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Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation
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Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation

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David J. Moore, PhD of the UC San Diego Department of Psychiatry presents "Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation" …

David J. Moore, PhD of the UC San Diego Department of Psychiatry presents "Update on Individualized Texting for Adherence Building (iTAB): Lessons for Implementation"

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  • 1. AIDS CLINICAL ROUNDSThe UC San Diego AntiViral Research Center sponsors weeklypresentations by infectious disease clinicians, physicians andresearchers. The goal of these presentations is to provide the mostcurrent research, clinical practices and trends in HIV, HBV, HCV, TBand other infectious diseases of global significance.The slides from the AIDS Clinical Rounds presentation that you areabout to view are intended for the educational purposes of ouraudience. They may not be used for other purposes without thepresenter’s express permission.
  • 2. Update on Individualized Texting forAdherence Building (iTAB): Lessons for Implementation David J. Moore, Ph.D. University of California, San Diego Department of Psychiatry HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 3. Brief Outline Texting and adherence in HIV iTAB System Results from completed/ongoing studies » iTAB-B: HIV+ with bipolar disorder » iTAB-M: HIV+ with active meth use » CCTG 595: HIV- taking PrEP Conclusions HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 4. Texting Improves ART Adherence SMS (texting) interventions for improving ART adherence show promise In a 2012 Cochrane report, two RCTs shown to be efficacious for ART improvement: » 1X week text over a 12-month interval decreased non-adherence and virologic failure (Lester et al., 2010) » 1X week versus 1X day text messages; at 48-weeks, weekly messages were more likely to reduce non-adherence and treatment interruptions (Pop-Eleches et al., 2011) Optimal texting systems for adherence improvement in difficult-to-treat populations in US still evolving Horvath et al., Cochran Report, 2012; Lester et al., 2010; Pop-Eleches et al. 2011 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 5. Personalized iTAB intervention iTAB -- Pts create personalized med reminder texts: • Description of medications • Personalized reminder stems (e.g., “remember to take your meds, they make you healthy”) • Preferred name • Ideal time for reminders each day by med Both iTAB and CTRL received: • Adherence psychoeducation (~30 min) • A daily text message asking about mood • Process of medication reminder creation • Sentinel med for MEMS: ARV: Mostly combo medication; PSY: Primary mood stabilizer HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 6. Example of Customizable iTAB System HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 7. Example of Customizable iTAB System HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 8. iTAB Decision Tree Other iTAB components: • 3 consecutive days of non- responses get a “noncompliance” text • 5 consecutive days of non- responses, call from RA • Adherence Targets:“Ur current adherence: xx%. Adhr when u take ur next dose: xx% (x/x doses)” • Personalized ReinforcerHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 9. iTAB Studies iTAB-B iTAB-M CCTG 595Group HIV+ Bipolar HIV+ Meth HIV-Design RCT (n=50) RCT (n=75) RCT (n=400)Status Enrolled Enrolling (n=23) Start 12/1Duration 4 weeks 6 weeks 48 weeksReferrals N/A Please!619-543- 619-543-5011 5000 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 10. iTAB in HIV+ with Bipolar Disorder (iTAB-B) HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 11. iTAB-B Study Flow Enrollment Assessed for eligibility (n=62) Excluded (n=4) • Not meeting inclusion criteria (n=2) • Declined to participate (n=1) Randomized (n=58) • Withdrawn (n=1) AllocationAllocated to iTab intervention Allocated to CTRL intervention (n=30) (n=28) Follow-up Lost to follow up Lost to follow up (n=2) (n=2) Analysis Analyzed (n=25) Analyzed (n=25) • Lost MEMS (n=3) • Lost MEMS (n=1)) HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 12. Example iTAB-B Intervention StemsStems of personal reminder messages reflect different themes: » Celebrate Health » Empowering • Stay healthy! It’s time 2 • It’s med time, only u can take ur meds, pls take ur… control this. Rmber 2 » Time and Focus take ur… • It’s pill time! Take ur… » Importance of Adherence » Control Disease • Adherence is impt. Pls • Taking ur meds helps take ur… control ur disease. Rmber 2 take ur… HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 13. Demographics CTRL (n=25) ITAB (n=25) P-valueAge 45.9 (10.2) 48.4 (9.2) 0.36Education 13.0 (3.1) 13.3 (2.2) 0.67Ethnicity (% White) 44.0 64.0 0.26Sex (% Male) 84.0 92.0 0.67Global Deficit Score 0.7 (0.7) 0.6 (0.6) 0.68 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 14. Psychiatric Characteristics CTRL (n=25) ITAB (n=25) P-valueLifetime Substance 87.5 68.0 0.10Diagnosis,%Current Substance 4.2 4.0 0.98Diagnosis, %Euthymic during the 64.0 64.0 0.62prior month, %Beck Depression 18.0 (10.6) 17.0 (12.6) 0.77Inventory–IIYoung Mania Rating 5.2 (4.5) 6.4 (7.6) 0.49ScaleGAF 67.3 (10.9) 68.0 (10.0) 0.82 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 15. Medical Characteristics CTRL (n=25) ITAB (n=25) P-valueCurrent CD4 Count 655.8 (324.2) 603.4 (392.8) 0.67Nadir CD4 Count 225.7 (153.1) 281.2 (258.2) 0.44HIV RNA Detectable, % 8.0 24.0 0.12AIDS Status, % 60.9 70.0 0.75 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 16. Medication Characteristics CTRL (n=25) ITAB (n=25) P-valueSelf report % ARV doses 87.9 (16.8) 96.0 (7.2) 0.10taken (past month)Self report % PSY doses 89.0 (19.2) 94.1 (9.9) 0.41taken (past month)Total No. of ARVs 6.9 (4.5) 7.1 (4.5) 0.75Total No. of rx doses, ARV 42.7 (13.8) 41.5 (14.2) 0.61Total No. of rx doses, PSY 47.7 (24.1) 44.7 (19.0) 0.57 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 17. Overall MEMS Adherence by Group 100 90MEMS % of Prescribed Doeses 80 70 60 Taken 50 CTRL 40 iTAB 30 20 N=25 N=25 N=2 N=25 10 5 0 ARV PSY p = 0.28 p = 0.94 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 18. Overall MEMS % On Schedule by Group 90 80 70 60 50 CTRL 40 iTAB 30 20 10 N=25 N=25 N=25 N=25 0 ARV PSY p = 0.25 p = 0.89 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 19. Time from Target Dose by Group N=25 N=25 N=25 N=25 p = 0.03 p = 0.34 Cohen’s d = -0.33 Cohen’s d = 0.04 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 20. Adherence & Mania Ratings YMRS total YMRS totalF (1, 49) = 6.774 F (1, 46) = 2.705 p = 0.012 p = 0.107 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 21. Frequency of Stems Selected Frequency Selected (N=25) 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17# Stem # Stem1 Ur health is impt, rmber 2 take ur meds. Take ur [med] now. 10 Adherence is impt. Pls take ur [med] now.2 Stay healthy! Its time 2 take ur meds, pls take ur [med] now. 11 2 help keep u feeling good, rmber 2 take ur [med] now.3 No matter what else is going on, its impt 2 take ur [med] now. 12 Ur meds are important. Its time for ur next dose of ur [med] now.4 Its med time! Pls take ur [med] now. 13 Ready, set, get healthy! Its meds time. Time for ur [med] now.5 Its med time, only u can control this. Rmber 2 take ur [med] now. 14 Protect ur health. Its that time again 2 take ur [med] now.6 Taking ur meds helps control ur disease. Rmber 2 take ur [med] now. 15 Its pill time! Take ur [med] now.7 Yay, health! Dont frgt 2 take ur [med] now. 16 2 control ur health u need 2 take ur [med] now.8 Taking ur meds helps 2 keep ur body healthy! Take ur [med] now. 17 Other/Custom9 Uve been doing gr8 w/ ur adherence. Its time 2 take ur [med] now. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 22. Adherence Rates by Stem Adherence Rate ARV Adherence Rate PSY 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17# Stem # Stem1 Ur health is impt, rmber 2 take ur meds. Take ur [med] now. 10 Adherence is impt. Pls take ur [med] now.2 Stay healthy! Its time 2 take ur meds, pls take ur [med] now. 11 2 help keep u feeling good, rmber 2 take ur [med] now.3 No matter what else is going on, its impt 2 take ur [med] now. 12 Ur meds are important. Its time for ur next dose of ur [med] now.4 Its med time! Pls take ur [med] now. 13 Ready, set, get healthy! Its meds time. Time for ur [med] now.5 Its med time, only u can control this. Rmber 2 take ur [med] now. 14 Protect ur health. Its that time again 2 take ur [med] now.6 Taking ur meds helps control ur disease. Rmber 2 take ur [med] now. 15 Its pill time! Take ur [med] now.7 Yay, health! Dont frgt 2 take ur [med] now. 16 2 control ur health u need 2 take ur [med] now.8 Taking ur meds helps 2 keep ur body healthy! Take ur [med] now. 17 Other/Custom9 Uve been doing gr8 w/ ur adherence. Its time 2 take ur [med] now. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 23. iTAB in HIV+ METH Users: iTAB-M HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 24. METH is Risk Factor for HIV  In 2008, 850,000 Americans ≥12 y.o. abused METH in previous year (National Survey on Drug Use and Health, 2008)  CDC estimates 12% of incident US HIV cases attributable to IVDU (HIV/AIDS Surveillance Report, 2007)  Strong association between METH use among MSMs and continued high incidence of HIV/AIDS in the US (CDC HIV/AIDS Fact Sheet, 2007)HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 25. iTAB-M Focus GroupsAIM: To identify barriers and strategies for ART adherence specific to HIV+/MA+ persons and to integrate feedback on the content of the text-message reminders for iTAB-MMETHOD: Two focus groups, each with ten HIV+/MA+ individuals, were conducted Participants were middle aged (43.6 years, SD=7.7), predominantly male (90%), Caucasian (60%), and high school educated (12.3 years; SD=2.8). HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 26. iTAB-M Focus Group Data Analysis Audio recordings transcribed Independently coded by two investigators using QSR NVivo software Codes identified emergent themes related to barriers and strategies of adherence and feedback on the content of proposed text messages Disagreements in coding resolved through consensus Kappa calculated for final assigned codes High Interrater reliability: kappa = 98.7 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 27. Adherence Barriers in Meth HIV+ Nodes clustered by Word similarity Mental Health Lack of Social Support Pill Burden Accessibility Apathy Cognitive Problems Medicine Side Effects Stigma Lack of Education Meth-related HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 28. Example: Adherence Barriers“My biggest problem was losing track of time,you know, and so I would have them but I maytake it, you know, 12 hours and then 36 hoursand that kind of deal, but I always adhered. Itwas just very sloppy, you know, while I wasusing that weekend. So, that was my ”biggest issue. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 29. Strategies for AdherenceNodes clustered by Word similarity Planning Health Promotion Self Efficacy Spirituality Pharmacy Assistance Increase Accessibility Utilize Reminders Efficient Medication Regimen Education Engagement of Health Care System Social Support Token Economy Self-EsteemHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 30. Strategies for Adherence“I was thinking about taking meds andthings like that, if we have somethingcalled the buddy system. Or just maybehave one of the nurses giving you a calleveryday saying are you taking your ”meds? HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 31. Meth and Adherence % of Days Reporting Meth Use Adherence by Meth Status50% 100%45% 90%40% 80%35% 70%30% 60%25% 50%20% 40%15% 30%10% 20% 5% 10% 0% 0% Control ITAB Meth+ days Meth- days HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 32. Example iTAB-M Intervention StemsStems of personal reminder messages reflect different themes: » Celebrate Health » Self-Esteem • Stay healthy! It’s time 2 take ur • U are special. Pls take ur… meds, pls take ur… » Meth Focus » Time and Focus • Take ur meds so u can keep • It only takes a second! Take ur… having fun. Time 4 ur… » Social Support » Dangers of Non-adherence • People care about u. Pls take • Not taking ur meds could ur… make u resistant. Take ur… » Control Disease » Spiritual • It’s impt to take care of urself. • God grant me the serenity to Pls take ur… do this. It’s time 4 ur… HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 33. iTAB-M Intervention Stems# Reminder Stem1 Stay healthy! It’s time to take your meds, please take your medications.2 To help keep you feeling good, remember to take your medications.3 Ready, set, get healthy! It’s med time. Time for your medications.4 Live longer! Take your medications.5 Yay, health! Don’t forget to take your medications.6 It only takes a second! Take your medications.7 Its med time! Please take your medications.8 It’s pill time! Take your medications.9 No matter what else is going on, it’s important to take your medications.10 Stop everything and take your meds! Take your medications.11 People care about you. Please take your medications.12 Think about the people who love you. Take your medications.13 We care about u and your health. Please take your medications.14 [name] needs you. Take your medications.15 You are not alone. It’s time to take your medications.16 It’s important to take care of yourself. Please take your medications.17 Your health is important, remember to take your meds. Take your medications.18 To control your health you need to take your medications.19 Adherence is important. Please take your medications.20 Protect your health. It’s that time again to take your medications. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 34. iTAB-M Intervention Stems# Reminder Stem21 You are special. Please take your medications.22 Stay strong. It’s time for your medications.23 You’ve been doing great with your adherence. It’s time to take your medications.24 You can do it! Take your medications.25 It’s a great accomplishment to be adherent! Take your medications.26 Take your meds so you can keep having fun. Time for your medications.27 Ignore Tina and take your medications.28 It’s not party time; it’s med time! Please take your medications.29 You can have fun and take your meds. Time for your medications.30 Stop screwing around and take your medications.31 Not taking your meds has severe consequences. Take your medications.32 Not taking your meds could make u resistant. Take your medications.33 You need your meds to live longer. Time for your medications.34 You will only get sicker if you don’t take your meds. Time for your medications.35 Not taking your meds puts others at risk. Please take your medications.36 God loves you. It’s time for your medications.37 WWJD? Take his meds! Time for your medications.38 Trust in the Lord. Take your medications.39 The Lord believes in you; believe in yourself. Take your medications.40 God grant me the serenity to do this. It’s time for your medications. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 35. iTAB-M Frequency of Stem Selection100% Frequency Selected (N=10)90% 6. It only takes a second! Take your medications.80% 8. It’s pill time! Take your medications. 9. No matter what else is going on, it’s important70% to take your medications.60%50%40%30%20%10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 36. Self-reported Adherence by Stem Adherence Rate by Stem (N=10)100%90%80%70% Overall Mean: 64.5%60%50%40%30%20%10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 37. Frequency Chosen by Adherence Adherence Rate100%90% Frequency Selected (N=10)80%70%60%50%40%30%20%10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 38. iTAB in HIV- for PrEP: CCTG 595 HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 39. Study Design Controlled, un-blinded, two-armed, randomized (1:1) clinical trial in the setting of PrEP implementation at three HIV testing/ HIV provider sites in Southern California Randomized either to PrEP + SoC or PrEP + SoC + iTAB Duration: endpoint analysis at 48 weeks Sample size: 400 subjects, 200 per arm Stratification by clinic site HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 40. CCTG 595 SchemaHIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 41. CCTG 595 Hypotheses Objective: To compare adherence to fixed dose TDF/FTC, between subjects randomized to receive SoC plus text message reminders versus SoC, when used for pre- exposure prophylaxis among MSM at high risk for HIV acquisition Hypothesis: MSM and transgender M to F having sex with men with high risk of HIV acquisition randomized to the iTAB intervention will have higher self-reported adherence to TDF/FTC for PrEP over 48 weeks (‘adherent’ defined with a composite endpoint of continued retention on PrEP and > 90% adherence to TDF/FTC at 48 weeks) compared to MSM that have comprehensive SoC alone HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 42. CCTG 595 Focus Group 1 Mixed Group of HIV+ and HIV- individuals About half of the participants knew of PrEP Liked the idea of medication reminders via text If to ask about unprotected sex, ask very directly HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 43. CCTG 595 Focus Group 2 HIV- only Liked idea of medication reminders via text Specific Feedback on System: » System needs to be varied; prefer no repeat messages » Want daily messages for 48 weeks » Want short messages, no names or med description. » Want fun, witty, playful messages (e.g., snapple facts) » Interested in selecting messages by domain related to interests; not specifc messages (e.g., want to be surprised) » Prefer not to have medication name or any mention of med or drug » Provided good examples: “Pill O’Clock” “Med Thirty” “Y.O.L.O” Similar for other groups, SES? HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 44. Conclusions & Future DirectionsiTAB :1.Higher ARV adherence in HIV+/BD+ as compared to observational study2.Significantly better dose timing  improves therapeutic coverage iin HIV+/BD+3.Different stems/reminders may be needed by group (Meth using)4.Interventions for PrEP may need to be highly different from those for HIV HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 45. Future Directions1. Continue enrollment of iTAB-M (Refer Patients: 619-543- 5000)2. Refine and implement system for CCTG 5953. Evaluate iTAB over longer periods of time4. Begin development of app for targeted group via SBIR collaboration HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 46. Acknowledgments Participants  Fellows Funding Support » Pariya Fazeli, Ph.D. » California HIV/AIDS Research Program ID- » Maria Marquine, Ph.D. 09-047, EI-11-SD-005  Staff » NIDA R34 DA31058 » Jayraan Badiee » NIMH/CSPAR P30 MH062512 » Candy Carson Co-investigators/Consultants » Eric Ellorin » J. Hampton Atkinson, M.D. » Roberto Gallardo » Colin Depp, Ph.D. » Ben Gouaux » Igor Grant, M.D. » Jenn Marquie-Beck » Richard Haubrich, M.D. » Amelia Poquette » Scott Letendre, M.D. » Alexandra Rooney » Sheldon Morris, M.D., M.P.H. » Crossby Vargas » Tom Patterson, Ph.D. » Mel Willard » Steven Safren, Ph.D.  Cal-IT2 Technical Experts Students » Kevin Patrick, M.D., M.S. » Kaitlin Blackstone » Allison Flick » Shereen Georges » Fred Raab » Jessica Montoya » Mark Sullivan » Carolina Posada HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 47. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO

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