Targeting PM to Improve HIV Adherence in Adolescents at Risk for Substance Abuse
Condition: Adherence; Substance Abuse
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      Medication adherence rates among youth living with HIV are inadequate to effectively manage
      the disease, and novel interventions grounded in basic behavioral sciences are needed. This
      multi-site phased (3 phases) study plans to translate basic cognitive neuroscience regarding
      prospective memory (PM) into a more potent adherence intervention for youth living with HIV
      (YLH).

      The phases are:

      Phase 1: To improve PM in basic laboratory tasks in YLH with and without substance abuse.

      -Hypothesis 1: Manipulations in three theory-based components of PM (strategic encoding,
      self-monitoring and cue salience) will improve PM within each participant.

      Phase 2: To conduct proof of concept studies of a text-delivered PM intervention for taking
      ART in YLH with suboptimal adherence.

        -  Hypothesis 2: Using a multiple baseline across subjects design, adherence to
           antiretroviral therapy (ART) will improve following initiation of the PM adherence
           intervention and will be maintained for 6 weeks after tapering of the intervention.

        -  Hypothesis 2a: Similar feasibility, tolerability, and adherence improvement trends will
           be seen in youth with and without substance problems.

      Phase 3: To conduct additional proof of concept studies, based on Phase 2 findings, of a
      text-delivered PM intervention for taking ART in YLH with suboptimal adherence.

        -  Hypothesis 3: Using a multiple baseline across subjects design, adherence to ART will
           improve following initiation of the PM adherence intervention and will be maintained for
           6 weeks after tapering of the intervention.

        -  Hypothesis 3a: Similar feasibility, tolerability, and adherence improvement trends will
           be seen in youth.
    

Detailed description: 
      Medication adherence rates among youth living with HIV are inadequate to effectively manage
      the disease, and novel interventions grounded in basic behavioral sciences are needed.
      Emerging evidence suggests that prospective memory (PM) could represent an important piece of
      the puzzle. PM is defined as the neurocognitive capacity to successfully form, maintain, and
      execute an intention at a particular point in the future in response to a specific cue. This
      study plans to translate basic cognitive neuroscience regarding PM into a more potent
      adherence intervention for YLH, a population at high risk for poor cognitive function,
      substance abuse, and poor adherence. While text message reminders are an increasingly popular
      adherence support, evidence of efficacy is equivocal particularly for the maintenance of
      adherence after reminders end. By using basic cognitive neuroscience to enhance the potency
      of technology-based interventions to improve PM for adherence tasks, we hope to achieve both
      greater initial gains as well as sustained improvements in adherence for youth with and
      without substance abuse.

      This multi-site phased study plans to translate basic cognitive neuroscience regarding PM
      into a more potent adherence intervention for youth living with HIV (YLH).

        -  In Phase 1, we conducted theory-driven laboratory studies to improve three components of
           PM using a within-subjects design and traditional cognitive neuroscience tasks
           (strategic encoding, monitoring, and cue salience) in 60 youth from clinics where the
           principal investigators (PIs) are located (Detroit and San Diego).

        -  In Phase 2, we translated promising Phase 1 PM interventions to the youth's natural
           context, targeting adherence in combination with text messaging, and test for signals of
           efficacy using a multiple baseline design for YLH with suboptimal adherence (N=24; 12
           with substance abuse and 12 without from Detroit).

        -  In Phase 3, we repeated the Phase 2 study (targeted adherence in combination with text
           message reminders and two-way assessment text messages, and tested for signals of
           efficacy using a multiple baseline design for YLH with suboptimal adherence; N=20;
           Detroit and national online recruitment).
    

Intervention name(s): PM Component Text Reminders
Intervention type(s): Behavioral
Intervention description(s): The number of PM components (strategic encoding, monitoring, and cue salience) that will comprise the tailored text reminders will be determined by Phase 1.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: HIV; Substance Abuse; Prospective Memory