The Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression Among Young People Living With HIV: Single-Arm, Prospective Study With a Pre-Post Design
BackgroundThe HIV epidemic has revealed considerable disparities in health among sexual and gender minorities of color within the Unites States, disproportionately affecting cisgender men who have sex with men (MSM) and trans women. Social inequities further disadvantage thos...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2022-07-01
|
| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2022/7/e33990 |
| _version_ | 1797734955949752320 |
|---|---|
| author | Sean Arayasirikul Caitlin M Turner Dillon Trujillo Jarett Maycott Erin C Wilson |
| author_facet | Sean Arayasirikul Caitlin M Turner Dillon Trujillo Jarett Maycott Erin C Wilson |
| author_sort | Sean Arayasirikul |
| collection | DOAJ |
| description |
BackgroundThe HIV epidemic has revealed considerable disparities in health among sexual and gender minorities of color within the Unites States, disproportionately affecting cisgender men who have sex with men (MSM) and trans women. Social inequities further disadvantage those with intersectional identities through homophobia, antitrans discrimination, and racism, shaping not only those at risk for HIV infection but also HIV prevention and care outcomes. Digital interventions have great potential to address barriers and improve HIV care among cisgender MSM and trans women; however, efficacy of digital HIV care interventions vary and need further examination.
ObjectiveThis study assessed the 12-month efficacy of a 6-month digital HIV care navigation intervention among young people living with HIV in San Francisco, California. We examined dose-response relationships among intervention exposure (eg, text messaging), viral suppression, and mental health. Health electronic navigation (eNav) is a 6-month, text message–based, digital HIV care navigation intervention, in which young people living with HIV are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care.
MethodsThis study had a single-arm, prospective, pre-post design. Eligibility criteria for the study included the following: identifying as cisgender MSM or trans women, being between the ages of 18 and 34 years, being newly diagnosed with HIV, or not being engaged or retained in HIV care or having a detectable viral load. We assessed and analyzed sociodemographics, intervention exposure, and HIV care and mental health outcome data for participants who completed the 6-month Health eNav intervention. We assessed all outcomes using generalized estimating equations to account for within-subjects correlation, and marginal effects of texting engagement on all outcomes were calculated over the entire 12-month study period. Finally, we specified an interaction between texting engagement and time to evaluate the effects of texting engagement on outcomes.
ResultsOver the entire 12-month period, this study shows that every one-text increase in engagement was associated with an increased odds of undetectable viral load (adjusted odds ratio 1.01, 95% CI 1.00-1.02; P=.03). Mean negative mental health experiences decreased significantly at 12 months compared to baseline for every one-text increase in engagement (coefficient on interaction term 0.97, 95% CI 0.96-0.99; P<.01).
ConclusionsDigital care navigation interventions including Health eNav may be a critical component in the health delivery service system as the digital safety net for those whose social vulnerability is exacerbated in times of crisis, disasters, or global pandemics owing to multiple social inequities. We found that increased engagement in a digital HIV care navigation intervention helped improve viral suppression and mental health—intersecting comorbid conditions—6 months after the intervention concluded. Digital care navigation may be a promising, effective, sustainable, and scalable intervention.
International Registered Report Identifier (IRRID)RR2-10.2196/16406 |
| first_indexed | 2024-03-12T12:50:58Z |
| format | Article |
| id | doaj.art-d887bff490254e14ab9c4685256a4060 |
| institution | Directory Open Access Journal |
| issn | 1438-8871 |
| language | English |
| last_indexed | 2024-03-12T12:50:58Z |
| publishDate | 2022-07-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj.art-d887bff490254e14ab9c4685256a40602023-08-28T22:44:00ZengJMIR PublicationsJournal of Medical Internet Research1438-88712022-07-01247e3399010.2196/33990The Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression Among Young People Living With HIV: Single-Arm, Prospective Study With a Pre-Post DesignSean Arayasirikulhttps://orcid.org/0000-0001-7698-6206Caitlin M Turnerhttps://orcid.org/0000-0003-2894-2318Dillon Trujillohttps://orcid.org/0000-0001-7990-1909Jarett Maycotthttps://orcid.org/0000-0002-3123-4470Erin C Wilsonhttps://orcid.org/0000-0002-0237-495X BackgroundThe HIV epidemic has revealed considerable disparities in health among sexual and gender minorities of color within the Unites States, disproportionately affecting cisgender men who have sex with men (MSM) and trans women. Social inequities further disadvantage those with intersectional identities through homophobia, antitrans discrimination, and racism, shaping not only those at risk for HIV infection but also HIV prevention and care outcomes. Digital interventions have great potential to address barriers and improve HIV care among cisgender MSM and trans women; however, efficacy of digital HIV care interventions vary and need further examination. ObjectiveThis study assessed the 12-month efficacy of a 6-month digital HIV care navigation intervention among young people living with HIV in San Francisco, California. We examined dose-response relationships among intervention exposure (eg, text messaging), viral suppression, and mental health. Health electronic navigation (eNav) is a 6-month, text message–based, digital HIV care navigation intervention, in which young people living with HIV are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. MethodsThis study had a single-arm, prospective, pre-post design. Eligibility criteria for the study included the following: identifying as cisgender MSM or trans women, being between the ages of 18 and 34 years, being newly diagnosed with HIV, or not being engaged or retained in HIV care or having a detectable viral load. We assessed and analyzed sociodemographics, intervention exposure, and HIV care and mental health outcome data for participants who completed the 6-month Health eNav intervention. We assessed all outcomes using generalized estimating equations to account for within-subjects correlation, and marginal effects of texting engagement on all outcomes were calculated over the entire 12-month study period. Finally, we specified an interaction between texting engagement and time to evaluate the effects of texting engagement on outcomes. ResultsOver the entire 12-month period, this study shows that every one-text increase in engagement was associated with an increased odds of undetectable viral load (adjusted odds ratio 1.01, 95% CI 1.00-1.02; P=.03). Mean negative mental health experiences decreased significantly at 12 months compared to baseline for every one-text increase in engagement (coefficient on interaction term 0.97, 95% CI 0.96-0.99; P<.01). ConclusionsDigital care navigation interventions including Health eNav may be a critical component in the health delivery service system as the digital safety net for those whose social vulnerability is exacerbated in times of crisis, disasters, or global pandemics owing to multiple social inequities. We found that increased engagement in a digital HIV care navigation intervention helped improve viral suppression and mental health—intersecting comorbid conditions—6 months after the intervention concluded. Digital care navigation may be a promising, effective, sustainable, and scalable intervention. International Registered Report Identifier (IRRID)RR2-10.2196/16406https://www.jmir.org/2022/7/e33990 |
| spellingShingle | Sean Arayasirikul Caitlin M Turner Dillon Trujillo Jarett Maycott Erin C Wilson The Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression Among Young People Living With HIV: Single-Arm, Prospective Study With a Pre-Post Design Journal of Medical Internet Research |
| title | The Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression Among Young People Living With HIV: Single-Arm, Prospective Study With a Pre-Post Design |
| title_full | The Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression Among Young People Living With HIV: Single-Arm, Prospective Study With a Pre-Post Design |
| title_fullStr | The Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression Among Young People Living With HIV: Single-Arm, Prospective Study With a Pre-Post Design |
| title_full_unstemmed | The Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression Among Young People Living With HIV: Single-Arm, Prospective Study With a Pre-Post Design |
| title_short | The Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression Among Young People Living With HIV: Single-Arm, Prospective Study With a Pre-Post Design |
| title_sort | dose response effects of digital hiv care navigation on mental health and viral suppression among young people living with hiv single arm prospective study with a pre post design |
| url | https://www.jmir.org/2022/7/e33990 |
| work_keys_str_mv | AT seanarayasirikul thedoseresponseeffectsofdigitalhivcarenavigationonmentalhealthandviralsuppressionamongyoungpeoplelivingwithhivsinglearmprospectivestudywithaprepostdesign AT caitlinmturner thedoseresponseeffectsofdigitalhivcarenavigationonmentalhealthandviralsuppressionamongyoungpeoplelivingwithhivsinglearmprospectivestudywithaprepostdesign AT dillontrujillo thedoseresponseeffectsofdigitalhivcarenavigationonmentalhealthandviralsuppressionamongyoungpeoplelivingwithhivsinglearmprospectivestudywithaprepostdesign AT jarettmaycott thedoseresponseeffectsofdigitalhivcarenavigationonmentalhealthandviralsuppressionamongyoungpeoplelivingwithhivsinglearmprospectivestudywithaprepostdesign AT erincwilson thedoseresponseeffectsofdigitalhivcarenavigationonmentalhealthandviralsuppressionamongyoungpeoplelivingwithhivsinglearmprospectivestudywithaprepostdesign AT seanarayasirikul doseresponseeffectsofdigitalhivcarenavigationonmentalhealthandviralsuppressionamongyoungpeoplelivingwithhivsinglearmprospectivestudywithaprepostdesign AT caitlinmturner doseresponseeffectsofdigitalhivcarenavigationonmentalhealthandviralsuppressionamongyoungpeoplelivingwithhivsinglearmprospectivestudywithaprepostdesign AT dillontrujillo doseresponseeffectsofdigitalhivcarenavigationonmentalhealthandviralsuppressionamongyoungpeoplelivingwithhivsinglearmprospectivestudywithaprepostdesign AT jarettmaycott doseresponseeffectsofdigitalhivcarenavigationonmentalhealthandviralsuppressionamongyoungpeoplelivingwithhivsinglearmprospectivestudywithaprepostdesign AT erincwilson doseresponseeffectsofdigitalhivcarenavigationonmentalhealthandviralsuppressionamongyoungpeoplelivingwithhivsinglearmprospectivestudywithaprepostdesign |