The Use of Cell Phone Support for Non-adherent HIV-Infected Youth and Young Adults: An Initial Randomized and Controlled Intervention Trial

Abstract

This randomized behavioral trial examined whether youth living with HIV (YLH) receiving cell-phone support with study funded phone plans, demonstrated improved adherence and viral control during the 24 week intervention and 24 weeks post-intervention compared to controls. Monday through Friday phone calls confirmed medications were taken, provided problem-solving support, and referred to services to address adherence barriers. Of 37 participants (ages 15–24), 62 % were male and 70 % were African American. Self-reported adherence was significantly higher in the intervention group compared to the control at 24 and 48 weeks for the past month (P = 0.007) and log 10 HIV VL was significantly lower at both 24 weeks (2.82 versus 4.52 P = 0.002) and 48 weeks (3.23 versus 4.23 P = 0.043). Adherence and viral load showed medium to large effect sizes across the 48 week study. This is the first study to demonstrate sustained clinically significant reductions in HIV VL using youth friendly technology.

Acceptability and Feasibility of a Cell Phone Support Intervention for Youth Living with HIV with Nonadherence to Antiretroviral Therapy

“…14 The study was conducted between February 2010 and November 2011. Briefly, 37 participants were enrolled with 19 randomized to the intervention and 18 to the control group.…”

“…Adherence decreased in the control group over the 48 weeks. 14 Findings indicate a very nonadherent cohort that likely represent the least adherent youth living with HIV.…”

Understanding Adolescent Nonresponsiveness to Text Messages: Lessons from the DepoText Trial

“…7 A systematic review (2009) of 14 RCTs using text message interventions showed positive preventative health and clinical care behavioral outcomes. 8 Moreover, access to technology does not appear to be a limiting factor in the implementation of such a program: in a focus group of urban minority and low-income youth, participants denied the existence of a Bdigital divide^or that a technology-based intervention would fail due to access difficulties.…”

Triggered Escalating Real-Time Adherence Intervention to Promote Rapid HIV Viral Suppression Among Youth Living With HIV Failing Antiretroviral Therapy: Protocol for a Triggered Escalating Real-Time Adherence Intervention (Preprint)

“…While texting has a strong evidence base for adults [14] [16] [37], use with youth, while intuitively appealing given the widespread use of texting, remains supported largely only by pilot studies. [19] Similarly, phone-based problem solving discussion with adherence coaches has preliminary evidence [20] demonstrated in a pilot study. Our work leverages the wealth of pilot evidence to create an intervention approach with demonstrated promise but not yet rigorously evaluated.…”

“…Evidence has supported the utility of phone-based outreach using a problem solving approach. [20] [21] In a recent review, harnessing mobile phone technology was identified as a promising area for future interventions encouraging optimal adherence among YLWH. [18] Furthermore, evidence suggests using phone-based technology to engage adolescent social support networks may promote optimal engagement in care and adherence to medications.…”