson JA, Lee A, Vinson D, Seale JP. Use of AUDIT-based measures to identify unhealthy alcohol use and alcohol dependence in primary care: a Validation Study. Alcohol Clin Exp Res 2013;37:E253–E259
    1. Skinner HA The drug abuse screening test. Addict Behav 1982;7:363–371
    1. Humeniuk R, Ali R, Babor TF, et al. . Validation of the Alcohol, Smoking And Substance Involvement Screening Test (ASSIST). Addiction 2008;103:1039–1047
    1. Spitzer RL, Kroenke K, Williams JB, et al. . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092–1097
    1. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999;282:1737–1744
    1. Weathers FW, Litz BT, Keane TM, et al. . The PTSD Checklist for DSM-5 (PCL-5)—Standard. 2013. Available at Accessed October3, 2020
    1. Balfour L, Kowal J, Tasca GA, et al. . Development and psychometric validation of the HIV Treatment Knowledge Scale. Aids Care 2007;19:1141–1148
    1. Earnshaw VA, Smith LR, Chaudoir SR, et al. . HIV stigma mechanisms and well-being among PLWH: a test of the HIV Stigma Framework. Aids Behav 2013;17:1785–1795
    1. King-Kallimanis BL, Oort FJ, Lynn N, et al. . Testing the assumption of measurement invariance in the SAMHSA Mental Health and Alcohol Abuse Stigma Assessment in older adults. Ageing Int 2012;37:441–458
    1. Cella D, Riley W, Stone A, et al. . The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol 2010;63:1179–1194
    1. Buysse DJ, Reynolds CF, 3rd, Monk TH, et al. . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193–213
    1. Dube SR, Felitti VJ, Dong M, et al. . Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics 2003;111:564–572
    1. Felitti VJ, Anda RF, Nordenberg D, et al. . Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998;14:245–258
    1. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety 2003;18:76–82
    1. Smith BW, Dalen J, Wiggins K, et al. . The brief resilience scale: assessing the ability to bounce back. Int J Behav Med 2008;15:194–200
    1. Chen WT, Wantland D, Reid P, et al. . Engagement with health care providers affects self-efficacy, self-esteem, medication adherence and quality of life in people living with HIV. J AIDS Clin Res 2013;4:256.
    1. Wilson IB, Lee Y, Michaud J, et al. . Validation of a new three-item self-report measure for medication adherence. Aids Behav 2016;20:2700–2708
    1. Riley ED, Moore K, Sorensen JL, et al. . Basic subsistence needs and overall health among human immunodeficiency virus-infected homeless and unstably housed women. Am J Epidemiol 2011;174:515–522
    1. Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res 2011;45:626–629
    1. National Center for Complementary and Integrative Health. Pilot Studies: Common Uses and Misuses. Available at Accessed October1, 2020
    1. Whitehead AL, Sully BGO, Campbell MJ. Pilot and feasibility studies: is there a difference from each other and from a randomised controlled trial? Contemp Clin Trials 2014;38:130–133
    1. Kraemer HC, Mintz J, Noda A, et al. . Caution regarding the use of pilot studies to guide power calculations for study proposals. Arch Gen Psychiat 2006;63:484–489
    1. Wootton AR, McCuistian C, Packard DAL, et al. . Overcoming technological challenges: lessons learned from a Telehealth Counseling Study. Telemed EHealth 2020;26(10):1278–1283
    1. Saag LA, Tamhane AR, Batey DS, et al. . Mental health service utilization is associated with retention in care among persons living with HIV at a university-affiliated HIV clinic. AIDS Res Ther 2018;15:1.
    1. Pence BW, Mills JC, Bengtson AM, et al. . Association of increased chronicity of depression with HIV appointment attendance, treatment failure, and mortality among HIV-infected adults in the United States. Jama Psychiatry 2018;75:379–385
    1. Coyle RP, Schneck CD, Morrow M, et al. . Engagement in mental health care is associated with higher cumulative drug exposure and adherence to antiretroviral therapy. Aids Behav 2019;23:3493–3502
    1. DeLorenze GN, Satre DD, Quesenberry CP, et al. . Mortality after diagnosis of psychiatric disorders and co-occurring substance use disorders among HIV-infected patients. Aids Patient Care STDS 2010;24:705–712
    1. National Institute of Mental Health. 2017 National Survey on Drug Use and Health (NSDUH). 2019. Available at Accessed February26, 2020
    1. Moukaddam N, Shah A. Psychiatrists Beware! The Impact of COVID-19 and Pandemics on Mental Health. 2020. Available at Accessed March30, 2020
    1. Shuja KH, Aqeel M, Jaffar A, et al. . COVID-19 pandemic and impending global mental health implications. Psychiatr Danub 2020;32:32–35
    1. Demyttenaere K, Bruffaerts R, Posada-Villa J, et al. . Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. J Am Med Assoc 2004;291:2581–2590
    1. Pence BW, O'Donnell JK, Gaynes BN. The depression treatment cascade in primary care: a public health perspective. Curr Psychiatry Rep 2012;14:328–335
    1. Wainberg ML, Scorza P, Shultz JM, et al. . Challenges and opportunities in global mental health: a research-to-practice perspective. Curr Psychiatry Rep 2017;19:28.
    1. Zuckerbrot RA, Cheung A, Jensen PS, et al. . Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. practice preparation, identification, assessment, and initial management. Pediatrics 2018;141:e20174081.
    1. Cholera R, Pence BW, Bengtson AM, et al. . Mind the gap: gaps in antidepressant treatment, treatment adjustments, and outcomes among patients in routine HIV Care in a Multisite US Clinical Cohort. PLos One 2017;12
    1. Asch SM, Kilbourne AM, Gifford AL, et al. . Underdiagnosis of depression in HIV—who are we missing? J Gen Intern Med 2003;18:450–460
    1. 2017 Review of Physician and Advanced Practitioner Recruiting Incentives. 2017. Available at Accessed February12, 2020
    1. Satiani A, Niedermier J, Satiani B, et al. . Projected workforce of psychiatrists in the United States: a population analysis. Psychiatr Serv 2018;69:710–713
    1. Thomas KC, Ellis AR, Konrad TR, et al. . County-level estimates of mental health professional shortage in the United States. Psychiatr Serv 2009;60:1323–1328
    1. World Health Organization (WHO): Global Health Expenditure Database. Geneva, Switzerland, 2014
    1. World Health Organization (WHO) Mental Health Atlas 2014. Geneva, Switzerland, 2015
    1. Saberi P, Ming K, Dawson-Rose C. What does it mean to be youth-friendly? Results from qualitative interviews with health care providers and clinic staff serving youth and young adults living with HIV. Adolesc Health Med Ther 2018;9:65–75
    1. Substance Abuse and Mental Health Services Administration. California 2018 Mental Health National Outcome Measures (NOMS): SAMHSA Uniform Report System. 2018. Available at Accessed April1, 2019
    1. Saberi P Research in the Time of coronavirus: continuing ongoing studies in the midst of the COVID-19 pandemic. Aids Behav 2020;24:2232–2235
    1. Remien RH, Stirratt MJ, Nguyen N, et al. . Mental health and HIV/AIDS: the need for an integrated response. AIDS 2019;33:1411–1420
    1. World Health Organization: Task Shifting: Rational Redistribution of Task Among Health Workforce Teams: Global Recommendations and Guidelines. Geneva, Switzerland, 2008
    1. Rosso IM, Killgore WDS, Olson EA, et al. . Internet-based cognitive behavior therapy for major depressive disorder: a randomized controlled trial. Depress Anxiety 2017;34:236–245
    1. Andrews G, Williams AD. Up-scaling clinician assisted internet cognitive behavioural therapy (iCBT) for depression: a model for dissemination into primary care. Clin Psychol Rev 2015;41:40–48

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren