Variation in local Ryan White HIV/AIDS program service use and impacts on viral suppression: informing quality improvement efforts

Wheatley, Margo M; Peterson, Aaron D; Wolfson, Julian; Hanft, Jonathan; Rowles, Darin; Blissett, Thomas; Enns, Eva A.

doi:10.1080/09540121.2022.2126960

Cited by 2 publications

(2 citation statements)

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“…We calculated 95% confidence intervals (CIs) for the main effect of each intervention component in a model for log 10 HIV viral load at the second FU. Missing data were imputed 80 times with a chained equation approach where baseline HIV viral load, first FU HIV viral load, and all intervention components were included in the imputation model.…”

Section: Confidence Intervalsmentioning

confidence: 99%

“…For example, most PLWH are virally suppressed (66%) (1). However, African American/Black and Latino persons living with HIV, who are mainly from socioeconomically disadvantaged backgrounds, experience disproportionately lower rates of engagement along the HIV care continuum compared to White PLWH, including in HIV viral suppression and sustained HIV viral suppression (6)(7)(8)(9)(10). Only an estimated 40% of African American/Black and 50% of Latino PLWH sustain HIV viral suppression, compared to 56% of their White counterparts (7).…”

Section: Introductionmentioning

confidence: 99%

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A virtual pilot optimization trial for African American/Black and Latino persons with non-suppressed HIV viral load grounded in motivational interviewing and behavioral economics

Filippone

Serrano

Gwadz

et al. 2023

Front. Public Health

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IntroductionVirtual and low-touch behavioral interventions are needed for African American/Black and Latino persons living with HIV (PLWH) with barriers to HIV viral suppression, particularly during COVID-19. Guided by the multiphase optimization strategy, we explored three components for PLWH without viral suppression, grounded in motivational interviewing and behavioral economics: (1) motivational interviewing counseling, (2) 21-weeks of automated text messages and quiz questions about HIV management, and (3) financial rewards for viral suppression (lottery prize vs. fixed compensation).MethodsThis pilot optimization trial used sequential explanatory mixed methods to explore the components' feasibility, acceptability, and preliminary evidence of effects using an efficient factorial design. The primary outcome was viral suppression. Participants engaged in baseline and two structured follow-up assessments over an 8-month period, and provided laboratory reports to document HIV viral load. A subset engaged in qualitative interviews. We carried out descriptive quantitative analyses. Then, qualitative data were analyzed using directed content analysis. Data integration used the joint display method.ResultsParticipants (N = 80) were 49 years old, on average (SD = 9), and 75% were assigned male sex at birth. Most (79%) were African American/Black, and the remainder were Latino. Participants were diagnosed with HIV 20 years previously on average (SD = 9). Overall, components were feasible (>80% attended) and acceptability was satisfactory. A total of 39% (26/66) who provided laboratory reports at follow-up evidenced viral suppression. Findings suggested no components were entirely unsuccessful. The lottery prize compared to fixed compensation was the most promising component level. In qualitative analyses, all components were seen as beneficial to individual wellbeing. The lottery prize appeared more interesting and engaging than fixed compensation. However, structural barriers including financial hardship interfered with abilities to reach viral suppression. The integrated analyses yielded areas of convergence and discrepancy and qualitative findings added depth and context to the quantitative results.ConclusionsThe virtual and/or low-touch behavioral intervention components tested are acceptable and feasible and show enough potential to warrant refinement and testing in future research, particularly the lottery prize. Results must be interpreted in the context of the COVID-19 pandemic.Trial registrationNCT04518241 (https://clinicaltrials.gov/ct2/show/NCT04518241).

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Section: Confidence Intervalsmentioning

confidence: 99%