Use of an mHealth Intervention to Improve Engagement in HIV Community-Based Care Among Persons Recently Released from a Correctional Facility in Washington, DC: A Pilot Study
We examined the preliminary effectiveness of a computerized counseling session plus post-incarceration text messaging intervention (CARE + Corrections) to support ART adherence and linkage/engagement in community care among recently incarcerated persons with HIV in Washington, D.C. Recently incarcerated persons with HIV ≥ 18 years old were recruited from the D.C. jail or community outreach and randomized to CARE + Corrections or control arm. Participants completed assessments at baseline, 3-months and 6-months. Multivariable random effects modeling identified predictors of suppressed viral load (≤ 200 copies/mL) and engagement in HIV care at 6 months. Participants (N = 110) were aged 42 (IQR 30–49); 58% male, 24% female, 18% transgender, 85% Black, and lifetime incarceration was a median of 7 years (IQR 2–15). More controls had a regular healthcare provider at baseline. Although not statistically significant, intervention participants had increased odds of viral suppression versus controls at 6 months (AOR 2.04; 95% CI 0.62, 6.70). Those reporting high ART adherence at baseline had higher odds of viral suppression at follow-up (AOR 10.77; 95% CI 1.83, 63.31). HIV care engagement was similar between the two groups, although both groups reported increased engagement at 6 months versus baseline. We observed a positive but non-significant association of viral suppression in the CARE + Corrections group, and care engagement increased in both groups after 6 months. Further attention to increasing viral suppression among CJ-involved persons with HIV upon community reentry is warranted.
KeywordsHIV Engagement in care Incarcerated persons mHealth
We would like to acknowledge funding from the National Institutes of Health, National Institute on Drug Abuse (R01DA030747), National Institute on Allergy and Infectious Diseases and institutional support from the Providence/Boston Center for AIDS Research (P30AI42853) and the District of Columbia Center for AIDS Research (P30AI117970). We would also like to acknowledge former study staff members (Avery Barber, Alice Cates, Halli Olsen, Anthony Rawls, and Hannah Yellin), our District of Columbia Department of Corrections partners (Drs. Beth Mynett and Reena Chakraborty) and community-based partners and advisory board for their support and assistance in conducting this work. Lastly, we would like to give our deepest thanks to the study participants without whom we could not do this work.
This study was funded by the National Institutes of Health National Institute on Drug Abuse (R01DA030747). The authors also received institutional support from the Providence/Boston Center for AIDS Research (P30AI42853) and the District of Columbia Center for AIDS Research (P30AI117970).
Compliance with Ethical Standards
Conflict of interest
Irene Kuo, Tao Liu, Rudy Patrick, Claudia Trezza, Lauri Bazerman, Breana Uhrig Castonguay, James Peterson and Ann Kurth have all declared no conflicts of interest. Curt Beckwith has received research support from Gilead Sciences.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 10.Horvath T, Azman H, Kennedy GE, Rutherford GW. Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. Cochrane Database Syst Rev. 2012;3:CD009756.Google Scholar
- 21.District of Columbia Department of Health HIV/AIDS Hepatitis STDs and Tuberculosis Administration. District of Columbia Department of Health HIV/AIDS, Hepatitis, STD and TB Epidemiology Annual Report, 2015. Washington, DC: District of Columbia Department of Health, 2016.Google Scholar
- 22.Kurth A, Kuo I, Peterson J, et al. Information and communication technology to link criminal justice reentrants to HIV care in the community. AIDS Res Treat. 2013;2013:547381.Google Scholar
- 25.Skeels MM, Kurth A, Clausen M, Severynen A, Garcia-Smith H. CARE + user study: usability and attitudes towards a tablet pc computer counseling tool for HIV+ men and women. AMIA Annual Symposium proceedings AMIA Symposium. 2006:729-33.Google Scholar
- 27.Daeppen JB, Yersin B, Landry U, Pecoud A, Decrey H. Reliability and validity of the alcohol use disorders identification test (AUDIT) imbedded within a general health risk screening questionnaire: results of a survey in 332 primary care patients. Alcohol Clin Exp Res. 2000;24(5):659–65.CrossRefGoogle Scholar
- 32.Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Clin Oral Investig. 2003;7(1):2–7.Google Scholar
- 37.Christopoulos KA, Riley ED, Carrico AW, et al. A randomized controlled trial of a text messaging intervention to promote virologic suppression and retention in care in an urban safety-net human immunodeficiency virus clinic: the connect4care trial. Clin Infect Dis. 2018;67(5):751–9.CrossRefGoogle Scholar