Randomized Controlled Trial of a Remote Coaching mHealth Adherence Intervention in Youth Living with HIV

• DOI: 10.1007/s10461-022-03717-2
• Publication Date: 2022-06-07T07:02:43Z
• Authors: K. Rivet Amico; Jane C. Lindsey; Michael Hudgens; Ronald Dallas; Keith J. Horvath; Amanda Dunlap; Rachel Goolsby; Megan Mueller Joh...; Barbara Heckman; Jessica Crawford; Elizabeth Secord; Murli Purswani; Danial Reirden; Mobeen Rathore; Lisa-Gaye Robinson; Aditya H. Gaur
• Keywords: Original Paper; Adolescent; Anti-HIV Agents; Humans; Mentoring; HIV Infections; Prospective Studies; Viral Load; Telemedicine; Medication Adherence

Youth living with HIV (YLWH) in the US have low rates of viral suppression (VS). In a prospective randomized clinical trial (ATN152) that enrolled 89 YLWH on antiretroviral therapy (ART) with detectable viral load, we evaluated a 12 week triggered escalating real-time adherence (TERA) intervention with remote coaching, electronic dose monitoring (EDM), and outreach for missed/delayed doses compared to standard of care (SOC). Median [Q1, Q3] percent days with EDM opening was higher in TERA (72% (47%, 89%)) versus SOC (41% (21%, 59%); p<0.001) and incidence of numbers of 7 day gaps between openings were lower (TERA to SOC ratio: 0.40; 95% CI 0.30, 0.53; p<0.001). There were no differences in VS at week 12 (TERA 35%; 95% CI 21%, 51% versus SOC 36%; 95% CI 22%, 51%; p>0.99) or later time-points. The intervention improved adherence but not VS in heavily ART-experienced YLWH. Remote coaching more closely tailored to the unique dosing patterns and duration of need for youth struggling to reach VS warrants further investigation.