An Adaptive Antiretroviral Therapy Adherence Intervention for Youth with HIV Through Text Message and Cell Phone Support with and without Incentives: A Sequential Multiple Assignment Randomized Trial (SMART)

Authors

Marvin E Belzer
Karen MacDonell
Demetria Cain
Samiran Ghosh
Richard Zhao
Julie McAvoy-Banerjea
Sitaji Gurung
Sylvie Naar

Publication Date

3-1-2025

Journal

AIDS and Behavior

Abstract

Youth living with HIV have low rates of medication adherence. Youth ages 15-24 years with adherence ≤ 80% or with HIV RNA PCRs (VL) ≥ 200 recruited through social media and clinical sites were randomized to brief weekday cell phone support (CPS) calls or daily, two-way, personalized text message (SMS) reminders for 3 months. Those with VL ≥ 200 or adherence ≤ 80% were rerandomized to receive SMS or CPS with monthly incentives for those utilizing the intervention at least 75% of days for 3 months. Those with VL < 200 or adherence > 80% after the initial 3 months were rerandomized to usual care or 3 months of tapered, 2x/week CPS or SMS. Self-reported adherence and VLs were collected every 3 months for one year. Eighty-three youth were recruited with 81% identifying as cisgender males, 55% Black, 22% Latine/x, and 76% gay, and 56% recruited from the Southern US. Both cohorts initially randomized to CPS and SMS demonstrated significant improvements in adherence over the 12-months (P <.001). Participants randomized to CPS had significant improvements in 7-day self-reported adherence over 12 months compared to those on SMS (P <.027). Those receiving a tapered intervention for an additional 3 months had improved self-reported adherence compared to those randomized to the standard of care arm (P <.001). Both SMS and CPS appear to be effective interventions for youth with poor antiretroviral adherence. Tapering the intervention for an additional 3 months is useful in maintaining adherence after the initial intervention. Additional research is required to determine how to best sequence these interventions, including the use of incentives.

Keywords

Humans, Text Messaging, Male, Medication Adherence, Female, HIV Infections, Adolescent, Cell Phone, Reminder Systems, Young Adult, Motivation, Anti-HIV Agents, Viral Load, HIV, Medication adherence, Adolescents, RCT

DOI

10.1007/s10461-024-04558-x

PMID

39702557

PMCID

PMC11830638

PubMedCentral® Posted Date

12-20-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes