Interventions to promote adherence to endocrine therapy among breast cancer survivors: A meta-analysis.

OBJECTIVE: Adjuvant endocrine therapy (AET) significantly reduces risk of breast cancer recurrence in those patients whose tumor tests hormone (estrogen and/or progesterone) receptor positive. Many who are prescribed AET do not adhere adequately. Studies have sought to examine the effects of interventions to enhance patients' AET adherence, with strikingly mixed results. In order to reconcile a disparate literature, this paper aims to (1) quantitatively review the aggregate effect of interventions designed to optimize AET adherence within the current literature and (2) meta-analyze these effects across studies' by intervention design. METHODS: Duplicate searches were conducted using multiple electronic databases as well as hand searches of recent year conference abstracts. Studies were included that (1) tested an intervention to promote AET adherence; (2) reported at least one measure of medication adherence; and (3) reported (or provided upon request) data sufficient to calculate effect size. Effect sizes were calculated using random effects models. RESULTS: Seven studies representing eight unique interventions were included. We observed an overall null effect across all interventions (k = 8; d [95% CI] = 0.28 [-0.05, 0.61]); however, sensitivity analyses showed that interventions that used bi-directional communication showed statistically significant effects relative to control groups within each study (k = 4; d [95% CI] = 0.59 [0.23, 0.95]) while those relying only on providing information to the patient (one-way communication) did not (k = 4; d [95% CI] = -0.03 [-0.27, 0.20]). CONCLUSIONS: Interventions that promote patient self-report may improve AET adherence through enhancing patient engagement. Investigators and clinicians who wish to optimize medication adherence in this population can consider this approach.

A Randomized Clinical Trial of a Brief Internet-based Group Intervention to Reduce Sexual Transmission Risk Behavior Among HIV-Positive Gay and Bisexual Men.

Background: HIV disproportionately affects sexual minority men, and developing strategies to reduce transmission risk is a public health priority. Purpose: The goal was to empirically test a newly developed, Information, Motivation, Behavioral skills (IMB) theoretically derived, online HIV sexual risk reduction intervention (called HINTS) among a sample of sexual minority men living with HIV. Methods: Participants were 167 men randomized to either the four-session online HINTS intervention or to a time-matched, online control condition. Participants were assessed at baseline and at 6-month follow-up for demographic, medical and psychosocial factors, and sexual risk behavior. Analyses examined group differences in incidence rates of condomless anal sex (CAS) at follow-up with all male sex partners and by partner serostatus, either seroconcordant or serodiscordant for HIV infection. Results: Men assigned to the HINTS intervention reported decreased CAS with serodiscordant partners, a behavior that confers high risk of HIV transmission, compared to the control group. Men assigned to the HINTS intervention also reported increased CAS with seroconcordant partners, a behavior indicative of serosorting. Although the IMB model did not appear to mediate these intervention effects, some IMB components were associated with behavioral outcomes at 6-month follow-up. Conclusions: A new group-based sexual risk reduction intervention conducted exclusively online was successful in reducing HIV transmission risk behavior in a sample of gay and bisexual men living with HIV. Future work should consider utilizing this intervention with other groups living with HIV, perhaps in combination with biomedical HIV prevention strategies.

Online Partner Seeking and Sexual Risk Among HIV+ Gay and Bisexual Men: A Dialectical Perspective.

For almost two decades, researchers have explored the relationship between online partner seeking (OPS) and HIV/STI transmission risk behavior among men who have sex with men (MSM), including gay- and bisexual-identified men. A dichotomy has emerged with some findings that OPS is associated with greater sexual risk behavior, and a sparser but emerging literature that men may use OPS for sexual risk reduction. This study examined the association between proportion of partners met online and sexual risk behavior in a sample of 170 HIV-positive gay- and bisexual-identified men. Participants completed assessments including psychosocial factors and a comprehensive assessment of sexual behavior, including total number of male partners, and condomless insertive and receptive anal sex with HIV-negative/unknown serostatus partners or HIV-positive male partners. Our findings support taking a dialectical stance and indicate that OPS may impact risk differently given different individual and contextual circumstances.

Visual analogue scale (VAS) measurement of antiretroviral adherence in people living with HIV (PLWH): a meta-analysis.

Effective treatment of HIV hinges upon maintaining adequate antiretroviral therapy adherence. Accurate, cost-effective measurement of medication adherence is needed to best respond to the HIV pandemic. The visual analogue scale (VAS) appears to be a simple and easy to use measure of adherence but the current literature on its use is mixed. This meta-analysis (1) describes VAS concordance with other measures of medication adherence and viral load; and (2) examines how research methods moderate the reported strength of the VAS-viral load relationship. Literature searches were conducted electronically and by hand with a total of 20 studies included in the present study. The VAS showed large strength associations with most other measures of adherence and a smaller association with viral load. More rigorous methodological quality significantly improved the VAS-viral load effect size. We conclude with optimization recommendations for VAS use in clinical practice and research design.

Reliability and validity of a single-item rating scale to monitor medication adherence for people living with HIV and lower health literacy.

BACKGROUND: Monitoring medication adherence in clinical and research settings may be especially challenging for people with lower literacy skills. OBJECTIVE: The current study examined the measurement properties of a single-item rating scale (SIRS) for assessing medication adherence in a sample of 468 people living with HIV and lower health literacy skills. METHODS: Participants completed two versions (computerized and telephone interview) of an SIRS as well as unannounced monthly pill counts. We also collected measures of common correlates of adherence and obtained participants' HIV RNA viral load from medical records. RESULTS: Results indicated that the SIRS is time stable over one month (r = 0.46 to 0.52). There was limited evidence for modality effects between the computerized and phone administered SIRS. Associations with unannounced pill counts demonstrated concurrent and predictive validity of the SIRS, and criterion-related validity by associations with viral load. However, the SIRS also demonstrated inflated adherence estimates relative to unannounced pill counts and these discrepancies were greatest for persons of lower income and who reported alcohol use. CONCLUSIONS: A simple SIRS to monitor medication adherence may therefore be reliable and valid for use with people challenged by lower literacy skills in both clinical and research settings.

Service priorities and unmet service needs among people living with HIV/AIDS: results from a nationwide interview of HIV/AIDS housing organizations.

Housing for people living with HIV/AIDS (PLWHA) has been linked to a number of positive physical and mental health outcomes, in addition to decreased sexual and drug-related risk behavior. The current study identified service priorities for PLWHA, services provided by HIV/AIDS housing agencies, and unmet service needs for PLWHA through a nationwide telephone survey of HIV/AIDS housing agencies in the USA. Housing, alcohol/drug treatment, and mental health services were identified as the three highest priorities for PLWHA and assistance finding employment, dental care, vocational assistance, and mental health services were the top needs not being met. Differences by geographical region were also examined. Findings indicate that while housing affords PLWHA access to services, there are still areas (e.g., mental health services) where gaps in linkages to care exist.

Brief, peer-delivered motivational interview promotes help seeking behavior among college students with needle anxiety: A randomized controlled trial.

Needle anxiety symptoms are prevalent among college students and predict lack of engagement in student health initiatives including influenza immunization programs. Most do not seek treatment for their anxiety. Objective: To develop and test a peer-delivered, brief motivational interview to promote help-seeking behaviors among college students with needle anxiety symptoms. Participants/Methods: 61 university students who reported needle anxiety symptoms and having avoided medical situations involving needles in the last year were randomized to intervention or control conditions. Analyses compared self-reported help seeking behaviors at three months post-intervention. Results: Intervention group participants were more than twice as likely to report help-seeking behavior at follow up (IR = 2.41; 95%CI = 1.29, 4.50; p=.006) than the control group. Participants also endorsed high levels of satisfaction with the intervention. Conclusions: This pilot intervention appears acceptable and feasible to implement using peers in the college setting. There is preliminary evidence for efficacy, with larger-scale replication needed.

Incorporating Multiple Perspectives Into the Development of an Electronic Survivorship Platform for Head and Neck Cancer.

PURPOSE: To improve the care of survivors of head and neck cancer, we developed the Head and Neck Survivorship Tool: Assessment and Recommendations (HN-STAR). HN-STAR is an electronic platform that incorporates patient-reported outcomes into a clinical decision support tool for use at a survivorship visit. Selections in the clinical decision support tool automatically populate a survivorship care plan (SCP). We aimed to refine HN-STAR by eliciting and incorporating feedback on its ease of use and usefulness. METHODS: Human-computer interaction (HCI) experts reviewed HN-STAR using think-aloud testing and the Nielsen Heuristic Checklist. Nurse practitioners (NPs) thought aloud while reviewing the clinical decision support tool and SCP and responded to an interview. Survivors used HN-STAR as part of a routine visit and were interviewed afterward. We analyzed themes from the feedback. We described how we addressed each theme to improve the usability of HN-STAR. RESULTS: Five HCI experts, 10 NPs, and 10 cancer survivors provided complementary usability insight that we categorized into themes of improvements. For ease of use, themes included technical design considerations to enhance user interface, ease of completion of a self-assessment, streamlining text, disruption of the clinic visit, and threshold for symptoms to appear on the SCP. The theme addressing usefulness was efficiency and comprehensiveness of the clinic visit. For each theme, we report revisions to HN-STAR in response to the feedback. CONCLUSION: HCI experts provided key technical design insights into HN-STAR, whereas NPs and survivors provided usability feedback and clinical perspectives. We incorporated the feedback into the preparation for additional testing of HN-STAR. This method can inform and improve the ease of use and usefulness of the survivorship applications.

Text message intervention designs to promote adherence to antiretroviral therapy (ART): a meta-analysis of randomized controlled trials.

BACKGROUND: The efficacy of antiretroviral therapy depends on patient adherence to a daily medication regimen, yet many patients fail to adhere at high enough rates to maintain health and reduce the risk of transmitting HIV. Given the explosive global growth of cellular-mobile phone use, text-messaging interventions to promote adherence are especially appropriate. This meta-analysis synthesized available text messaging interventions to promote antiretroviral therapy adherence in people living with HIV. METHODS: We performed Boolean searches of electronic databases, hand searches of recent year conference abstracts and reverse searches. Included studies (1) targeted antiretroviral therapy adherence in a sample of people living with HIV, (2) used a randomized-controlled trial design to examine a text messaging intervention, and (3) reported at least one adherence measurement or clinical outcome. RESULTS: Eight studies, including 9 interventions, met inclusion criteria. Text-messaging interventions yielded significantly higher adherence than control conditions (OR = 1.39; 95% CI = 1.18, 1.64). Sensitivity analyses of intervention characteristics suggested that studies had larger effects when interventions (1) were sent less frequently than daily, (2) supported bidirectional communication, (3) included personalized message content, and (4) were matched to participants' antiretroviral therapy dosing schedule. Interventions were also associated with improved viral load and/or CD4+ count (k = 3; OR = 1.56; 95% CI = 1.11, 2.20). CONCLUSIONS: Text-messaging can support antiretroviral therapy adherence. Researchers should consider the adoption of less frequent messaging interventions with content and timing that is individually tailored and designed to evoke a reply from the recipient. Future research is needed in order to determine how best to optimize efficacy.