Comparative Effectiveness of Community-Based vs Clinic-Based Healthy Choices Motivational Intervention to Improve Health Behaviors Among Youth Living With HIV

Naar, Sylvie; Robles, Gabriel; MacDonell, Karen; Dinaj-Koci, Veronica; Simpson, Kit N.; Lam, Phebe; Parsons, Jeffrey T.; Sizemore, Kayla M.; Starks, Tyrel J.

doi:10.1001/jamanetworkopen.2020.14650

Cited by 24 publications

(13 citation statements)

References 45 publications

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“…[49][50][51] Behavioral interventions have demonstrated efficacy in improving behaviors directly aimed at enhancing TasP. [52][53][54][55] Structural interventions and resource investments are now needed to bring these and other evidence-based interventions into the standard of clinical care for people receiving ART.…”

Section: Discussionmentioning

confidence: 99%

Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention

2021

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Undetected sexually transmitted infections (STIs) pose health threats to people living with HIV and when combined with uncontrolled HIV can amplify HIV transmission. The current study screened 174 self-identified men under age 36 living with HIV and receiving antiretroviral therapy (ART) for urethral and rectal incident chlamydia and gonorrhea infections. Participants were also screened for biomarkers indicating alcohol and other drug use, subclinical genital inflammation, and HIV viral load. ART adherence and sexual behaviors were also assessed prospectively over 1 month. Results detected an undiagnosed STI in 32 (18%) individuals. Participants with a previously undetected STI had significantly greater HIV viremia than those who did not have an STI after controlling for several confounding variables. Participants with an undetected STI also engaged in greater condomless anal intercourse with HIV negative and unknown status partners, including partners to whom they had not disclosed their HIV status. These findings show that undetected STI are associated with incomplete ART adherence and unsuppressed HIV, all of which are important for preventing HIV transmission.

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Section: Discussionmentioning

confidence: 99%

Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention

2021

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“…Most psychosocial staff achieved at least intermediate competency, the level of fidelity typically required in randomized clinical trials, 45 suggesting that psychologists and social workers maybe the most successful as internal facilitators. However, one-third of physicians and paraprofessional staffs achieved this competency, which may have positive rippling effects across the organization.…”

Section: Discussionmentioning

confidence: 99%

Tailored Motivational Interviewing in Adolescent HIV Clinics: Primary Outcome Analysis of a Stepped Wedge Implementation Trial

Naar

MacDonell

Chapman

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Youth continue to have the poorest outcomes along the HIV prevention and care continua. Motivational Interviewing (MI) may promote behavior change and reduce perceived stigma, but providers often demonstrate inadequate MI competence. This study tested Tailored Motivational Interviewing (TMI), a set of implementation strategies designed to improve MI competence in youth HIV providers.Setting:Ten HIV clinics in the Adolescent Trials Network for HIV/AIDS Interventions.Methods:In a stepped wedge design, 10 clinics (N = 151 providers) were randomized in 5 clusters every 3 months to receive TMI for a 12-month implementation period. Sites were rerandomized within each cluster to receive communities of practice guidance with or without internal facilitator support in the sustainment period. Standard patient assessments were coded every 3 months for 36 months.Results:Nesting was addressed using mixed-effects regression models, with random effects for providers and sites. TMI resulted in significantly improved MI competence over baseline. Despite small reductions in competence in the sustainment window, competence was still significantly improved over baseline, with no difference between the 2 sustainment conditions.Conclusions:TMI may be an important tool to capacitate the HIV HealthForce to end the HIV epidemic in young people.

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“…The HIV behavioral-intervention literature includes relatively few completed randomized controlled trials comparing one structured intervention with another structured intervention diverging only in certain components or mode of delivery. 7,[39][40][41][42] Findings of significant outcome differences between such interventions are rare, 39,40 with some manifesting in the opposite direction from that expected. 40 A faithbased adaptation of the evidence-based "SISTA" HIV prevention intervention stands out in its demonstration of noninferiority for the primary outcome (consistent condom use) and some benefits beyond those of the original intervention, 39 perhaps due to the collaborative redesign process (with a "Church Advisory Board") and/or the testing of the intervention in the community and congregation to which it was tailored.…”

Section: Contextualization Of Null Findingsmentioning

confidence: 99%

“…7,[39][40][41][42] Findings of significant outcome differences between such interventions are rare, 39,40 with some manifesting in the opposite direction from that expected. 40 A faithbased adaptation of the evidence-based "SISTA" HIV prevention intervention stands out in its demonstration of noninferiority for the primary outcome (consistent condom use) and some benefits beyond those of the original intervention, 39 perhaps due to the collaborative redesign process (with a "Church Advisory Board") and/or the testing of the intervention in the community and congregation to which it was tailored. In a Baltimore randomized controlled trial, an evidence-based case-management intervention ("Project Bridge," designed for PWH transitioning from incarceration) that was adapted to support PWH on probation/parole showed no outcome benefits over usual care.…”

Section: Contextualization Of Null Findingsmentioning

confidence: 99%

Evaluation of the Revised Versus Original Ryan White Part A HIV Care Coordination Program in a Cluster-Randomized, Stepped-Wedge Trial

Irvine

Levin

Abdelqader

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: To address challenges with delivery of an evidencebased HIV care coordination program (CCP), the New York City Health Department initiated a CCP redesign. We conducted a siterandomized stepped-wedge trial to evaluate effectiveness of the revised versus the original model. Setting:The CCP is delivered in New York City hospitals, community health centers, and community-based organizations to people experiencing or at risk for poor HIV outcomes. Methods:The outcome, timely viral suppression (TVS), was defined as achievement of viral load ,200 copies/mL within 4 months among enrollees with unsuppressed viral load ($200 copies/mL). Seventeen original-CCP provider agencies were randomized within matched pairs to early (August 2018) or delayed (May 2019) starts of revised-model implementation. Data from 3 periods were examined to compare revised versus original CCP effects on TVS. The primary analysis of the intervention effect applied fully conditional maximum likelihood estimation together with an exact, conditional P-value and an exact test-based 95% CI. We assigned each trial enrollee the implementation level of their site (based on a three-component measure) and tested for association with TVS, adjusting for period and study arm.Results: Over 3 nine-month periods, 960 individuals were eligible for trial inclusion (intention to treat). The odds ratio of TVS versus no TVS comparing revised with original CCP was 0.88 (95% CI: 0.45, 1.7). Thus, the revised program yielded slightly lower TVS, although the effect was statistically nonsignificant. TVS was not significantly associated with revised-CCP implementation level. Conclusion:Program revisions did not increase TVS, irrespective of the implementation level.

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Comparative Effectiveness of Community-Based vs Clinic-Based Healthy Choices Motivational Intervention to Improve Health Behaviors Among Youth Living With HIV

Abstract: This randomized clinical trial assesses the comparative effectiveness of the Healthy Choices intervention when delivered in a clinic- vs home-based setting on medication adherence and alcohol use among youths and young adults living with HIV.

Cited by 24 publications

References 45 publications

Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention

Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention

Tailored Motivational Interviewing in Adolescent HIV Clinics: Primary Outcome Analysis of a Stepped Wedge Implementation Trial

Evaluation of the Revised Versus Original Ryan White Part A HIV Care Coordination Program in a Cluster-Randomized, Stepped-Wedge Trial

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