Mediating Effects of Stigma and Depressive Symptoms in a Social Media–Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial

Abstract

Background Mobile health (mHealth) interventions have been shown to effectively improve the quality of life (QOL) among people living with HIV. However, little is known about the long-term effects of mHealth interventions. Objective This study aims to explore the intervention mechanisms of a social media–based intervention, Run4Love, on the QOL of people with HIV over across a 9-month follow-up period. Methods We recruited people living with HIV who were concurrently experiencing elevated depressive symptoms from an HIV outpatient clinic in South China. A total of 300 eligible participants were randomized either to the intervention group or the control group in a 1:1 ratio after they provided informed consent and completed a baseline survey. The intervention group received a 3-month WeChat-based intervention, comprising cognitive-behavioral stress management (CBSM) courses and physical activity promotion. The control group received a printed brochure on nutrition guidelines in addition to the usual care for HIV treatment. Neither participants nor the research staff were blinded to group assignment. All patients were followed at 3, 6, and 9 months. The primary outcome was depressive symptoms. Structural equation model (SEM) with longitudinal data was conducted to examine the sequential mediating effects of HIV-related stigma and depressive symptoms on the long-term intervention effects on participants’ QOL. Results About 91.3% (274/300), 88.3% (265/300), and 86.7% (260/300) of all participants completed follow-up surveys at 3, 6, and 9 months, respectively. Results showed that the intervention had significantly improved participants' QOL at 9 months, via complete mediating effects of reduced HIV-related stigma at 3 months and decreased depressive symptoms at 6 months. No adverse events were reported. Conclusions These findings underscore the critical roles of HIV-related stigma and depressive symptoms in an mHealth intervention with long-term effects on QOL improvements. We call for targeted mHealth interventions to improve QOL among people living with HIV, especially social media–based interventions that can address HIV-related stigma and alleviate depressive symptoms. Trial Registration Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019

Leveraging mHealth for the Treatment and Management of PLHIV

“…There were 18/74 (24%) instances of "improved mental health conditions" which included the following observations: Decreased anxiety, decreased depression, decreased stress, reduced suicidal ideations, and increased coping. 20,23,24,33,36,38,40,43,44,49,51 There were 13/74 (18%) instances of "increased care engagement" which included the following: increased patient-toprovider relationship, increased retention in treatment program, improved medication adherence, and increased selfefficacy. [21][22][23][24]29,31,34,38,39,47 There were 10/74 (14%) instances of changed behavior, which included the following: decreased risk-taking behavior, decreased risky sex behavior, increased mindfulness, decreased impulsivity, decreased condomless anal intercourse, changed diet, and safer sex agreements with partner.…”

“…22,31,32,39 There were 3/74 (4%) instances of two themes: decreased substance use, which included a decrease in drug cravings, [21][22][23] and an increased quality of life, which included peace of mind or increased confidence to enjoy a sex life. 44,45,51 There were 2/74 (3%) instances of four themes: decreased PLHIV stigma 36,44 and decreased interpersonal problems, which included fewer discordant relationships, 20,50 highlighting a digital literacy gap 41,48 and security or privacy concerns. 41,48 The last two results are also listed as barriers to adoption.…”

“…The intervention frees the patient from a typical HIV stigma usually felt when visiting the clinic occurred 23/119 (19%) times. 20,23,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][49][50][51] There were 15/119 (13%) instances of improvements in medical conditions, which included the following: weight loss, chills, sweats, fever, neuropathy, fatigue, genital tract inflammation, anxiety, depression,…”

“…As established in the literature, a summary table is provided in Table 1: PICOS (participants, intervention, comparison (to control or other group), observation, study design). Of the 32 studies analyzed over the 5-year period, two were from 2017, 20,21 five were from 2018, [22][23][24][25][26] ten were from 2019, [27][28][29][30][31][32][33][34][35][36] seven were from 2020, [37][38][39][40][41][42][43] five were from 2021, [44][45][46][47][48] and three were from 2022. [49][50][51] All the studies used adults as participants (>18).…”

Exploring core mental health symptoms among persons living with HIV: A network analysis

“…However, PLWH commonly suffer from mental health symptoms, which have become one of the major barriers to achieving the "90-90-90-90" goal (4). The global depression prevalence among PLWH is greater than 30% (5).…”