Optimization of Multicomponent Behavioral and Biobehavioral Interventions for the Prevention and Treatment of HIV/AIDS

Linda M Collins, Kari C Kugler, Marya Viorst Gwadz, Linda M Collins, Kari C Kugler, Marya Viorst Gwadz

Abstract

To move society toward an AIDS-free generation, behavioral interventions for prevention and treatment of HIV/AIDS must be not only effective, but also cost-effective, efficient, and readily scalable. The purpose of this article is to introduce to the HIV/AIDS research community the multiphase optimization strategy (MOST), a new methodological framework inspired by engineering principles and designed to develop behavioral interventions that have these important characteristics. Many behavioral interventions comprise multiple components. In MOST, randomized experimentation is conducted to assess the individual performance of each intervention component, and whether its presence/absence/setting has an impact on the performance of other components. This information is used to engineer an intervention that meets a specific optimization criterion, defined a priori in terms of effectiveness, cost, cost-effectiveness, and/or scalability. MOST will enable intervention science to develop a coherent knowledge base about what works and does not work. Ultimately this will improve behavioral interventions systematically and incrementally.

Keywords: Behavioral intervention; Biobehavioral intervention; Factorial design; Fractional factorial design; Multiphase optimization strategy.

Figures

Fig. 1
Fig. 1
Conceptual model of alcohol use and ART adherence among persons living with HIV/AIDS
Fig. 2
Fig. 2
Comparison of treatment package approach and multiphase optimization strategy (MOST) Differences are in bold

References

    1. Collins LM, Murphy SA, Nair VN, Strecher VJ. A strategy for optimizing and evaluating behavioral interventions. Annals of Behavioral Medicine. 2005;30(1):65–73.
    1. Collins LM, Murphy SA, Strecher V. The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): New methods for more potent e-health interventions. American Journal of Preventive Medicine. 2007;32:S112–S8.
    1. Collins LM, Baker TB, Mermelstein RJ, Piper ME, Jorenby DE, Smith SS, et al. The multiphase optimization strategy for engineering effective tobacco use interventions. Annals of Behavioral Medicine. 2011;41(2):208–26.
    1. Collins LM, Nahum-Shani I, Almirall D. Optimization of behavioral dynamic treatment regimens based on the sequential, multiple assignment, randomized trial (SMART) Clinical Trials. 2014:1740774514536795.
    1. Seeley J, Watts CH, Kippax S, Russell S, Heise L, Whiteside A. Addressing the structural drivers of HIV: a luxury or necessity for programmes? Journal of the International AIDS Society. 2012;15(Suppl 1)
    1. Latkin C, Kuramoto S, Davey-Rothwell M, Tobin K. Social norms, social networks, and HIV risk behavior among injection drug users. AIDS and Behavior. 2010;14(5):1159–68.
    1. Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? Journal of the International AIDS Society. 2013;16(3Suppl 2)
    1. Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, et al. Global epidemiology of HIV infection in men who have sex with men. The Lancet. 2012;380(9839):367–77.
    1. Hagan H, Jenness S, Wendel T, Murrill C, Neaigus A, Gelpi-Acosta C. Herpes simplex virus type 2 associated with HIV infection among New York heterosexuals living in high-risk areas. International journal of STD & AIDS. 2010;21(8):580–3.
    1. Oster AM, Sternberg M, Nebenzahl S, Broz D, Xu F, Hariri S, et al. Prevalence of HIV, Sexually Transmitted Infections, and Viral Hepatitis by Urbanicity, Among Men Who Have Sex With Men, Injection Drug Users, and Heterosexuals in the United States. Sexually transmitted diseases. 2014;41(4):272–9.
    1. Adimora AA, Auerbach JD. Structural interventions for HIV prevention in the United States. Journal of acquired immune deficiency syndromes (1999) 2010;55(0 2):S132.
    1. Degenhardt L, Mathers B, Vickerman P, Rhodes T, Latkin C, Hickman M. Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed. The Lancet. 2010;376(9737):285–301.
    1. Kurth AE, Celum C, Baeten JM, Vermund SH, Wasserheit JN. Combination HIV prevention: significance, challenges, and opportunities. Current HIV/AIDS Reports. 2011;8(1):62–72.
    1. Centers for Disease Control and Prevention. HIV Transmission. 2014 [cited 2014]. Available from: .
    1. Dosekun O, Fox J. An overview of the relative risks of different sexual behaviours on HIV transmission. Current Opinion in HIV and AIDS. 2010;5(4):291–7.
    1. Grinsztejn B, Hosseinipour MC, Ribaudo HJ, Swindells S, Eron J, Chen YQ, et al. Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. The Lancet infectious diseases. 2014;14(4):281–90.
    1. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. New England journal of medicine. 2011;365(6):493–505.
    1. Gwads MV BCAP Collaborative Research Team. STTR with heterosexuals at high risk for HIV: Preliminary findings. Annual Meetings of the Society for Prevention Research; San Francisco, CA. 2013.
    1. Baliunas D, Rehm J, Irving H, Shuper P. Alcohol consumption and risk of incident human immunodeficiency virus infection: A meta-analysis. International Journal of Public Health. 2010;55(3):159–66.
    1. Rehm J, Shield KD, Joharchi N, Shuper PA. Alcohol consumption and the intention to engage in unprotected sex: systematic review and meta-analysis of experimental studies. Addiction. 2012;107(1):51–9.
    1. Kahler CW, Wray TB, Pantalone DW, Kruis RD, Mastroleo NR, Monti PM, et al. Daily Associations Between Alcohol Use and Unprotected Anal Sex Among Heavy Drinking HIV-Positive Men Who Have Sex with Men. AIDS and Behavior. 2014:1–9.
    1. Kelly JA, DiFranceisco WJ, Lawrence JSS, Amirkhanian YA, Anderson-Lamb M. Situational, partner, and contextual factors associated with level of risk at most recent intercourse among Black men who have sex with men. AIDS and Behavior. 2014;18(1):26–35.
    1. Woolf SE, Maisto SA. Alcohol use and risk of HIV infection among men who have sex with men. AIDS and Behavior. 2009;13(4):757–82.
    1. Azar MM, Springer SA, Meyer JP, Altice FL. A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug and alcohol dependence. 2010;112(3):178–93.
    1. Braithwaite RS, Bryant KJ. Influence of alcohol consumption on adherence to and toxicity of antiretroviral therapy and survival. Alcohol Research & Health. 2010;33(3):280.
    1. Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. Journal of acquired immune deficiency syndromes (1999) 2009;52(2):180.
    1. Glass TR, Battegay M, Cavassini M, De Geest S, Furrer H, Vernazza PL, et al. Longitudinal analysis of patterns and predictors of changes in self-reported adherence to antiretroviral therapy: Swiss HIV Cohort Study. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2010;54(2):197–203.
    1. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine. 2010;363(27):2587–99.
    1. Attia S, Egger M, Müller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. Aids. 2009;23(11):1397–404.
    1. Shuper PA, Neuman M, Kanteres F, Baliunas D, Joharchi N, Rehm J. Causal considerations on alcohol and HIV/AIDS—a systematic review. Alcohol and Alcoholism. 2010;45(2):159.
    1. Wu ES, Metzger DS, Lynch KG, Douglas SD. Association between alcohol use and HIV viral load. Journal of acquired immune deficiency syndromes (1999) 2011;56(5):e129.
    1. Lewis MA, Patrick ME, Litt DM, Atkins DC, Kim T, Blayney JA, et al. Randomized controlled trial of a web-delivered personalized normative feedback intervention to reduce alcohol-related risky sexual behavior among college students. Journal of consulting and clinical psychology. 2014;82(3):429.
    1. Parsons JT, Golub SA, Rosof E, Holder C. Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: a randomized controlled trial. Journal of acquired immune deficiency syndromes (1999) 2007;46(4):443.
    1. Office of National AIDS Policy. National HIV/AIDS strategy: Update of the 2014 federal actions to achieve national goals and improve outcomes along the HIV care continuum; Washington, DC. 2014.
    1. Miller WR, Rollnick S. Motivational interviewing: Helping people change. Guilford Press; 2012.
    1. Ajzen I. From intentions to actions: A theory of planned behavior. Springer; 1985.
    1. Vansteenkiste M, Sheldon KM. There’s nothing more practical than a good theory: Integrating motivational interviewing and self-determination theory. British journal of clinical psychology. 2006;45(1):63–82.
    1. Bandura A. Social learning theory. Englewood Cliffs, NJ: Prentice Hall; 1977.
    1. Bandura A. Social foundations of thought and action. Englewood Cliffs, NJ: Prentice Hall; 1986.
    1. Ewart CK. Social action theory for a public health psychology. American Psychologist. 1991;46(9):931.
    1. Kalichman SC, Grebler T, Amaral CM, McNerey M, White D, Kalichman MO, et al. Intentional non-adherence to medications among HIV positive alcohol drinkers: prospective study of interactive toxicity beliefs. Journal of general internal medicine. 2013;28(3):399–405.
    1. Nyamathi A, Flaskerud JH, Leake B, Dixon EL, Lu A. Evaluating the impact of peer, nurse case-managed, and standard HIV risk-reduction programs on psychosocial and health-promoting behavioral outcomes among homeless women. Research in nursing & health. 2001;24(5):410–22.
    1. Purcell DW, Latka MH, Metsch LR, Latkin CA, Gómez CA, Mizuno Y, et al. Results from a randomized controlled trial of a peer-mentoring intervention to reduce HIV transmission and increase access to care and adherence to HIV medications among HIV-seropositive injection drug users. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2007;46:S35–S47.
    1. Brown JL, Littlewood RA, Vanable PA. Social-cognitive correlates of antiretroviral therapy adherence among HIV-infected individuals receiving infectious disease care in a medium-sized northeastern US city. AIDS care. 2013;25(9):1149–58.
    1. Langebeek N, Gisolf EH, Reiss P, Vervoort SC, Thóra B, Richter C, et al. Predictors and correlates of adherence to combination antiretroviral therapy (cART) for chronic HIV infection: a meta-analysis. BMC medicine. 2014;12(1):142.
    1. Sullivan LE, Goulet JL, Justice AC, Fiellin DA. Alcohol consumption and depressive symptoms over time: a longitudinal study of patients with and without HIV infection. Drug and alcohol dependence. 2011;117(2):158–63.
    1. Cruess DG, Kalichman SC, Amaral C, Swetzes C, Cherry C, Kalichman MO. Benefits of adherence to psychotropic medications on depressive symptoms and antiretroviral medication adherence among men and women living with HIV/AIDS. Annals of Behavioral Medicine. 2012;43(2):189–97.
    1. Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. Journal of acquired immune deficiency syndromes (1999) 2011;58(2)
    1. Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS and Behavior. 2012;16(8):2119–43.
    1. Norton WE, Amico KR, Fisher WA, Shuper PA, Ferrer RA, Cornman DH, et al. Information–motivation–behavioral skills barriers associated with intentional versus unintentional ARV non-adherence behavior among HIV+ patients in clinical care. AIDS care. 2010;22(8):979–87.
    1. Lazo M, Gange SJ, Wilson TE, Anastos K, Ostrow DG, Witt MD, et al. Patterns and predictors of changes in adherence to highly active antiretroviral therapy: longitudinal study of men and women. Clinical Infectious Diseases. 2007;45(10):1377–85.
    1. Oh DL, Sarafian F, Silvestre A, Brown T, Jacobson L, Badri S, et al. Evaluation of adherence and factors affecting adherence to combination antiretroviral therapy among White, Hispanic, and Black men in the MACS Cohort. Journal of acquired immune deficiency syndromes (1999) 2009;52(2):290.
    1. Harris GE, Larsen D. HIV peer counseling and the development of hope: Perspectives from peer counselors and peer counseling recipients. AIDS patient care and STDs. 2007;21(11):843–60.
    1. Gay G, Reid MC. Piloting a Text Message-Based Social Support Intervention for Patients with Chronic Pain: Establishing Feasibility and Preliminary Efficacy. 2014
    1. Mo PK, Coulson NS. Exploring the communication of social support within virtual communities: A content analysis of messages posted to an online HIV/AIDS support group. Cyberpsychology & behavior. 2008;11(3):371–4.
    1. Uhrig JD, Lewis MA, Bann CM, Harris JL, Furberg RD, Coomes CM, et al. Addressing HIV knowledge, risk reduction, social support, and patient involvement using SMS: results of a proof-of-concept study. Journal of health communication. 2012;17(sup1):128–45.
    1. Safren SA, Reisner SL, Herrick A, Mimiaga MJ, Stall R. Mental health and HIV risk in men who have sex with men. Journal of acquired immune deficiency syndromes (1999) 2010;55(Suppl 2):S74.
    1. McIntosh RC, Rosselli M. Stress and coping in women living with HIV: a meta-analytic review. AIDS and Behavior. 2012;16(8):2144–59.
    1. Duncan LG, Moskowitz JT, Neilands TB, Dilworth SE, Hecht FM, Johnson MO. Mindfulness-based stress reduction for HIV treatment side effects: a randomized, wait-list controlled trial. Journal of pain and symptom management. 2012;43(2):161–71.
    1. Riley KE, Kalichman S. Mindfulness-based stress reduction for people living with HIV/AIDS: preliminary review of intervention trial methodologies and findings. Health Psychology Review. 2014:1–20. ahead-of-print.
    1. AidsInfo. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. National Institutes of Health; 2014. [cited 2014]. Available from: .
    1. Kalichman SC, Cherry C, Kalichman MO, Amaral CM, White D, Pope H, et al. Integrated behavioral intervention to improve HIV/AIDS treatment adherence and reduce HIV transmission. American journal of public health. 2011;101(3):531–8.
    1. Kaufman MR, Cornish F, Zimmerman RS, Johnson BT. Health behavior change models for HIV prevention and AIDS care: practical recommendations for a multi-level approach. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2014;66:S250–S8.
    1. Binford MC, Kahana SY, Altice FL. A systematic review of antiretroviral adherence interventions for HIV-infected people who use drugs. Current HIV/AIDS Reports. 2012;9(4):287–312.
    1. Charania MR, Marshall KJ, Lyles CM, Crepaz N, Kay LS, Koenig LJ, et al. Identification of evidence-based interventions for promoting HIV medication adherence: Findings from a systematic review of US-based studies, 1996–2011. AIDS and Behavior. 2014;18(4):646–60.
    1. Simoni JM, Nelson KM, Franks JC, Yard SS, Lehavot K. Are peer interventions for HIV efficacious? A systematic review. AIDS and Behavior. 2011;15(8):1589–95.
    1. Collins LM, Dziak JJ, Li R. Design of experiments with multiple independent variables: A resource management perspective on complete and reduced factorial designs. Psychological Methods. 2009;14(3):202–24.
    1. Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. Journal of Psychiatric Research. 2011;45(5):626–9.
    1. Dziak JJ, Collins LM, Wagner AT. FactorialPowerPlan SAS macro suite users’ guide. 1.0 ed. University Park, PA: The Methodology Center, Penn State; 2013.
    1. Collins LM, Dziak JJ, Kugler KC, Trail JB. Factorial Experiments: Efficient Tools for Evaluation of Intervention Components. American journal of preventive medicine. 2014;47(4):498–504.
    1. Kuehl RO, Kuehl R. Design of experiments: statistical principles of research design and analysis. 2000
    1. Pellegrini CA, Hoffman SA, Collins LM, Spring B. Optimization of remotely delivered intensive lifestyle treatment for obesity using the Multiphase Optimization Strategy: Opt-IN study protocol. Contemporary clinical trials. 2014
    1. Strecher VJ, McClure JB, Alexander GL, Chakraborty B, Nair VN, Konkel JM, et al. Web-based smoking-cessation programs: Results of a randomized trial. American Journal of Preventive Medicine. 2008;34(5):373–81.
    1. Sas S. Guide SUs. SAS Institute. Inc; Cary, NC: 1990. p. 355.
    1. Kugler K, Trail J, Dziak J, Collins L. Effect Coding Versus Dummy Coding in Analysis of Data from Factorial Experiments. Technical Report. 2012
    1. Collins LM, Trail JB, Kugler KC, Baker TB, Piper ME, Mermelstein RJ. Evaluating individual intervention components: making decisions based on the results of a factorial screening experiment. Translational Behavioral Medicine. 2014:1–14.
    1. Caldwell LL, Smith EA, Collins LM, Graham JW, Lai M, Wegner L, et al., editors. Child & youth care forum. Springer; 2012. Translational research in South Africa: Evaluating implementation quality using a factorial design.
    1. Caldwell LL, Patrick ME, Smith EA, Palen L, Wegner L. Influencing adolescent leisure motivation: Intervention effects of HealthWise South Africa. Journal of Leisure Research. 2010;42(2):203–20.
    1. Collins LM, Murphy SA, Bierman KL. A conceptual framework for adaptive preventive interventions. Prevention Science. 2004;5(3):185–96.
    1. McKay JR. Is there a case for extended interventions for alcohol and drug use disorders? Addiction. 2005;100(11):1594–610.
    1. Rivera DE, Pew MD, Collins LM. Using engineering control principles to inform the design of adaptive interventions: A conceptual introduction. Drug and Alcohol Dependence. 2007;88:S31–S40.
    1. Lagoa CM, Bekiroglu K, Lanza ST, Murphy SA. Designing adaptive intensive interventions using methods from engineering. Journal of consulting and clinical psychology. 2014;82(5):868.
    1. Navarro-Barrientos J-E, Rivera DE, Collins LM. A dynamical model for describing behavioural interventions for weight loss and body composition change. Mathematical and computer modelling of dynamical systems. 2011;17(2):183–203.
    1. Savage JS, Downs DS, Dong Y, Rivera DE. Control systems engineering for optimizing a prenatal weight gain intervention to regulate infant birth weight. American journal of public health. 2014:e1–e8.
    1. Johnson BT, Michie S, Snyder LB. Effects of behavioral intervention content on HIV prevention outcomes: A meta-review of meta-analyses. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2014;66:S259–S70.
    1. Pals SL, Murray DM, Alfano CM, Shadish WR, Hannan PJ, Baker WL. Individually randomized group treatment trials: a critical appraisal of frequently used design and analytic approaches. American journal of public health. 2008;98(8):1418.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa