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

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

Abstract

Introduction: Youth and young adults living with HIV (YLWH) experience worse clinical outcomes than adults and high rates of behavioural health challenges that impact their engagement in care and adherence to antiretroviral therapy. This study in the San Francisco Bay area aims to evaluate the feasibility, acceptability and preliminary clinical outcomes of a 12-session telehealth counselling series provided to 80 YLWH, including education, motivational enhancement and problem-solving around HIV care, mental health, substance use and other challenges. Findings will provide information about benefits and challenges of telehealth counselling for YLWH and will guide the development of new technology-based strategies for care.

Methods and analysis: The Youth to Telehealth and Text to Improve Engagement in Care study is a pilot randomised, crossover trial examining the feasibility and acceptability of a telehealth counselling intervention consisting of twelve 20-30 min weekly sessions focused on identifying and problem-solving around barriers to HIV care access and adherence and on addressing mental health, substance use and/or other issues. Participants also receive text messages for check-ins, appointment reminders and to improve engagement. Participants complete quantitative online surveys at baseline, 4 and 8 months and qualitative exit interviews. Clinical outcomes, including plasma HIV RNA and CD4+ cell count, are collected from medical records. Study staff will explore outcomes of the intervention using quantitative and qualitative methods.

Ethics and dissemination: This study and its protocols have been approved by the University of California, San Francisco (UCSF) Institutional Review Board. Study staff will work with the UCSF Center for AIDS Prevention Studies' Community Engagement Core and the Youth Advisory Panel to disseminate results to the community, participants and the academic community.

Trial registration: NCT03681145.

Keywords: HIV; antiretroviral therapy; counselling; mental health; substance use; telehealth; text messaging; young adults.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. CDC. HIV among youth. 2018. (Retrieved 4 Jun 2018).
    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;28:128–35. 10.1089/apc.2013.0345
    1. Chesney MA. The elusive gold standard. Future perspectives for HIV adherence assessment and intervention. J Acquir Immune Defic Syndr 2006;43(Suppl 1):S149–55. 10.1097/01.qai.0000243112.91293.26
    1. World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization, 2003.
    1. Cohen MS, Chen YQ, McCauley M, et al. . Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011;365:493–505. 10.1056/NEJMoa1105243
    1. Brown LK, Whiteley L, Harper GW, et al. . Psychological Symptoms Among 2032 Youth Living with HIV: A Multisite Study. AIDS Patient Care STDS 2015;29:212–9. 10.1089/apc.2014.0113
    1. Whiteley LB, Brown LK, Swenson R, et al. . Disparities in mental health care among HIV-infected youth. J Int Assoc Provid AIDS Care 2014;13:29–34. 10.1177/2325957413488172
    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 Depend 2016;169:11–18. 10.1016/j.drugalcdep.2016.10.002
    1. MacDonell K, Naar-King S, Huszti H, et al. . Barriers to medication adherence in behaviorally and perinatally infected youth living with HIV. AIDS Behav 2013;17:86–93. 10.1007/s10461-012-0364-1
    1. Fortenberry JD, Martinez J, Rudy BJ, et al. . Linkage to care for HIV-positive adolescents: a multisite study of the adolescent medicine trials units of the adolescent trials network. J Adolesc Health 2012;51:551–6. 10.1016/j.jadohealth.2012.03.012
    1. Uthman OA, Magidson JF, Safren SA, et al. . Depression and adherence to antiretroviral therapy in low-, middle- and high-income countries: a systematic review and meta-analysis. Curr HIV/AIDS Rep 2014;11:291–307. 10.1007/s11904-014-0220-1
    1. Brown LK, Whiteley L, Harper GW, et al. . Psychological symptoms among 2032 youth living with HIV: a multisite study. AIDS Patient Care STDS 2015;29:212–9. 10.1089/apc.2014.0113
    1. Reisner SL, Mimiaga MJ, Skeer M, et al. . A review of HIV antiretroviral adherence and intervention studies among HIV-infected youth. Top HIV Med 2009;17:14–25.
    1. Smith A. U.S. Smartphone Use in 2015. 2015. Available at .
    1. Saberi P, Yuan P, John M, et al. . A pilot study to engage and counsel HIV-positive African American youth via telehealth technology. AIDS Patient Care STDS 2013;27:529–32. 10.1089/apc.2013.0185
    1. Saberi P, Siedle-Khan R, Sheon N, et al. . The Use of Mobile Health Applications Among Youth and Young Adults Living with HIV: Focus Group Findings. AIDS Patient Care STDS 2016;30:254–60. 10.1089/apc.2016.0044
    1. Salesforce. State of the Connected Patient. 2015. (Retrieved 4 Jun 2018).
    1. Hightow-Weidman LB, Muessig KE, Bauermeister J, et al. . Youth, Technology, and HIV: Recent Advances and Future Directions. Curr HIV/AIDS Rep 2015;12:500–15. 10.1007/s11904-015-0280-x
    1. Haberer JE, Sabin L, Amico KR, et al. . Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations. J Int AIDS Soc 2017;20:21371 10.7448/IAS.20.1.21371
    1. Garofalo R, Kuhns LM, Hotton A, et al. . A Randomized Controlled Trial of Personalized Text Message Reminders to Promote Medication Adherence Among HIV-Positive Adolescents and Young Adults. AIDS Behav 2016;20:1049–59. 10.1007/s10461-015-1192-x
    1. Linnemayr S, Huang HC, Luoto J, et al. . Text messaging for improving antiretroviral therapy adherence, 2017.
    1. Hintze J. NCSS PASS 16 (Version 14). Kaysville, Utah: NCSS Statistical Software, 2018.
    1. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, New Jersey: Lawrence Erlbaum Associates, 1987.
    1. Nezu AM, Maguth Nezu C, D’Zurilla TJ. Problem-solving therapy: a treatment manual. New York, NY, US: Springer Publishing Co, 2013.
    1. Rapp C. The Strengths Model: Case Management with People Suffering from Severe and Persistent Mental Illness. 1st Ed New York: Oxford University Press, 1997.
    1. Miller WR, Rollnick S. Motivational interviewing: preparing people to change: Guilford press, 2002.
    1. Duncan BL, Miller SD, Sparks JA, et al. . The Session Rating Scale: Preliminary psychometric properties of a “working” alliance measure. Journal of brief Therapy 2003;3:3–12.
    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 Psychiatry 2006;63:484–9. 10.1001/archpsyc.63.5.484
    1. Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res 2011;45:626–9. 10.1016/j.jpsychires.2010.10.008
    1. National Association of Social Workers. (n.d.). [Brochure]. Author. (Retrieved 11 Oct 2018).
    1. Turvey C, Coleman M, Dennison O, et al. . Telemedicine and e-Health. 2013. 10.1089/tmj.2013.9989.
    1. National Association of Social Workers, Association of Social Work Boards, Council on Social Work Education, & Clinical Social Work Association. Standards for Technology in Social Work Practice [Pamphlet]: National Association of Social Workers, 2017.
    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. 10.2147/AHMT.S158759
    1. Balfour L, Kowal J, Tasca GA, et al. . Development and psychometric validation of the HIV Treatment Knowledge Scale. AIDS Care 2007;19:1141–8. 10.1080/09540120701352241
    1. Bohn MJ, Babor TF, Kranzler HR. The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings. J Stud Alcohol 1995;56:423–32. 10.15288/jsa.1995.56.423
    1. Humeniuk R, Henry-Edwards S, Ali R, et al. . The ASSIST-linked brief intervention for hazardous and harmful substance use: a manual for use in primary care: World Health Organization, 2010.
    1. Skinner HA. The drug abuse screening test (DAST): Guidelines for Administration and Scoring. Toronto: Addiction Research Foundation, 1982.
    1. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Jama 1999;282:1737–44.
    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;111:564–72. 10.1542/peds.111.3.564
    1. Weathers FW, Litz BT, Keane TM, et al. . The ptsd checklist for dsm-5 (pcl-5). Scale. 2013.
    1. Spitzer RL, Kroenke K, Williams JB, et al. . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092–7. 10.1001/archinte.166.10.1092
    1. Buysse DJ, Reynolds CF, Monk TH, et al. . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193–213. 10.1016/0165-1781(89)90047-4
    1. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety 2003;18:76–82. 10.1002/da.10113
    1. Tsai AC, Weiser SD, Steward WT, et al. . Evidence for the reliability and validity of the internalized AIDS-related stigma scale in rural Uganda. AIDS Behav 2013;17:427–33. 10.1007/s10461-012-0281-3
    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;37:441–58. 10.1007/s12126-011-9125-0
    1. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med 1991;32:705–14. 10.1016/0277-9536(91)90150-B
    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;63:1179–94. 10.1016/j.jclinepi.2010.04.011
    1. Gagnon M, Hibert R, Dubé M, et al. . Development and validation of an instrument measuring individual empowerment in relation to personal health care: the Health Care Empowerment Questionnaire (HCEQ). Am J Health Promot 2006;20:429–35. 10.4278/0890-1171-20.6.429
    1. Bakken S, Holzemer WL, Brown MA, et al. . Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. AIDS Patient Care STDS 2000;14:189–97. 10.1089/108729100317795
    1. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-83.

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