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BMC Public Health. 2018 Jul 13;18(1):867. doi: 10.1186/s12889-018-5815-9.

Positive STEPS - a randomized controlled efficacy trial of an adaptive intervention for strengthening adherence to antiretroviral HIV treatment among youth: study protocol.

Author information

1
Center for Health Equity Research, Brown University, 121 South Main Street, Providence, RI, 02903, USA. matthew_mimiaga@brown.edu.
2
Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA. matthew_mimiaga@brown.edu.
3
Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA. matthew_mimiaga@brown.edu.
4
The Fenway Institute, Fenway Health, Boston, MA, USA. matthew_mimiaga@brown.edu.
5
Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
6
Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, IL, USA.
7
Center for Health Equity Research, Brown University, 121 South Main Street, Providence, RI, 02903, USA.
8
Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA.
9
The Fenway Institute, Fenway Health, Boston, MA, USA.

Abstract

BACKGROUND:

HIV infection among youth in the United States is on the rise. A high level of antiretroviral therapy (ART) adherence is crucial to treatment success and can minimize the population burden of the disease. However, the overall rate of ART adherence among youth is generally suboptimal and no published efficacious interventions exist to address the specific needs of this population. This paper describes the design of a stepped-care, "adaptive" ART adherence intervention protocol for HIV-infected adolescents and young adults.

METHODS:

This is a randomized controlled trial (RCT) to establish the efficacy of "Positive STEPS," a behavioral and technology-based intervention to optimize ART adherence and viral suppression among HIV-infected youth, ages 16 to 29. Participants are equally randomized to 1) the Positive STEPS intervention, which begins with two-way daily text messaging as a reminder system to take their medications; participants progress to a more intensive in-person counseling intervention if text messaging is not sufficient to overcome barriers; or 2) or standard of care (SOC). At randomization, all participants receive standardized ART adherence education. During the 4 major study assessment visits (baseline, 4-, 8-, and 12-months), participants have their blood drawn to measure HIV viral load and complete a mix of computer-based self-administered and interviewer-administered behavioral and psychosocial measures. The primary outcomes are improvements in viral load and ART adherence measured via a medication-tracking device (i.e., Wisepill) and self-report.

DISCUSSION:

Behavioral interventions are greatly needed to improve ART adherence among HIV-infected adolescents and young adults and prevent onward transmission. If effective, the intervention tested here will be one of the first rigorously-designed efficacy trials to promote ART adherence in this population, using an approach that holds promise for being readily integrated into real-world clinical settings.

TRIAL REGISTRATION:

ClinicalTrials.gov number NCT03092531 , registered March 28, 2017.

KEYWORDS:

Adherence; Antiretroviral therapy (ART); HIV treatment; Youth

PMID:
30001703
PMCID:
PMC6043988
DOI:
10.1186/s12889-018-5815-9
[Indexed for MEDLINE]
Free PMC Article

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