An Adaptive Antiretroviral Therapy Adherence Intervention for Youth with HIV Through Text Message and Cell Phone Support with and without Incentives: A Sequential Multiple Assignment Randomized Trial (SMART)

Marvin E Belzer; Karen MacDonell; Demetria Cain; Samiran Ghosh; Richard Zhao; Julie McAvoy-Banerjea; Sitaji Gurung; Sylvie Naar

doi:10.1007/s10461-024-04558-x

An Adaptive Antiretroviral Therapy Adherence Intervention for Youth with HIV Through Text Message and Cell Phone Support with and without Incentives: A Sequential Multiple Assignment Randomized Trial (SMART)

AIDS Behav. 2024 Dec 20. doi: 10.1007/s10461-024-04558-x. Online ahead of print.

Authors

Marvin E Belzer¹, Karen MacDonell², Demetria Cain³, Samiran Ghosh⁴, Richard Zhao³, Julie McAvoy-Banerjea⁵, Sitaji Gurung⁶, Sylvie Naar²

Affiliations

¹ Children's Hospital of Los Angeles, Los Angeles, CA, USA. mbelzer@chla.usc.edu.
² Center for Translational Behavioral Science, Florida State University, Tallahassee, FL, USA.
³ Department of Psychology, Hunter College, City University of New York, New York, NY, USA.
⁴ Department of Biostatistics and Data Science, University of Texas School of Public Health, Houston, TX, USA.
⁵ Children's Hospital of Los Angeles, Los Angeles, CA, USA.
⁶ Department of Health Sciences, New York College of Technology, City University of New York, New York, NY, USA.

PMID: 39702557
DOI: 10.1007/s10461-024-04558-x

Abstract

Youth living with HIV have low rates of medication adherence. Youth ages 15-24 years with adherence ≤ 80% or with HIV RNA PCRs (VL) ≥ 200 recruited through social media and clinical sites were randomized to brief weekday cell phone support (CPS) calls or daily, two-way, personalized text message (SMS) reminders for 3 months. Those with VL ≥ 200 or adherence ≤ 80% were rerandomized to receive SMS or CPS with monthly incentives for those utilizing the intervention at least 75% of days for 3 months. Those with VL < 200 or adherence > 80% after the initial 3 months were rerandomized to usual care or 3 months of tapered, 2x/week CPS or SMS. Self-reported adherence and VLs were collected every 3 months for one year. Eighty-three youth were recruited with 81% identifying as cisgender males, 55% Black, 22% Latine/x, and 76% gay, and 56% recruited from the Southern US. Both cohorts initially randomized to CPS and SMS demonstrated significant improvements in adherence over the 12-months (P <.001). Participants randomized to CPS had significant improvements in 7-day self-reported adherence over 12 months compared to those on SMS (P <.027). Those receiving a tapered intervention for an additional 3 months had improved self-reported adherence compared to those randomized to the standard of care arm (P <.001). Both SMS and CPS appear to be effective interventions for youth with poor antiretroviral adherence. Tapering the intervention for an additional 3 months is useful in maintaining adherence after the initial intervention. Additional research is required to determine how to best sequence these interventions, including the use of incentives.

Keywords: Adolescents; HIV; Medication adherence; RCT.