Effectiveness of an Interactive, Highly Tailored "Video Doctor" Intervention to Suppress Viral Load and Retain Patients With HIV in Clinical Care: A Randomized Clinical Trial.

BACKGROUND: To determine whether Positive Health Check, a highly tailored video doctor intervention, can improve viral suppression and retention in care. SETTING: Four clinics that deliver HIV primary care. METHODS: A hybrid type 1 effectiveness-implementation randomized trial design was used to test study hypotheses. Participants (N = 799) who were not virally suppressed, were new to care, or had fallen out of care were randomly assigned to receive Positive Health Check or the standard of care alone. The primary endpoint was viral load suppression, and the secondary endpoint was retention in care, both assessed at 12 months, using an intention-to-treat approach. A priori subgroup analyses based on sex assigned at birth and race were examined as well. RESULTS: There were no statistically significant differences between Positive Health Check (N = 397) and standard of care (N = 402) for either endpoint. However, statistically significant group differences were identified from a priori subgroup analyses. Male participants receiving Positive Health Check were more likely to achieve suppression at 12 months than male participants receiving standard of care adjusted risk ratio [aRR] [95% confidence interval (CI)] = 1.14 (1.00 to 1.29), P = 0.046}. For retention in care, there was a statistically significant lower risk for a 6-month visit gap in the Positive Health Check arm for the youngest participants, 18-29 years old [aRR (95% CI) = 0.55 (0.33 to 0.92), P = 0.024] and the oldest participants, 60-81 years old [aRR (95% CI) = 0.49 (0.30 to 0.81), P = 0.006]. CONCLUSIONS: Positive Health Check may help male participants with HIV achieve viral suppression, and younger and older patients consistently attend HIV care. REGISTRY NAME: Positive Health Check Evaluation Trial. Trial ID: 1U18PS004967-01. URL: https://clinicaltrials.gov/ct2/show/NCT03292913.

Implementing an Interactive Introduction to Complementary Medicine for Chronic Pain Management Into the Medical School Curriculum.

Introduction: In the setting of the opioid crisis, chronic pain management requires new approaches and open dialogue between physicians and patients to explore evidence-based nonpharmacologic treatments. We developed an educational session on the role of complementary and alternative medicine (CAM) for chronic pain management as part of our larger curriculum on health equity and social justice. Methods: Students and faculty developed a novel educational session for second-year medical students consisting of a lecture and an experiential small-group session immersing the students in CAM. We conducted pre- and postsurveys to assess the students' self-reported learning and impressions of the session. Results: Over the academic years of 2018-2019 and 2019-2020, 345 second-year medical students participated in this mandatory session. In matched pre-and postsession surveys, students rated their knowledge of the evidence behind CAM practices, and reported statistically significant increases in their understanding. When asked about the importance of physician familiarity with common CAM practices, students noted both a high baseline agreement and a statistically significant increase after the session concluded. Familiarity with financial costs of each of the practices also saw statistically significant increases after the session. Discussion: Our results indicated that the session met the educational objectives. A critical part of improving our session between academic years involved gathering feedback and implementing changes based on these suggestions. Our model is easy to implement and replicate at medical schools across the country. Future studies should assess the effects of CAM-focused educational interventions on practices in the clinical setting.