Research shows that the majority of late adolescents and young adults living with HIV struggle to remain in care. Over the past decade, clinicians have examined a variety of new ways to engage and retain youth in HIV care, including methods that leverage mobile phone technology. A recent study compared data from these trials and found that SMS text messaging and other technology-enabled healthcare platforms have the potential to help young adults more effectively manage their HIV treatment.
The study, published in August in AIDS and Behavior, reviewed a total of nine previous clinical trials to determine what methods work best for supporting young adults in HIV care. Approximately 275 participants were represented in these trials, and most of them were around 21 years old, male, and identified as either African American or Hispanic. In more ways than one, these participants mirror the changing demographics of HIV in the United States.
Researchers examined five trials that tested the feasibility and effectiveness of using SMS texting to motivate young adults to adhere to their HIV medication and stay in care. Text interventions ranged from “personalized, interactive, daily SMS reminders” to more automated text reminders to take medication and attend clinic visits. In general, participants considered the texts to be helpful and demonstrated significant improvements in medication adherence six months after the texts ceased.
Young adults who struggle to consistently take HIV medications also benefited from phone call interventions with trained health professionals. One study demonstrated that daily cell phone conversations to remind participants to take their medication resulted in a significant improvement in self-reported adherence and HIV viral load.
The first author of the review, Ann-Margaret Dunn Navarra, is a pediatric nurse practitioner who researches technology use and HIV self-management among young people. She expressed amazement at the scarcity of research that has been conducted in this area given the routine use of technology in the daily lives of all young people today.
“Adhering to antiretroviral treatment is one of the greatest challenges for HIV-infected teens and young adults, and technology offers a practical option for patient care and support. Yet among this population, there is a dearth of published research studies describing feasibility and/or efficacy of technology platforms for adherence support. This is despite the proliferation of much new technology during the past decade.”
Navarra’s findings clearly indicate the feasibility and efficacy of using SMS texting to help young people ages 16 – 29 years old adhere to their HIV medication regimens. Still, more research is required to determine exactly how to use technology to improve HIV care for young people.
“More data is needed,” said Navarra “before specific recommendations are translated to clinical practice. This includes the need for studies directed to understanding the optimal dose, frequency and duration of these, and other technology-enabled adherence interventions.”
The study’s results show that young adults could achieve better HIV treatment outcomes if clinics systems were to systematically expand their mobile health platforms. Every year, hundreds of millions of dollars are dedicated to the research and development of new HIV medications. If patients do not properly adhere to these medications, however, their benefit is significantly reduced. Studies like these are part of an expanding area of public health research that is taking a behavioral – rather than biomedical – approach to investigating how to improve HIV treatment. These nine trials foreshadow an era of telehealth in which patient-provider interactions increasingly will take place via mobile platforms instead of in clinic offices and hospitals.
By: Grant Schleifer