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Leveraging mHealth and peers to Engage African- Americans and Latinxs in HIV care (LEAN)
Baltimore’s HIV prevalence rate (586/100,000) is among the top 5 in metropolitan areas in the US, and disparities are profound. African Americans have an HIV prevalence that is 5 times higher than among whites, and they account for 78% of all HIV cases. Latinxs also have a higher prevalence of HIV than whites and are at the highest risk for late HIV diagnosis among all racial/ethnic groups. In addition, HIV viral load suppression, which is the best predictor of long-term survival among HIV-infected patients, is substantially lower among minority populations in Baltimore.
The hypothesis of this study is that an mHealth-enhanced Linkage to Care and Retention (mLTCR) intervention can improve HIV outcomes among HIV-infected African Americans and Latinxs compared to standard linkage and care support protocols. The mLTCR intervention consists of two smartphone applications (app), one for patients and one for support staff such as linkage officers or patient navigators, to help facilitate communication. Communication will focus on issues related to HIV care (e.g. appointment scheduling, need for laboratory tests), as well as patient-directed requests. Using HIV surveillance data (e.g. dated HIV viral load), support staff will be automatically alerted if a patient has a high viral load or has not had labs done in > 4 months and prompted to contact the patient. In addition to appointment and laboratory reminders, patients will receive positive reinforcement behavioral text messages.
This is a pragmatic randomized controlled study comparing existing linkage and care support (LTC) services to an mHealth-enhanced linkage to care and retention (mLTCR) protocol.
According to modelling studies, improvement in linkage and retention in care indicators is the single most important component to achieve the 2020 National HIV/AIDS Strategy targets and substantially reduce the burden of HIV in the United States. The results of this randomized study will contribute to the evidence on the effectiveness of mHealth-enhanced LTCR initiatives implemented by the local health department and clinics. Evidence supporting the feasibility and effectiveness of this intervention will be important for HIV clinics, the BCHD and other health departments as they allocate limited resources to address the HIV epidemic in their jurisdictions. The information will also be relevant to Ryan White officials responsible for allocating federal dollars to support clinical and ancillary services to improve HIV outcomes, particularly among patients who are uninsured or underinsured.
Aim 1: To compare virologic suppression and retention in care between HIV-infected individuals who are randomized to receive standard of care linkage and care support services versus mHealth-enhanced LTCR (mLTCR) services. The primary outcome measure will be virologic suppression at 12 months of study enrollment, and secondary outcomes will include retention in care at 12 months.
Aim 2: To examine the implementation of mLTCR services using a mixed-methods approach to determine the intervention’s feasibility, acceptability, coverage, fidelity, sustainability, and patient satisfaction.
i Flynn C. Baltimore City HIV Annual Epidemiologic Profile. Available at https://phpa.health.maryland.gov/OIDEOR/CHSE/SiteAssets/Pages/statistics/Baltimore-City-HIV-Annual-Epidemiological-Profile-2016.pdf.
ii Flynn C. Maryland Annual HIV Epidemiologic Profile. Available at https://phpa.health.maryland.gov/OIDEOR/CHSE/SiteAssets/Pages/statistics/Maryland-HIV-Annual-Epidemiological-Profile-2015.pdf.
iii Shah M, Perry A, Risher K, et al. Effect of the US National HIV/AIDS Strategy targets for improved HIV care engagement: a modelling study. Lancet HIV 2016; 3(3): e140-6.