Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 26, 2018
Open Peer Review Period: Dec 31, 2018 - Jan 3, 2019
Date Accepted: Mar 29, 2019
(closed for review but you can still tweet)
Social inequity and structural barriers to completion of ecological momentary assessments for young MSM and trans women living with HIV in San Francisco
ABSTRACT
Background:
Ecological momentary assessments (EMA) administered via text messaging facilitate real-time data collection. With widespread cell phone access, EMA are becoming more available to even the most disenfranchised communities, such as those living with HIV. However, structural barriers disproportionately burden young MSM and trans women (TW) living with HIV and threaten participation in HIV research.
Objective:
We aim to identify structural barriers to completing EMA text surveys nested within a digital HIV care intervention for young MSM and TW living with HIV in San Francisco.
Methods:
A total of 10,800 EMA SMS text messages were delivered daily over a period of 90 days to 120 participants enrolled in the Health eNav intervention at San Francisco Department of Public Health from 2017 to 2018. EMA surveys inquired about participants’ daily affect, sexual behaviors, substance use, and treatment adherence. EMA survey completion was calculated after 30, 60, and 90 days of follow up. We described characteristics of non-starters (those who provided less than 4 complete responses to the first 7 EMA surveys) and analyzed structural correlates of days to first weeklong or more EMA survey non-completion using multivariable Cox proportional hazards regression. Qualitative interviews were used to evaluate acceptability of EMA surveys.
Results:
Participants completed 4,384 out of 10,800 (40.6%) EMA surveys. Completion of 70% or more of EMA surveys was attained by 56/120 participants (46.7%) at 30 days of follow-up, 40/120 (33.3%) at 60 days of follow-up, and 30/120 (25.0%) by the end of the 90-day study period. Twenty-eight participants (23.3%) were identified as non-starters, and were more likely to be recently incarcerated (prevalence ratio [PR]=2.3,95%CI=1.3-4.4), forego basic needs for HIV medications (PR=2.4,95%CI=1.3-4.5), and be diagnosed with HIV in the last year (PR=2.2,95%CI=1.1-4.1). Adjusting for non-starters, young MSM and TW living in temporary/transitional housing (adjusted hazard ratio [aHR]=1.8,95%CI=1.1-3.0), foregoing HIV medications to afford basic needs (aHR=1.7,95%CI=1.1-2.7), and having less than a college education (aHR=3.5,95%CI=1.4-9.0) had greater hazard of weeklong or more EMA survey non-completion. Overall, there was high acceptability of the EMA surveys.
Conclusions:
While access to and use of technology is increasingly ubiquitous, this analysis demonstrates persisting gaps in EMA completion by socio-economic factors such as incarceration, education level, housing, and competing needs for young MSM and TW living with HIV in San Francisco. Moreover, those recently diagnosed with HIV were more likely to experience an immediate drop-off in completing EMA surveys. EMA is feasible for individuals not experiencing social inequity and structural barriers. HIV prevention technologies addressing the aforementioned barriers and leveraging similar methodology may prove effective for young MSM and TW living with HIV.
Citation
Per the author's request the PDF is not available.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.