Supporting Health Behavior Among Persons Living With HIV Using Tech, MOST, and Behavioral Economics
Condition: HIV Seropositivity; Adherence, Medication
MeSH terms: HIV Seropositivity
Study type: Interventional

Summary: 
      The present study focuses on adult persons living with HIV in the New York City and Newark,
      New Jersey metropolitan areas who are not highly adherent to HIV medication and who do not
      evidence undetectable HIV viral load (the ultimate goal of HIV treatment). Those who have not
      decided whether they wish to take HIV medications are invited to enroll. The study uses
      technology, is grounded in principles of behavioral economics, and uses the multiphase
      optimization strategy (MOST) to examine the acceptability, feasibility, and evidence of
      efficacy of three intervention components. The components are intended to increase rates of
      HIV viral suppression in the sample. The three components are: prizes for viral suppression
      (fixed compensation [$275] or lottery prizes [up to $500]), text messages and quiz questions
      that generate points to earn prizes (to foster engagement), and counseling sessions grounded
      in the motivational interviewing approach to help participants articulate goals with respect
      to health and viral suppression, identify and resolve barriers to HIV medication use, and
      build motivation for viral suppression. Participants are assessed at baseline and then 5- and
      8-months later.
    

Detailed description: 
      The present study focuses on adult persons living with HIV who are not highly adherent to HIV
      medication and who do not evidence undetectable HIV viral load (the ultimate goal of HIV
      treatment). The study uses technology, is grounded in principles of behavioral economics, and
      uses the multiphase optimization strategy (MOST) to examine the acceptability, feasibility,
      and evidence of efficacy of three intervention components. The components are intended to
      increase rates of HIV viral suppression in the sample. All participants receive a core
      intervention comprised of referrals to care and case management. The three components are:
      compensation for viral suppression (fixed compensation or lottery-type prizes), weekly text
      messages and quiz questions (TMQQ) for 21 weeks that generate points to earn compensation (to
      foster engagement), and three counseling sessions grounded in the motivational interviewing
      (MI) approach to help participants articulate goals with respect to health and viral
      suppression, identify and resolve barriers to HIV medication use, and build motivation for
      viral suppression. We have previously tested variations of these components together as a
      "packaged" intervention and found high acceptability, feasibility, and evidence of efficacy.
      We now seek to understand this approach with more precision by testing the effects of
      individual components using MOST. The components will be tested in a factorial design with 8
      intervention conditions. Consistent with the factorial design, each condition will comprise a
      unique combination of components. Each condition includes at least one component.
      Participants will be recruited by a proven hybrid strategy that includes peer recruitment,
      ads placed in a free newspaper, and direct recruitment from an NYU Recruitment Registry
      managed by Dr. Gwadz. Participants will be screened for eligibility and a total of 80 adult
      persons living with HIV and with detectable HIV viral load will be enrolled in the study and
      randomly assigned to an intervention condition. Participants will be assessed at baseline and
      5- and 8-months post-baseline with a structured assessment battery. A subset will receive
      in-depth interviews. The primary outcome is viral suppression. This is a pilot study. It is
      not powered for efficacy but we will examine evidence of efficacy. All study activities can
      be carried out in a virtual format, and we can switch to in-person contact for screening,
      assessment, and some components when appropriate. In-person activities would be conducted at
      the New York University Silver field site in Manhattan. The study is funded through the
      Constance and Martin Silver Artificial Intelligence and Social Impact Fund at the New York
      University Silver School of Social Work.
    

Intervention name(s): MI sessions; TMQQ; Type of compensation
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Three counseling sessions lasting less than 60 minutes each to identify goals, factors that promote or impede goals, and increase "readiness" for ART with high adherence; Weekly text messages with health information as well as motivational messages. Two days later a true/false quiz question is sent. Participants earn 4 points for answering correctly, 2 points for answering incorrectly, and 0 points for not answering. Participants earn $1 for each point. Messages are sent over 21 weeks.; Participants who achieve HIV viral suppression at 21 weeks will receive either fixed compensation of $275 or be entered into a lottery where they have a 3/10 chance of winning $500, and a 7/10 chance of winning $175. Those who do not achieve HIV viral suppression receive a $50 participant incentive.
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: Factorial design with 3 components and 8 conditions
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: HIV; behavioral economics; adherence; HIV antiretroviral therapy; ART non-persistence; HIV non-suppression