JMIR Publications

ABSTRACT

Background:

African Americans are disproportionally affected by HIV and have poorer rates of antiretroviral therapy (ART) adherence compared to other racial or ethnic groups in the U.S. Factors associated with poor HIV disease outcomes are commonly associated with socio-structural barriers that prevent engagement with, and retention in HIV care. Text messaging interventions to promote ART adherence among predominantly non-Hispanic White persons with HIV (PWH) have been shown efficacious; however, limited research has been devoted to culturally tailoring interventions for underrepresented racial/ethnic groups. Considering African Americans show poorer engagement along the HIV care continuum, we developed an individualized and culturally-tailored two-way text messaging intervention to improve ART adherence and associated virologic suppression among African American PWH.

Objective:

In this paper we describe the protocol of a culturally-tailored individualized Texting for Adherence Building (iTAB) intervention in a 24- to 48-week, single-arm study.

Methods:

We developed a culturally-tailored iTAB intervention, which we are implementing in a 24- to 48-week, single arm study. Participants were recruited from the Family Health Centers of San Diego (FHCSD), a federally qualified health center. Patient inclusion criteria were (1) receiving care at the FHCSD, (2) living with HIV, (3) self-identification as Black, African American, or of African ancestry, (4) English-speaking, (5) age 18 or older, (6) currently on ART, and (7) able to provide informed consent. Study enrollment began in November 2017 and closed in July 2019. A total of 90 participants from the FHCSD enrolled in the iTAB intervention, and we anticipate completing data collection in July 2020. Participants were assisted in individualizing and customizing their text message preferences at the baseline study visit. Self-assessment measures are collected at baseline, interim, and final study visits. Problems related to sending/receiving text messages and barriers to ART adherence are assessed at each interim study visit. The FHCSD staff monitors and tracks participants’ daily text message responses to ART adherence reminders using a clinical dashboard.

Results:

We hypothesize the proportion of individuals achieving HIV virologic suppression (VL<40 copies/ml) will be greater at the end of the intervention period compared to the proportion prior to study implementation. Additionally, we anticipate rates of virologic suppression at the end of the intervention among participants receiving iTAB will be comparable to those among the general FHCSD non-African American population who did not receive iTAB. Finally, we anticipate a high response rate to iTAB messages as well as positive participant feedback at the end of the intervention with regards to the acceptability of, satisfaction with, and perceived efficacy of iTAB.

Conclusions:

The iTAB intervention is a novel individualized two-way text messaging intervention that has been culturally tailored for use among African Americans with HIV. We anticipate that iTAB will demonstrate efficacy in future randomized control trials and will be supportive of medication adherence among other populations facing health disparities.