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AIDS CLINICAL ROUNDS
The UC San Diego AntiViral Research Center sponsors weekly
presentations by infectious disease clinicians, physicians and
researchers. The goal of these presentations is to provide the most
current research, clinical practices and trends in HIV, HBV, HCV, TB
and other infectious diseases of global significance.

The slides from the AIDS Clinical Rounds presentation that you are
about to view are intended for the educational purposes of our
audience. They may not be used for other purposes without the
presenter’s express permission.
Update on Individualized Texting for
Adherence 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
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
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
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
Example of Customizable iTAB System




    HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
Example of Customizable iTAB System




    HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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 Reinforcer

HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
iTAB Studies

              iTAB-B                      iTAB-M                   CCTG 595
Group         HIV+ Bipolar                HIV+ Meth                HIV-


Design        RCT (n=50)                  RCT (n=75)               RCT (n=400)


Status        Enrolled                    Enrolling (n=23)         Start 12/1


Duration      4 weeks                     6 weeks                  48 weeks


Referrals     N/A                         Please!619-543-          619-543-5011
                                          5000



      HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
iTAB in HIV+ with Bipolar Disorder
             (iTAB-B)




    HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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)



                                 Allocation
Allocated 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
Example iTAB-B Intervention Stems
Stems 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
Demographics

                                    CTRL (n=25)                 ITAB (n=25)                 P-value


Age                                   45.9 (10.2)                 48.4 (9.2)                 0.36


Education                             13.0 (3.1)                  13.3 (2.2)                 0.67


Ethnicity (% White)                       44.0                       64.0                    0.26

Sex (% Male)                              84.0                       92.0                    0.67

Global Deficit Score                   0.7 (0.7)                   0.6 (0.6)                 0.68



               HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
Psychiatric Characteristics

                                  CTRL (n=25)                ITAB (n=25)               P-value

Lifetime Substance
                                        87.5                       68.0                  0.10
Diagnosis,%

Current Substance
                                         4.2                        4.0                  0.98
Diagnosis, %
Euthymic during the
                                        64.0                       64.0                  0.62
prior month, %
Beck Depression
                                    18.0 (10.6)               17.0 (12.6)                0.77
Inventory–II
Young Mania Rating
                                     5.2 (4.5)                  6.4 (7.6)                0.49
Scale
GAF                                 67.3 (10.9)               68.0 (10.0)                0.82

          HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
Medical Characteristics


                                   CTRL (n=25)            ITAB (n=25)             P-value


Current CD4 Count                  655.8 (324.2)          603.4 (392.8)               0.67


Nadir CD4 Count                    225.7 (153.1)          281.2 (258.2)               0.44

HIV RNA Detectable, %                     8.0                    24.0                 0.12

AIDS Status, %                           60.9                    70.0                 0.75




         HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
Medication Characteristics

                                    CTRL (n=25)             ITAB (n=25)               P-value

Self report % ARV doses
                                      87.9 (16.8)             96.0 (7.2)                0.10
taken (past month)

Self report % PSY doses
                                      89.0 (19.2)             94.1 (9.9)                0.41
taken (past month)

Total No. of ARVs                       6.9 (4.5)              7.1 (4.5)                0.75


Total No. of rx doses, ARV            42.7 (13.8)            41.5 (14.2)                0.61


Total No. of rx doses, PSY            47.7 (24.1)            44.7 (19.0)                0.57

         HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
Overall MEMS Adherence by Group
                              100
                              90
MEMS % 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
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
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
Adherence & Mania Ratings




 YMRS total                                                  YMRS total
F (1, 49) = 6.774                                           F (1, 46) = 2.705
   p = 0.012                                                   p = 0.107



  HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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                                                                  #    Stem
1   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! It's 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, it's impt 2 take ur [med] now.       12   Ur meds are important. It's time for ur next dose of ur [med] now.
4   It's med time! Pls take ur [med] now.                                 13   Ready, set, get healthy! It's meds time. Time for ur [med] now.
5   It's med time, only u can control this. Rmber 2 take ur [med] now.    14   Protect ur health. It's that time again 2 take ur [med] now.
6   Taking ur meds helps control ur disease. Rmber 2 take ur [med] now.   15   It's pill time! Take ur [med] now.
7 Yay, health! Don't 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/Custom
9 U've been doing gr8 w/ ur adherence. It's time 2 take ur [med] now.

                          HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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                                                                    #    Stem
1   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! It's 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, it's impt 2 take ur [med] now.         12   Ur meds are important. It's time for ur next dose of ur [med] now.
4   It's med time! Pls take ur [med] now.                                   13   Ready, set, get healthy! It's meds time. Time for ur [med] now.
5   It's med time, only u can control this. Rmber 2 take ur [med] now.      14   Protect ur health. It's that time again 2 take ur [med] now.
6   Taking ur meds helps control ur disease. Rmber 2 take ur [med] now.     15   It's pill time! Take ur [med] now.
7 Yay, health! Don't 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/Custom
9 U've been doing gr8 w/ ur adherence. It's time 2 take ur [med] now.

                          HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
iTAB in HIV+ METH Users: iTAB-M




   HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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
iTAB-M Focus Groups
AIM:
 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-M

METHOD:
 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
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
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
Example: Adherence Barriers


“
My biggest problem was losing track of time,
you know, and so I would have them but I may
take it, you know, 12 hours and then 36 hours
and that kind of deal, but I always adhered. It
was just very sloppy, you know, while I was
using that weekend. So, that was my


              ”
biggest issue.




          HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
Strategies for Adherence
Nodes 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-Esteem
HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
Strategies for Adherence


“
I was thinking about taking meds and
things like that, if we have something
called the buddy system. Or just maybe
have one of the nurses giving you a call
everyday saying are you taking your


       ”
meds?




        HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
Meth and Adherence


      % of Days Reporting Meth Use                         Adherence by Meth Status
50%                                             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
Example iTAB-M Intervention Stems
Stems 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
iTAB-M Intervention Stems
#    Reminder Stem
1    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    It's 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
iTAB-M Intervention Stems
#    Reminder Stem
21   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
iTAB-M Frequency of Stem Selection
100%                         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 important
70%                                                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
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
Frequency Chosen by Adherence

                                               Adherence Rate
100%

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
iTAB in HIV- for PrEP: CCTG 595




   HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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
CCTG 595 Schema




HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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
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
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
Conclusions & Future Directions
iTAB :
1.Higher ARV adherence in HIV+/BD+ as compared to
 observational study
2.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
Future Directions

1. Continue enrollment of iTAB-M (Refer Patients: 619-543-
   5000)
2. Refine and implement system for CCTG 595
3. Evaluate iTAB over longer periods of time
4. Begin development of app for targeted group via SBIR
   collaboration




          HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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
HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO

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

  • 1. AIDS CLINICAL ROUNDS The UC San Diego AntiViral Research Center sponsors weekly presentations by infectious disease clinicians, physicians and researchers. The goal of these presentations is to provide the most current research, clinical practices and trends in HIV, HBV, HCV, TB and other infectious diseases of global significance. The slides from the AIDS Clinical Rounds presentation that you are about to view are intended for the educational purposes of our audience. They may not be used for other purposes without the presenter’s express permission.
  • 2. Update on Individualized Texting for Adherence 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 Reinforcer HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 9. iTAB Studies iTAB-B iTAB-M CCTG 595 Group HIV+ Bipolar HIV+ Meth HIV- Design RCT (n=50) RCT (n=75) RCT (n=400) Status Enrolled Enrolling (n=23) Start 12/1 Duration 4 weeks 6 weeks 48 weeks Referrals 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) Allocation Allocated 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 Stems Stems 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-value Age 45.9 (10.2) 48.4 (9.2) 0.36 Education 13.0 (3.1) 13.3 (2.2) 0.67 Ethnicity (% White) 44.0 64.0 0.26 Sex (% Male) 84.0 92.0 0.67 Global 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-value Lifetime Substance 87.5 68.0 0.10 Diagnosis,% Current Substance 4.2 4.0 0.98 Diagnosis, % Euthymic during the 64.0 64.0 0.62 prior month, % Beck Depression 18.0 (10.6) 17.0 (12.6) 0.77 Inventory–II Young Mania Rating 5.2 (4.5) 6.4 (7.6) 0.49 Scale GAF 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-value Current CD4 Count 655.8 (324.2) 603.4 (392.8) 0.67 Nadir CD4 Count 225.7 (153.1) 281.2 (258.2) 0.44 HIV RNA Detectable, % 8.0 24.0 0.12 AIDS 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-value Self report % ARV doses 87.9 (16.8) 96.0 (7.2) 0.10 taken (past month) Self report % PSY doses 89.0 (19.2) 94.1 (9.9) 0.41 taken (past month) Total No. of ARVs 6.9 (4.5) 7.1 (4.5) 0.75 Total No. of rx doses, ARV 42.7 (13.8) 41.5 (14.2) 0.61 Total 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 90 MEMS % 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 total F (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 # Stem 1 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! It's 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, it's impt 2 take ur [med] now. 12 Ur meds are important. It's time for ur next dose of ur [med] now. 4 It's med time! Pls take ur [med] now. 13 Ready, set, get healthy! It's meds time. Time for ur [med] now. 5 It's med time, only u can control this. Rmber 2 take ur [med] now. 14 Protect ur health. It's that time again 2 take ur [med] now. 6 Taking ur meds helps control ur disease. Rmber 2 take ur [med] now. 15 It's pill time! Take ur [med] now. 7 Yay, health! Don't 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/Custom 9 U've been doing gr8 w/ ur adherence. It's 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 # Stem 1 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! It's 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, it's impt 2 take ur [med] now. 12 Ur meds are important. It's time for ur next dose of ur [med] now. 4 It's med time! Pls take ur [med] now. 13 Ready, set, get healthy! It's meds time. Time for ur [med] now. 5 It's med time, only u can control this. Rmber 2 take ur [med] now. 14 Protect ur health. It's that time again 2 take ur [med] now. 6 Taking ur meds helps control ur disease. Rmber 2 take ur [med] now. 15 It's pill time! Take ur [med] now. 7 Yay, health! Don't 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/Custom 9 U've been doing gr8 w/ ur adherence. It's 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 Groups AIM:  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-M METHOD:  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 may take it, you know, 12 hours and then 36 hours and that kind of deal, but I always adhered. It was just very sloppy, you know, while I was using that weekend. So, that was my ” biggest issue. HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 29. Strategies for Adherence Nodes 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-Esteem HIV NEUROBEHAVIORAL RESEARCH PROGRAM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
  • 30. Strategies for Adherence “ I was thinking about taking meds and things like that, if we have something called the buddy system. Or just maybe have one of the nurses giving you a call everyday 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 Status 50% 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 Stems Stems 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 Stem 1 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 It's 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 Stem 21 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 Selection 100% 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 important 70% 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 Rate 100% 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 Schema HIV 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 Directions iTAB : 1.Higher ARV adherence in HIV+/BD+ as compared to observational study 2.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 Directions 1. Continue enrollment of iTAB-M (Refer Patients: 619-543- 5000) 2. Refine and implement system for CCTG 595 3. Evaluate iTAB over longer periods of time 4. 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