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AIDS and Behavior

, Volume 23, Issue 11, pp 3184–3198 | Cite as

A Pilot Study of a Mobile App to Support HIV Antiretroviral Therapy Adherence Among Men Who Have Sex with Men Who Use Stimulants

  • Keith J. HorvathEmail author
  • Sara Lammert
  • Richard F. MacLehose
  • Thu Danh
  • Jason V. Baker
  • Adam W. Carrico
Original Paper

Abstract

APP+ is a theoretically-grounded mobile app intervention to improve antiretroviral (ART) adherence among men who have sex with men (MSM) who use stimulants. We assessed the feasibility and acceptability of APP+ in a six-month randomized controlled trial among a national sample of 90 MSM recruited online; secondarily, we examined changes in self-reported ART adherence by study arm. Retention at the final assessment was 82%, and acceptability ratings were comparable to other technology-based interventions. MSM in the APP+ group reported higher self-reported percentage ART adherence in the past 30 days at the four-month timepoint compared to a no-treatment control group (89.0% vs. 77.2%). However, once access to the app was removed after month four, group differences in ART adherence diminished by month six. APP+ may be a potentially promising intervention approach for MSM living with HIV who use stimulants but would require enhancements to optimize acceptability and demonstrate more sustained effects.

Keywords

HIV/AIDS Medication adherence Drug use Mobile app 

Notes

Acknowledgements

We would like to thank participants for the time they offered during the conduct of this study. Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R34DA033833. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

References

  1. 1.
    Centers for Disease Control and Prevention. HIV surveillance report, 2017; vol. 29 2018. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2017-vol-29.pdf. Accessed 13 July 2019.
  2. 2.
    Singh S, Mitsch A, Wu B. HIV care outcomes among men who have sex with men with diagnosed HIV infection—United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66(37):969–74.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet. 9651;372:1733–45.Google Scholar
  4. 4.
    El-Bassel N, Shaw SA, Dasgupta A, Strathdee SA. Drug use as a driver of HIV risks: re-emerging and emerging issues. Curr Opin HIV AIDS. 2014;9(2):150–5.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Lansky A, Finlayson T, Johnson C, Holtzman D, Wejnert C, Mitsch A, et al. Estimating the number of persons who inject drugs in the united states by meta-analysis to calculate national rates of HIV and Hepatitis C virus infections. PLoS ONE. 2014;9(5):e97596.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Plankey MW, Ostrow DG, Stall R, Cox C, Li X, Peck JA, et al. The relationship between methamphetamine and popper use and risk of HIV seroconversion in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr. 2007;45(1):85–92.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Thiede H, Jenkins RA, Carey JW, Hutcheson R, Thomas KK, Stall RD, et al. Determinants of recent HIV infection among Seattle-area men who have sex with men. Am J Public Health. 2009;99(Suppl 1):S157–64.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Melendez-Torres GJ, Bourne A. Illicit drug use and its association with sexual risk behaviour among MSM: more questions than answers? Curr Opin Infect Dis. 2016;29(1):58–63.PubMedGoogle Scholar
  9. 9.
    Zlotorzynska M, Sullivan P, Sanchez T. The annual American men’s internet survey of behaviors of men who have sex with men in the United States: 2015 key indicators report. JMIR Public Health Surveill. 2017;3(1):e13.PubMedPubMedCentralGoogle Scholar
  10. 10.
    National Institute on Drug Abuse. Commonly abused drugs charts. https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts. Accessed 13 July 2019.
  11. 11.
    Reback CJ, Fletcher JB, Shoptaw S, Grella CE. Methamphetamine and other substance use trends among street-recruited men who have sex with men, from 2008 to 2011. Drug Alcohol Depend. 2013;133(1):262–5.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Forrest DW, Metsch LR, LaLota M, Cardenas G, Beck DW, Jeanty Y. Crystal methamphetamine use and sexual risk behaviors among HIV-positive and HIV-negative men who have sex with men in South Florida. J Urban Health: Bull N Y Acad Med. 2010;87(3):480–5.Google Scholar
  13. 13.
    Reback CJ, Fletcher JB. Reductions in HIV prevalence rates among substance-using men who have sex with men in Los Angeles County, 2008-2011. AIDS Educ Prev. 2014;26(5):459–70.PubMedGoogle Scholar
  14. 14.
    Ostrow DG, Plankey MW, Cox C, Li X, Shoptaw S, Jacobson LP, et al. Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS. J Acquir Immune Defic Syndr. 2009;51(3):349–55.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Carrico AW, Riley ED, Johnson MO, Charlebois ED, Neilands TB, Remien RH, et al. Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of antiretroviral therapy utilization. J Acquir Immune Defic Syndr. 2011;56(2):146–50.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Mayer KH, Skeer MR, O’Cleirigh C, Goshe BM, Safren SA. Factors associated with amplified HIV transmission behavior among American men who have sex with men engaged in care: implications for clinical providers. Ann Behav Med. 2014;47(2):165–71.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Carrico AW, Hunt PW, Neilands TB, Dilworth SE, Martin JN, Deeks SG, et al. Stimulant use and viral suppression in the era of universal antiretroviral therapy. J Acquir Immune Defic Syndr. 2019;80(1):89–93.PubMedGoogle Scholar
  18. 18.
    Carrico AW. Substance use and HIV disease progression in the HAART era: implications for the primary prevention of HIV. Life Sci. 2011;88(21–22):940–7.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Carrico AW, Shoptaw S, Cox C, Stall R, Li X, Ostrow DG, et al. Stimulant use and progression to AIDS or mortality after the initiation of highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2014;67(5):508–13.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Adams JW, Bryant KJ, Edelman EJ, Fiellin DA, Gaither JR, Gordon AJ, et al. Association of cannabis, stimulant, and alcohol use with mortality prognosis among HIV-infected men. AIDS Behav. 2018;22(4):1341–51.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Centers for Disease Control and Prevention. Compendium of evidence-based HIV behavioral interventions: medication adherence chapter: CDC; 2017. https://www.cdc.gov/hiv/research/interventionresearch/compendium/ma/index.html. Accessed 13 July 2019.
  22. 22.
    Kurth AE, Spielberg F, Cleland CM, Lambdin B, Bangsberg DR, Frick PA, et al. Computerized counseling reduces HIV-1 viral load and sexual transmission risk: findings from a randomized controlled trial. J Acquir Immune Defic Syndr. 2014;65(5):611–20.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Johnson MO, Charlebois E, Morin SF, Remien RH, Chesney MA. Effects of a behavioral intervention on antiretroviral medication adherence among people living with HIV: the healthy living project randomized controlled study. J Acquir Immune Defic Syndr. 2007;46(5):574–80.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Milam J, Richardson JL, McCutchan A, Stoyanoff S, Weiss J, Kemper C, et al. Effect of a brief antiretroviral adherence intervention delivered by HIV care providers. J Acquir Immune Defic Syndr. 2005;40(3):356–63.PubMedGoogle Scholar
  25. 25.
    Remien RH, Stirratt MJ, Dolezal C, Dognin JS, Wagner GJ, Carballo-Dieguez A, et al. Couple-focused support to improve HIV medication adherence: a randomized controlled trial. Aids. 2005;19(8):807–14.PubMedGoogle Scholar
  26. 26.
    Altice FL, Maru DS, Bruce RD, Springer SA, Friedland GH. Superiority of directly administered antiretroviral therapy over self-administered therapy among HIV-infected drug users: a prospective, randomized, controlled trial. Clin Infect Dis. 2007;45(6):770–8.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Lucas GM, Mullen BA, Weidle PJ, Hader S, McCaul ME, Moore RD. Directly administered antiretroviral therapy in methadone clinics is associated with improved HIV treatment outcomes, compared with outcomes among concurrent comparison groups. Clin Infect Dis. 2006;42(11):1628–35.PubMedGoogle Scholar
  28. 28.
    Simoni JM, Kutner BA, Horvath KJ. Opportunities and challenges of digital technology for HIV treatment and prevention. Curr HIV/AIDS Rep. 2015;12:437–40.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Horvath KJ, Lammert S, LeGrand S, Muessig KE, Bauermeister JA. Using technology to assess and intervene with illicit drug-using persons at risk for HIV. Curr Opin HIV AIDS. 2017;12(5):458–66.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Westergaard RP, Genz A, Panico K, Surkan PJ, Keruly J, Hutton HE, et al. Acceptability of a mobile health intervention to enhance HIV care coordination for patients with substance use disorders. Addict Sci Clin Pract. 2017;12(1):11.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Himelhoch S, Kreyenbuhl J, Palmer-Bacon J, Chu M, Brown C, Potts W. Pilot feasibility study of Heart2HAART: a smartphone application to assist with adherence among substance users living with HIV. AIDS Care. 2017;29:898–904.PubMedGoogle Scholar
  32. 32.
    Glasner-Edwards S, Patrick K, Ybarra ML, Reback CJ, Rawson RA, Chokron Garneau H, et al. A cognitive behavioral therapy-based text messaging intervention versus medical management for HIV-infected substance users: study protocol for a pilot randomized trial. JMIR Res Protoc. 2016;5(2):e131.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Muessig KE, LeGrand S, Horvath KJ, Bauermeister JA, Hightow-Weidman LB. Recent mobile health interventions to support medication adherence among HIV-positive MSM. Curr Opin HIV AIDS. 2017;12(5):432–41.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Carrico AW, Zepf R, Meanley S, Batchelder A, Stall R. Critical review: when the party is over: a systematic review of behavioral interventions for substance-using men who have sex with men. J Acquir Immune Defic Syndr. 2016;73(3):299–306.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Burnham KE, Cruess DG, Kalichman MO, Grebler T, Cherry C, Kalichman SC. Trauma symptoms, internalized stigma, social support, and sexual risk behavior among HIV-positive gay and bisexual MSM who have sought sex partners online. AIDS Care. 2016;28(3):347–53.PubMedGoogle Scholar
  36. 36.
    Wilson IB, Lee Y, Michaud J, Fowler FJ Jr, Rogers WH. Validation of a new three-item self-report measure for medication adherence. AIDS Behav. 2016;20(11):2700–8.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Simoni J, Kurth A, Pearson C, Pantalone D, Merrill J, Frick P. Self-report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav. 2006;10(3):227–45.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Walsh JC, Mandalia S, Gazzard BG. Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome. AIDS. 2002;16(2):269–77.PubMedGoogle Scholar
  39. 39.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1992;1:385–401.Google Scholar
  40. 40.
    Zhang W, O’Brien N, Forrest JI, Salters KA, Patterson TL, Montaner JS, et al. Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada. PLoS ONE. 2012;7(7):e40793.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Wong MD, Sarkisian CA, Davis C, Kinsler J, Cunningham WE. The association between life chaos, health care use, and health status among HIV-infected persons. J Gen Intern Med. 2007;22(9):1286–91.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17(5):1785–95.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II. Addiction. 1993;88(6):791–804.PubMedPubMedCentralGoogle Scholar
  44. 44.
    The LifeWindows Project Team. The LifeWindows information motivation behavioral skills ART adherence questionnaire (LW-IMB-AAQ). Storrs: University of Connecticut: Center for Health, Intervention, and Prevention; 2006.Google Scholar
  45. 45.
    Brook J. A quick and dirty usability scale. In: Jordan PW, Thomas B, Weerdmeester BA, McClellend, editors. Usability Evaluation in industry. London: Taylor Francis; 1996.Google Scholar
  46. 46.
    Sullivan PS, Driggers R, Stekler JD, Siegler A, Goldenberg T, McDougal SJ, et al. Usability and acceptability of a mobile comprehensive HIV prevention app for men who have sex with men: a pilot study. JMIR Mhealth Uhealth. 2017;5(3):e26.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, et al. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA. 1996;276(8):637–9.Google Scholar
  48. 48.
    Abshire M, Dinglas VD, Cajita MIA, Eakin MN, Needham DM, Himmelfarb CD. Participant retention practices in longitudinal clinical research studies with high retention rates. BMC Med Res Methodol. 2017;17(1):30.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Walters SJ, Bonacho dos Anjos Henriques-Cadby I, Bortolami O, Flight L, Hind D, Jacques RM, et al. Recruitment and retention of participants in randomised controlled trials: a review of trials funded and published by the United Kingdom Health Technology Assessment Programme. BMJ Open. 2017;7(3):76.Google Scholar
  50. 50.
    Reback CJ, Grant DL, Fletcher JB, Branson CM, Shoptaw S, Bowers JR, et al. Text messaging reduces HIV risk behaviors among methamphetamine-using men who have sex with men. AIDS Behav. 2012;16(7):1993–2002.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Reback CJ, Shoptaw S. Development of an evidence-based, gay-specific cognitive behavioral therapy intervention for methamphetamine-abusing gay and bisexual men. Addict Behav. 2014;39(8):1286–91.PubMedGoogle Scholar
  52. 52.
    Hirshfield S, Chiasson MA, Joseph H, Scheinmann R, Johnson WD, Remien RH, et al. An online randomized controlled trial evaluating HIV prevention digital media interventions for men who have sex with men. PLoS ONE. 2012;7(10):e46252.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2016. 2017 June 2018.Google Scholar
  54. 54.
    Centers for Disease Control and Prevention. HIV surveillance report, 2016. 2017 March 21, 2018.Google Scholar
  55. 55.
    Darbes L, Crepaz N, Lyles C, Kennedy G, Rutherford G. The efficacy of behavioral interventions in reducing HIV risk behaviors and incident sexually transmitted diseases in heterosexual African Americans. Aids. 2008;22(10):1177–94.PubMedPubMedCentralGoogle Scholar
  56. 56.
    U.S. Deptartment of Health and Human Services. Usability Testing. http://www.usability.gov/how-to-and-tools/methods/usability-testing.html. Accessed 13 July 2019.
  57. 57.
    Reback CJ, Fletcher JB, Shoptaw S, Mansergh G. Exposure to theory-driven text messages is associated with HIV risk reduction among methamphetamine-using men who have sex with men. AIDS Behav. 2015;19(Suppl 2):130–41.PubMedGoogle Scholar
  58. 58.
    Gustafson DH Sr, Landucci G, McTavish F, Kornfield R, Johnson RA, Mares ML, et al. The effect of bundling medication-assisted treatment for opioid addiction with mHealth: study protocol for a randomized clinical trial. Trials. 2016;17(1):592.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Guarino H, Acosta M, Marsch LA, Xie H, Aponte-Melendez Y. A mixed-methods evaluation of the feasibility, acceptability, and preliminary efficacy of a mobile intervention for methadone maintenance clients. Psychol Addict Behav: J Soc Psychol Addict Behav. 2016;30(1):1–11.Google Scholar
  60. 60.
    Cordova D, Alers-Rojas F, Lua FM, Bauermeister J, Nurenberg R, Ovadje L, et al. The usability and acceptability of an adolescent mHealth HIV/STI and drug abuse preventive intervention in primary care. Behav Med. 2018;44(1):36–47.PubMedGoogle Scholar
  61. 61.
    Marlatt GA. Harm reduction: pragmatic strategies for managing high-risk behaviors. New York: Guilford Press; 1998.Google Scholar
  62. 62.
    Finitsis DJ, Pellowski JA, Huedo-Medina TB, Fox MC, Kalichman SC. Visual analogue scale (VAS) measurement of antiretroviral adherence in people living with HIV (PLWH): a meta-analysis. J Behav Med. 2016;39(6):1043–55.PubMedGoogle Scholar
  63. 63.
    Glick SN, Burt R, Kummer K, Tinsley J, Banta-Green CJ, Golden MR. Increasing methamphetamine injection among non-MSM who inject drugs in King County, Washington. Drug Alcohol Depend. 2018;182:86–92.PubMedGoogle Scholar
  64. 64.
    Sewell J, Cambiano V, Miltz A, Speakman A, Lampe FC, Phillips A, et al. Changes in recreational drug use, drug use associated with chemsex, and HIV-related behaviours, among HIV-negative men who have sex with men in London and Brighton, 2013–2016. Sex Transm Infect. 2018;94:494–501.PubMedPubMedCentralGoogle Scholar

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Authors and Affiliations

  1. 1.Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisUSA
  2. 2.Division of Infectious DiseasesHennepin HealthcareMinneapolisUSA
  3. 3.Department of MedicineUniversity of MinnesotaMinneapolisUSA
  4. 4.School of MedicineUniversity of MiamiCoral GablesUSA

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