Implementing a Digital HIV Care Navigation Intervention (Health eNav): Protocol for a Feasibility Study

Arayasirikul, Sean; Trujillo, Dillon; Turner, Caitlin; Lê, Victory; Wilson, Erin C.

doi:10.2196/16406

Cited by 12 publications

(13 citation statements)

References 28 publications

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“…We further recommend that an individual’s socioeconomic status, the SDH metrics tied to their residence, and housing status are considered in how much re-engagement support a patient needs. Locally established services and pilot programs recognize this and have made strides in addressing related barriers [ 6 , 8 , 10 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…San Francisco also recently piloted a text message-based HIV care navigation program (Health eNav), aiming to overcome structural barriers to care engagement [ 34 ]. Evaluation found Health eNav improved engagement overall but that participants experiencing homelessness and poverty desired longer term outreach compared to other participants [ 34 ], supporting our conclusion that marginalized PWH may need additional support.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Social Determinants of Health on Uncontrolled Human Immunodeficiency Virus (HIV) Infection Among Persons With HIV in San Francisco, California

Melo

Hessol

Pipkin

et al. 2022

Open Forum Infectious Diseases

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BACKGROUND In 2010-2014, the San Francisco Department of Public Health (SFDPH) established programs to rapidly link people living with HIV (PLWH) to care and offer antiretroviral therapy (ART) at HIV diagnosis. Such programs reduced the number of PLWH out of care or with detectable HIV viral load (i.e., uncontrolled HIV infection). We investigated the role of social determinants of health (SDH) on uncontrolled HIV. METHODS Cross-sectional data from adult PLWH diagnosed and reported to the SFDPH as of December 31, 2019, prescribed ART, with confirmed San Francisco residency during 2017-2019 were analyzed in conjunction with SDH metrics derived from the American Community Survey 2015-2019. We focused on five census tract-level SDH metrics: percent of residents below the federal poverty level, with less than a high school diploma, or uninsured; median household income; and GINI index. We compared uncontrolled HIV prevalence odds ratios (PORs) across quartiles of each metric independently using logistic regression models. RESULTS The analysis included 7486 PLWH (6889 controlled HIV; 597 uncontrolled HIV). Unadjusted PORs of uncontrolled HIV rose with increasingly marginalized quartiles, compared to the least marginalized quartile for each metric. Adjusting for demographics and transmission category, the POR for uncontrolled HIV for PLWH in the most marginalized quartile remained significant across metrics for poverty (POR = 2.0; CI = 1.5,2.6), education (POR = 2.4; CI = 1.8,3.2), insurance (POR = 1.8; CI = 1.3,2.5), income (POR = 1.8; CI = 1.4,2.3), and income inequality (POR = 1.5; CI = 1.1,2.0). CONCLUSIONS Beyond demographics, SDH differentially affected the ability of PLWH to control HIV. Despite established care programs, PLWH experiencing socioeconomic marginalization require additional support to achieve health outcome goals

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of Social Determinants of Health on Uncontrolled Human Immunodeficiency Virus (HIV) Infection Among Persons With HIV in San Francisco, California

Melo

Hessol

Pipkin

et al. 2022

Open Forum Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Procedures for the Health eNav study are described in depth in a prior protocol [ 41 ]. Briefly, Health eNav was a 6-month digital HIV care navigation intervention among young MSM and TW living with HIV, a disproportionate number of whom experienced gaps in HIV care and subsequent disparities in ART use and viral suppression.…”

Section: Methodsmentioning

confidence: 99%

Event-Level Association Between Daily Alcohol Use and Same-Day Nonadherence to Antiretroviral Therapy Among Young Men Who Have Sex With Men and Trans Women Living With HIV: Intensive Longitudinal Study

Turner

Trujillo

Lê

et al. 2020

JMIR Mhealth Uhealth

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Background Young trans women (TW) and men who have sex with men (MSM) are disproportionately impacted by HIV. Optimizing adherence to antiretroviral therapy (ART) is one mechanism by which public health experts aim to achieve favorable HIV health outcomes while reducing disease transmission. However, alcohol use is prevalent among young TW and MSM and threatens optimal adherence. In addition, the daily variations in alcohol use and ART adherence and their association with each other are poorly understood, warranting more appropriate methodological approaches, such as analysis of ecological momentary assessment (EMA) data. Objective The aim of this analysis is to characterize the association between daily alcohol use and same-day ART nonadherence captured by an EMA study of young MSM and TW living with HIV in San Francisco. Methods Young MSM and TW enrolled in the Health eNav digital HIV care navigation intervention were included in the analytic sample (N=113). Data on alcohol and ART use were collected by daily EMA surveys administered via text messaging and were analyzed over 30 days of follow-up. A multivariable mixed-effects logistic regression model adjusting for baseline sociodemographic characteristics was specified to investigate whether daily alcohol use was associated with same-day ART nonuse. Results Daily alcohol use was associated with higher same-day ART nonuse. On average, participants drank alcohol on 15.20 (SD 8.93) days and used ART on 15.19 (SD 10.16) days out of 30 days. Daily alcohol use was associated with 1.89 (95% CI 1.14-3.15) times the adjusted odds of same-day ART nonuse for each participant. Conclusions Results are consistent with other analyses of daily alcohol and ART use and underscore the importance of individually targeted interventions that are sensitive to each participant’s dynamic risk environment. International Registered Report Identifier (IRRID) RR2-10.2196/16406

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“…This study had a single-arm, prospective, pre-post design. Study procedures are described in-depth in a prior manuscript [8].…”

Section: Study Design and Recruitmentmentioning

confidence: 99%

Efficacy and Impact of Digital HIV Care Navigation in Young People Living With HIV in San Francisco, California: Prospective Study

Arayasirikul

Turner

Trujillo

et al. 2020

JMIR Mhealth Uhealth

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Background Young people are disproportionately impacted by HIV infection and exhibit poor HIV care continuum outcomes. Mobile health (mHealth) interventions are promising approaches to meet the unique needs of young people living with HIV. Youth-focused interventions are needed to improve HIV care continuum outcomes. Objective This study assessed the preliminary efficacy and impact of a digital HIV care navigation intervention among young people living with HIV in San Francisco. Health electronic navigation (eNavigation or eNav) is a 6-month, text message–based, digital HIV care navigation intervention, in which young people living with HIV are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. Methods This study had a single-arm, prospective, pre-post design. The analysis included 120 young men who have sex with men or transwomen living with HIV aged between 18 and 34 years. We analyzed self-reported sociobehavioral information pre- and postintervention at baseline and 6 months, which was collected using computer-assisted self-interviewing surveys. We characterized the sample and built generalized estimating equation (GEE) models to assess differences in HIV care continuum outcomes at baseline and 6 months. Results The characteristics according to the intervention completion status were not different from those of the overall sample. The mean age of the participants was 27.75 years (SD 4.07). Most participants (103/120, 85.8%) identified as men, and the sample was racially/ethnically diverse. At baseline, majority (99/120, 82.5%) of the participants had recently received primary HIV care, yet this was more likely in those who completed the intervention than in those who did not (54/60, 90% vs 45/60, 75%; χ21=4.68, P=.03). More than half of the sample reported taking antiretroviral therapy (92/120, 76.7%) and having an undetectable viral load (65/120, 54.2%). The 6-month follow-up surveys were completed by 73.3% (88/120) of participants, and these participants were not characteristically different from the overall sample at baseline. GEE models indicated that participants had increased odds of viral suppression at 6 months as compared with baseline. No relevant additive or multiplicative interactions were noted on comparing outcome effects over time according to intervention completion. Conclusions Digital HIV care navigation fills a critical gap in public health and HIV care systems, making these systems more responsive and accountable to the needs of the most vulnerable individuals. Our intervention bridges the time between primary care visits with interactive, tailored, personalized, and peer-delivered social support; information; and motivational interviewing to scaffold behavioral change. This study is part of the next wave of system-informed mHealth intervention research that will offer potentially disruptive solutions to traditional in-person delivered interventions and improve the health of the most vulnerable individuals. International Registered Report Identifier (IRRID) RR2-10.2196/16406

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Implementing a Digital HIV Care Navigation Intervention (Health eNav): Protocol for a Feasibility Study

Cited by 12 publications

References 28 publications

Effect of Social Determinants of Health on Uncontrolled Human Immunodeficiency Virus (HIV) Infection Among Persons With HIV in San Francisco, California

Effect of Social Determinants of Health on Uncontrolled Human Immunodeficiency Virus (HIV) Infection Among Persons With HIV in San Francisco, California

Event-Level Association Between Daily Alcohol Use and Same-Day Nonadherence to Antiretroviral Therapy Among Young Men Who Have Sex With Men and Trans Women Living With HIV: Intensive Longitudinal Study

Efficacy and Impact of Digital HIV Care Navigation in Young People Living With HIV in San Francisco, California: Prospective Study

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