Purpose: In the United States, 42% of adults, and 81% of adults over 65 years of age live with multiple chronic condition (MCC). Current interventions to facilitate engagement in care focus primarily on the patient; however, many individuals with MCC manage and live with their conditions within the context of their family. This review sought to identify interventions used to facilitate patient and/or family engagement among adults with MCC. Methods: We adhered as closely as possible to PRISMA guidelines and conducted a systematic scoping review using a modified approach by Arksey and O’Malley. We searched PubMed, Web of Science, and Scopus using terms related to MCC, patient and family engagement, and intervention. We included articles that: (1) were published in English; (2) were peer-reviewed; (3) described an engagement intervention (with or without a comparator); and (4) targeted individuals with MCC. We abstracted data from included articles and classified them using the Multidimensional Framework for Patient and Family Engagement in Health and Health Care, and the Classification Model of Patient Engagement. Results: We identified 21 discrete interventions. Six (29%) were classified as having the highest degree of engagement. Eighteen (85%) focused on engagement at the direct care level. Only one was specifically designed to engage families. Conclusions: Many engagement interventions currently exist for adults with MCC. Few of these interventions foster the highest degree of engagement; most focus on engagement at the level of direct care and do not specifically target family member involvement.

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Background Adherence to antiretroviral (ARV) therapy is critical for achieving HIV RNA suppression in people living with HIV and for preventing HIV infection in uninfected individuals using preexposure prophylaxis. However, a high level of adherence can be challenging to achieve for people living with HIV on lifelong ARVs and for HIV-negative individuals using daily preexposure prophylaxis who are not at daily risk for HIV infection. Current biological measures of adherence are invasive and use bioanalytical methods that do not allow for real-time feedback during a clinic visit. This study was designed to test the feasibility and acceptability of using MedViewer, a novel, minimally invasive, hair-based assay that measures longitudinal ARV drug adherence in real time and provides an output for provider-patient discussion. Objective The primary objectives were to investigate the feasibility of delivering the MedViewer results as planned, the acceptability of participation in a discussion of the MedViewer results, and the appropriateness of using MedViewer for adherence counseling. The secondary objectives were to investigate additional dimensions of feasibility, acceptability, and appropriateness of using the MedViewer test during a routine clinic visit for people with HIV. Methods The proposed study was a single-arm cross-sectional study among patients receiving HIV care and providers of HIV care in a southeastern infectious disease clinic. The study originally planned to implement the MedViewer test with 50 eligible patients who were living with HIV across 2 viral load strata (undetectable or detectable plasma HIV RNA over the previous 2 years), administer brief visit-specific questionnaires to all patient and provider participants, and conduct qualitative in-depth interviews and quantitative end-line questionnaires with a subsample of patient participants (n=30) and all provider participants. Results The Establishing Novel Antiretroviral Imaging for Hair to Elucidate Nonadherence study was funded by the National Institute of Allergy and Infectious Diseases and approved by the local institutional review board on November 4, 2019. Provider participant enrollment began on January 17, 2020, and patient participant enrollment began on January 22, 2020. Participant enrollment was halted on March 16, 2020, because of the COVID-19 pandemic (16 providers and 10 patients on study). Study activities resumed on February 2, 2021, with COVID-19 modifications approved by the local institutional review board. Participant enrollment closed on October 8, 2021, and data collection closed on November 15, 2021. In total, 36 unique patient participants, representing 37 samples, and 20 provider participants were enrolled. Data analysis and manuscript writing will take place throughout 2023. Conclusions We anticipate that the data collected through this study will provide important insights regarding the feasibility, acceptability, and appropriateness of incorporating new real-time longitudinal, minimally invasive adherence tests into routine clinical care and identify potential barriers to medication adherence among patients. Trial Registration ClinicalTrials.gov NCT04232540; https://clinicaltrials.gov/ct2/show/NCT04232540 International Registered Report Identifier (IRRID) RR1-10.2196/41188

BACKGROUND Adherence to antiretroviral (ARV) therapy is critical for achieving HIV RNA suppression in people living with HIV and for preventing HIV acquisition in uninfected individuals using pre-exposure prophylaxis (PrEP). Yet a high level of adherence can be challenging to achieve for people living with HIV on life-long ARVs and for HIV-negative individuals using daily PrEP who are not at daily risk for HIV acquisition. Current biological measures of adherence are invasive and utilize bioanalytical methods that don’t allow for real-time feedback during a clinic visit. This study is designed to test the feasibility and acceptability of using MedViewer (MV), a novel, minimally invasive, hair-based assay that measures longitudinal antiretroviral drug adherence in real-time and provides an output for provider-patient discussion. OBJECTIVE The primary objectives are to investigate the feasibility of delivering the MV results as planned, the acceptability of participation in a discussion of the MV results, and the appropriateness of using MV for adherence counseling. The secondary objectives are to investigate additional dimensions of feasibility, acceptability, and appropriateness of using the MV test during a routine clinic visit for people with HIV. METHODS The proposed study is a single-arm cross-sectional study among patients receiving HIV care and providers of HIV care in a southeastern Infectious Diseases Clinic. The study originally planned to implement the MV test with 50 eligible patients who were living with HIV across two viral load strata (undetectable or detectable plasma HIV RNA over the past 2 years), administer brief visit-specific questionnaires to all patient and provider participants, and to conduct qualitative in-depth interviews (IDIs) and quantitative endline questionnaires with a subsample of patient participants (n=30) and all provider participants. RESULTS The ENLIGHTEN study was funded by NIAID and was approved by the local IRB on November 04, 2019. Provider participant enrollment began on January 17, 2020 and patient participant enrollment began on January 22, 2020. Participant enrollment was halted on March 16, 2020 due to the COVID-19 pandemic. Study activities resumed on February 02, 2021 with COVID-19 modifications approved by the local IRB. Participant enrollment closed on October 08, 2021 and data collection closed on November 15, 2021. In total, 36 unique patient participants were enrolled representing 37 samples, and 20 provider participants were enrolled. Data analysis and manuscript writing will take place through 2022. CONCLUSIONS We anticipate the data collected through this protocol will provide important insights regarding the feasibility, acceptability, and appropriateness of incorporating a new real-time longitudinal, minimally invasive adherence tests into routine clinical care and identify potential barriers to medication adherence among patients. CLINICALTRIAL NCT04232540