A Preliminary Test of an mHealth Facilitated Health Coaching Intervention to Improve Medication Adherence among Persons Living with HIV.

This study examined feasibility, acceptability, and preliminary efficacy of an mHealth facilitated health coaching antiretroviral therapy (ART) adherence intervention. Persons living with HIV (n = 53) were randomized to an in-person adherence session and 12 months of app access and health coaching via the app (Fitbit Plus) versus single adherence session (SOC). At baseline and 1, 3, 6, and 12 months, we measured ART adherence, substance use, and depressive symptoms. We also conducted individual qualitative interviews. The intervention was found to be largely feasible and highly acceptable, with the health coach spending an average of 2.4 min per month with a participant and 76.5% of Fitbit Plus participants using the app regularly at 12 months. While most comparisons were not significant, the pattern of results was consistent with better adherence in the Fitbit Plus compared to SOC condition. Substance use was significantly associated with poorer ART adherence while depressive symptoms were not.ClinicalTrials.gov Identifier: NCT02676128; Registered: 2/8/2016.

RESUMEN: En este estudio se examinó la viabilidad, aceptabilidad y la eficacia preliminar de una intervención de cumplimiento de la terapia antirretroviral (ART, por sus siglas en inglés) proporcionada por mHealth. Los pacientes con VIH (n = 53) fueron seleccionados al azar para participar en una sesión de cumplimiento presencial y para tener acceso a la aplicación y recibir asesoría médica a través de la aplicación (Fitbit Plus) durante 12 meses contra una sola sesión de cumplimiento (SOC, por sus siglas en inglés). Al comenzar y al mes 1, 3, 6 y 12, evaluamos el cumplimiento con la ART, el uso de sustancias y los síntomas de depresión; también realizamos entrevistas cualitativas individuales. Se encontró que la intervención es bastante viable y muy aceptable, con un promedio de 2.4 minutos de interacción entre el asesor médico y el participante y un 76.5% de uso de la aplicación por parte de los participantes de Fitbit Plus a los 12 meses. Si bien la mayoría de las comparaciones no fueron significativas, el patrón en los resultados fue consistente con un mayor cumplimiento en Fitbit Plus comparado con la condición SOC. El uso de sustancias se asoció significativamente con un cumplimiento de la ART más deficiente mientras que los síntomas depresivos no.

Linking Women Experiencing Incarceration to Community-Based HIV Pre-Exposure Prophylaxis Care: A Qualitative Study.

Women experiencing incarceration (WEI) in the United States are disproportionately impacted by HIV, yet HIV pre-exposure prophylaxis (PrEP) is underutilized by women in the United States. In order to inform an intervention to promote PrEP initiation during incarceration and facilitate linkage to PrEP care following release from incarceration, we conducted individual, semistructured qualitative interviews with WEI (N = 21) and key stakeholders (N = 14). While WEI had little or no previous knowledge about PrEP, they viewed it as something that would benefit women involved in the criminal justice system. Participants stated that HIV-related stigma and underestimation of HIV risk might serve as barriers to PrEP initiation during incarceration. Participants reported that competing priorities, difficulty scheduling an appointment, and lack of motivation could interfere with linkage to PrEP care in the community. Further, cost, substance use, and difficulty remembering to take the medication were cited most commonly as likely barriers to adherence.

Same-Day Associations Between Substance Use and Medication Nonadherence Among Persons Living with HIV.

OBJECTIVES: To examine the same-day associations between substance use and objectively measured antiretroviral therapy (ART) nonadherence among persons living with HIV (PLWH). METHODS: PLWH (N = 53) were given an electronic pill box (EPB), and their ART adherence was monitored for 14 days. During a follow-up interview, participants were asked about any alcohol or drug use that occurred during those same 14 days. RESULTS: Daily heavy drinking (⩾5 drinks for males and ⩾4 drinks for females) was associated with a nearly five times greater likelihood of same-day ART nonadherence (OR = 4.90, 95% CI = 1.79-13.36, P = .002). Further, drug use was associated with a nearly two times greater likelihood of ART nonadherence on the same day (OR = 1.80, 95% CI = 1.14-2.85, P = .012). CONCLUSIONS: These results highlight the importance of continuing to pursue interventions to effectively address heavy drinking and drug use among PLWH in order to improve ART adherence.

Linking women experiencing incarceration to community-based HIV pre-exposure prophylaxis care: protocol of a pilot trial.

BACKGROUND: Women experiencing incarceration (WEI) engage in high rates of sex- and drug-related behavior that places them at risk for HIV. Pre-exposure prophylaxis (PrEP) is an efficacious means of reducing HIV acquisition. There is a general lack of knowledge regarding PrEP among women at elevated risk, and only a small percentage of at-risk women are currently engaged in PrEP care. The period of incarceration represents an opportunity to identify at-risk women, initiate PrEP during incarceration, and establish linkage to community-based PrEP care upon release from incarceration. Further, post-release is a time period that is particularly risky, and there are numerous barriers, including substance use, that may impede linkage to community-based care in the absence of intervention. The current protocol describes plans for the development and pilot randomized controlled trial (RCT) of an intervention to promote PrEP uptake during incarceration and facilitate linkage to community-based PrEP care post-release. METHODS/DESIGN: The motivational interviewing-navigation (MI-NAV) study intervention is being developed, refined, and tested over three phases within the framework of the social ecological model. All phases of the study are being conducted at a women's correctional facility and community-based PrEP provider located in the Northeastern region of the United States. Phase 1 consists of individual qualitative interviews to be conducted with key stakeholders (n = 6-10) from the community-based PrEP care site and (n = 6-10) from the women's correctional facility, as well as with (n = 18-30) WEI. Recruitment for Phase 1 was initiated in November 2017. In Phase 2, MI-NAV will be piloted with a small cohort (n = 8-12) of WEI and will be refined based upon participant feedback. During Phase 3, a pilot RCT of MI-NAV and a standard of care condition will be conducted with 80 WEI. RCT participants will complete baseline and follow-up assessments 1, 3, and 6 months post-release. The primary study outcome is linkage to community-based PrEP care, verified via medical records. DISCUSSION: This study will develop and evaluate a psychosocial intervention (MI-NAV) to promote PrEP uptake and facilitate linkage to community-based PrEP care among women at-risk for HIV. It is expected that, as a result of this project, the feasibility, acceptability, and preliminary efficacy of MI-NAV will be determined. If found to be efficacious, this intervention has the potential to reduce HIV acquisition in a high-need, underserved community. Clinical trial registration NCT03281343.

The Need for Psychosocial Interventions to Facilitate the Transition to Extended-Release Naltrexone (XR-NTX) Treatment for Opioid Dependence: A Concise Review of the Literature.

Given the increase of opioid dependence and opioid-related morbidity and mortality, improving treatment options for individuals with opioid dependence warrants increased attention. This article provides a concise review of work in this area. Remission from opioid dependence can be very difficult to sustain, particularly in the absence of opioid replacement or opioid antagonist therapy. For those who wish to transition from opioid use or opioid replacement therapy to opioid antagonist therapy, a significant challenge can be the period of withdrawal symptoms that must be endured prior to the initiation of opioid antagonist therapy. Studies that have incorporated psychosocial interventions into detoxification protocols have found that they can result in improved treatment outcomes. Interventions based on Acceptance and Commitment Therapy have shown promise in the treatment of clinical disorders that present with symptoms similar to those of opioid withdrawal and have been found to positively impact outcomes among those tapering from methadone. However, the use of an Acceptance and Commitment Therapy-based intervention has yet to be studied among opioid-dependent patients transitioning to XR-NTX, and its value to those transitioning to XR-NTX is currently unknown.