Youth Engagement Study: Intervention to Increase HIV Treatment Engagement and Adherence for Young People Living With HIV
Condition: HIV/AIDS
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections
Study type: Interventional

Summary: 
      This pragmatic adaptive clinical trial will test the effects of a
      Stigma-Motivational-Decision intervention designed to increase HIV treatment engagement,
      retention, and medication adherence for substance using adolescents and young adults (AYA)
      living with HIV who are not in clinical care. The intervention uses a uniquely unified
      counseling approach at multiple points along the HIV continuum of care. The trial will use
      multiple modes of outreach including social media, passive media, clinic records, and chain
      referrals to seek and identify HIV positive AYA who are HIV untreated, under-dosed, or
      unsuppressed (HIV-U3). Participants will receive phone-delivered Stigma-Motivational-Decision
      counseling intervention sessions to achieve engagement or re-engagement in HIV care,
      treatment adherence and control of their HIV infection. Once viral control is achieved,
      participants will receive a low-cost approach to sustaining long-term retention in care and
      medication adherence.
    

Detailed description: 
      This pragmatic adaptive clinical trial will test the effects of a
      Stigma-Motivational-Decision intervention designed to increase HIV treatment engagement,
      retention, and antiretroviral (Art) medication adherence for substance using adolescents and
      young adults (AYA) living with HIV who are not in clinical care. The intervention uses a
      uniquely unified counseling approach at multiple points along the HIV continuum of care. In a
      first step, the study will use multiple modes of outreach including social media, passive
      media, clinic records, and chain referrals to seek and identify HIV positive AYA who are HIV
      untreated, under-dosed, or unsuppressed (HIV-U3). Identified AYA will be enrolled in a run-in
      to the trial to objectively confirm the following criteria for trial entry. In Step 2,
      Individuals who meet entry criteria -specifically - substance using HIV-U3 AYA - will be
      enrolled in a mobile health (mHealth) intervention to address substance use, HIV stigmas,
      medical care-related concerns, structural barriers, and other challenges to engaging youth in
      HIV care. Counseling will be provided weekly by cellphone until the time participants are
      receiving ART, adequately dosed on ART, and HIV suppressed within a maximum of 12 sessions
      (up to 3-months). The study will therefore determine the number of theory-based mHealth
      intervention sessions needed (minimally effective dose) for optimal treatment outcomes and
      the associated costs. Once engaged and optimally treated, Step 3 will conduct a randomized
      trial to test the comparative effects and cost effectiveness of two interventions to sustain
      long-term retention in care and medication adherence: (a) interactive text messaging with
      opportunities for ongoing supportive problem solving vs. (b) passive text message reminders.
      HIV positive AYA are likely to drop out of care because of known challenges such as substance
      use, social barriers such as stigma, and concerns regarding treatment. The 3-step study will
      use a single theory-based approach to determine the number of phone-delivered
      Stigma-Motivational-Decision counseling intervention sessions necessary to achieve engagement
      or re-engagement in HIV care, and will test the effects of a low-cost approach to sustaining
      long-term retention in care and medication adherence. The study will determine the minimally
      effective amount of counseling needed to engage substance using HIV positive AYA in care. The
      study will also test the effects of the counseling and text messaging interventions on
      maintaining HIV care retention, medication adherence, and HIV viral suppression over
      18-months. The study will perform economic evaluations to determine the cost-effectiveness of
      the engagement-retention-adherence intervention and the effects of low-burden
      retention/adherence interventions to maintain retention in care and avoid relapse to
      non-adherence for AYA living with HIV.
    

Intervention name(s): Youth Engagement in Services
Intervention type(s): Behavioral
Intervention description(s): Brief phone coaching to enhance engagement, retention, and sustain adherence to HIV and substance use services for younger people living with HIV.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment