A differentiated digital intervention to improve antiretroviral therapy adherence among men who have sex with men living with HIV in China: a randomized controlled trial

Abstract

Background Antiretroviral therapy (ART) adherence is still suboptimal among some key populations, highlighting the need for innovative tailored strategies. This randomized controlled trial (RCT) aimed to evaluate the effect of a differentiated digital intervention on ART adherence among men who have sex with men (MSM) living with HIV in China. Methods The two-armed parallel RCT was conducted at one HIV clinic in Jinan of China from October 19, 2020, to June 31, 2021. Men were referred by health providers to join the study and then choose one of three digital strategies—text message, only instant message, or instant message plus social media. They were assigned in a 1:1 ratio to the intervention arm or control arm using block randomization, and inside each arm, there were three groups depending on the type of delivering the message. The groups were divided according to participants’ preferred digital strategies. The intervention arm received ART medication messages, medication reminders, peer education, and involved in online discussion. The control arm received messages on health behavior and nutrition. The primary outcome was self-reported optimal ART adherence, defined as not missing any doses and not having any delayed doses within a one-month period. Secondary outcomes included CD4 T cell counts, viral suppression, HIV treatment adherence self-efficacy, and quality of life. Intention-to-treat analysis with generalized linear mixed models was used to evaluate the intervention’s effect. Results A total of 576 participants were enrolled, including 288 participants assigned in the intervention arm and 288 assigned in the control arm. Most were ≤ 40 years old (79.9%) and initiated ART ≤ 3 years (60.4%). After intervention, the proportion of participants achieving optimal ART adherence in the intervention arm was higher than in the control arm (82.9% vs 71.1%). The differentiated digital intervention significantly improved ART adherence (RR = 1.74, 95%CI 1.21–2.50). Subgroup analysis showed one-to-one instant message-based intervention significantly improved ART adherence (RR = 2.40, 95% CI 1.39–4.17). Conclusions The differentiated digital intervention improved ART adherence among MSM living with HIV in China, which could be integrated into people living with HIV (PLWH) management and further promoted in areas where PLWH can access text messaging and instant messaging services. Trial registration ChiCTR2000041282. Retrospectively registered on 23 December 2020.

The Effectiveness of Face-To-Face Counseling and Telenursing on the Drug Adherence for Individuals Suffering From HIV/AIDS

“…This researcher differentiated the intervention group with virtual group counseling via the Telegram application. (13) The other nine studies provided intervention with some media, such as the mHealth platform (10, [15][16][17], virtual counseling (18), digital media application (19,20), computer-based implementation (21), and cellular phones. (19) The researchers summarized the medicine consumption adherence with CD4 and virtual load checkup (10, [15][16][17][19][20][21].…”

“…(13) The other nine studies provided intervention with some media, such as the mHealth platform (10, [15][16][17], virtual counseling (18), digital media application (19,20), computer-based implementation (21), and cellular phones. (19) The researchers summarized the medicine consumption adherence with CD4 and virtual load checkup (10, [15][16][17][19][20][21]. The researchers also found a technique to measure the patients' adherence.…”

“…(20) On the other hand, the measurement of adherence levels to check the patients' pre-exposure prophylaxis on YMSM and YTGW PrEP with TEVDP measurement in the third and sixth months. The PrEP adherence was correlated with the TFV-DP level for more than 700 fmol/punch (14), the checkup of CD4 cellular amount and viral suppression (19), the ART adherence for chronic medication with the questionnaire of AIDS Clinical Trial Group adherence or ACTG. (23) Many inpatient patients have limited experience and are unreadiness to have long-term medicine consumption commitments (51, 52, 53).…”

“…The ART optimum adherence is defined as the action of not missing any single doses or delayed doses for more than one hour within a period of a month (19). The ARV medicine adherence must be higher than 95%, indicating the medicine is consumed correctly based on the doses, manner, and time by health professionals as the efforts to reach and suppress the virus.…”

HIV infection disclosure, treatment self-efficacy and quality of life in HIV-infected MSM receiving antiretroviral therapy

“…This study was a secondary analysis of baseline data from a randomized controlled study conducted from October to December 2020 in a hospital in Jinan, Shandong Province, China [ 35 ]. The hospital included more than 2000 PLWH, accounting for more than 90% of the PLWH in the city.…”