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Erschienen in: AIDS and Behavior 8/2021

19.03.2021 | Original Paper

Epic Allies: A Gamified Mobile App to Improve Engagement in HIV Care and Antiretroviral Adherence among Young Men Who have Sex with Men

verfasst von: Lisa Hightow-Weidman, Kathryn E. Muessig, Joseph R. Egger, Alyssa Vecchio, Alyssa Platt

Erschienen in: AIDS and Behavior | Ausgabe 8/2021

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Abstract

HIV incidence among young men who have sex with men (YMSM) is disproportionally high. Youth living with HIV demonstrate low rates of sustained virologic suppression (VS). Epic Allies, a theory-based behavioral intervention mobile app, utilizes self-management tools, gamification, and social support to improve engagement in care and antiretroviral adherence among YMSM living with HIV. A two-arm individually randomized-controlled trial enrolled 146 participants aged 16 to 24 years old to test the efficacy of Epic Allies to achieve VS. Both study arms showed improved VS at 26-weeks (62.9% intervention; 73.5% control; ARR = 0.93 (95% CI 0.73, 1.18)) and antiretroviral adherence; intervention effects were amplified in regular app users. Issues with recruitment and app usage metrics limit the ability to definitively say that the app was effective in causing behavior changes resulting in improved health outcomes. (ClinicalTrials.gov Identifier: NCT02782130).
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Literatur
1.
Zurück zum Zitat Moore LV, Diez Roux AV. Associations of neighborhood characteristics with the location and type of food stores. Am J Public Health. 2006;96(2):325–31.CrossRef Moore LV, Diez Roux AV. Associations of neighborhood characteristics with the location and type of food stores. Am J Public Health. 2006;96(2):325–31.CrossRef
2.
Zurück zum Zitat Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDS. 2014;28(3):128–35.CrossRef Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDS. 2014;28(3):128–35.CrossRef
3.
Zurück zum Zitat Garofalo R, Hotton AL, Kuhns LM, Gratzer B, Mustanski B. Incidence of HIV infection and sexually transmitted infections and related risk factors among very young men who have sex with men. J Acquir Immune Defic Syndr. 2016;72(1):79–86.CrossRef Garofalo R, Hotton AL, Kuhns LM, Gratzer B, Mustanski B. Incidence of HIV infection and sexually transmitted infections and related risk factors among very young men who have sex with men. J Acquir Immune Defic Syndr. 2016;72(1):79–86.CrossRef
4.
Zurück zum Zitat Ryscavage P, Anderson EJ, Sutton SH, Reddy S, Taiwo B. Clinical outcomes of adolescents and young adults in adult HIV care. J Acquir Immune Defic Syndr. 2011;58(2):193–7.CrossRef Ryscavage P, Anderson EJ, Sutton SH, Reddy S, Taiwo B. Clinical outcomes of adolescents and young adults in adult HIV care. J Acquir Immune Defic Syndr. 2011;58(2):193–7.CrossRef
5.
Zurück zum Zitat Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375(9):830–9.CrossRef Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375(9):830–9.CrossRef
6.
Zurück zum Zitat Kahana SY, Fernandez MI, Wilson PA, Bauermeister JA, Lee S, Wilson CM, et al. Rates and correlates of antiretroviral therapy use and virologic suppression among perinatally and behaviorally HIV-infected youth linked to care in the United States. J Acquir Immune Defic Syndr. 2015;68(2):169–77.CrossRef Kahana SY, Fernandez MI, Wilson PA, Bauermeister JA, Lee S, Wilson CM, et al. Rates and correlates of antiretroviral therapy use and virologic suppression among perinatally and behaviorally HIV-infected youth linked to care in the United States. J Acquir Immune Defic Syndr. 2015;68(2):169–77.CrossRef
7.
Zurück zum Zitat Kahana SY, Jenkins RA, Bruce D, Fernandez MI, Hightow-Weidman LB, Bauermeister JA, et al. Structural determinants of antiretroviral therapy use, HIV care attendance, and viral suppression among adolescents and young adults living with HIV. PLoS ONE. 2016;11(4):e0151106.CrossRef Kahana SY, Jenkins RA, Bruce D, Fernandez MI, Hightow-Weidman LB, Bauermeister JA, et al. Structural determinants of antiretroviral therapy use, HIV care attendance, and viral suppression among adolescents and young adults living with HIV. PLoS ONE. 2016;11(4):e0151106.CrossRef
8.
Zurück zum Zitat Lally MA, van den Berg JJ, Westfall AO, Rudy BJ, Hosek SG, Fortenberry JD, et al. HIV continuum of care for youth in the United States. J Acquir Immune Defic Syndr. 2018;77(1):110–7.CrossRef Lally MA, van den Berg JJ, Westfall AO, Rudy BJ, Hosek SG, Fortenberry JD, et al. HIV continuum of care for youth in the United States. J Acquir Immune Defic Syndr. 2018;77(1):110–7.CrossRef
9.
Zurück zum Zitat Mimiaga MJ, Hughto JMW, Biello KB, Santostefano CM, Kuhns LM, Reisner SL, et al. Longitudinal analysis of syndemic psychosocial problems predicting HIV risk behavior among a multicity prospective cohort of sexually active young transgender women in the United States. J Acquir Immune Defic Syndr. 2019;81(2):184–92.CrossRef Mimiaga MJ, Hughto JMW, Biello KB, Santostefano CM, Kuhns LM, Reisner SL, et al. Longitudinal analysis of syndemic psychosocial problems predicting HIV risk behavior among a multicity prospective cohort of sexually active young transgender women in the United States. J Acquir Immune Defic Syndr. 2019;81(2):184–92.CrossRef
10.
Zurück zum Zitat Stokes JP, Peterson JL. Homophobia, self-esteem, and risk for HIV among African American men who have sex with men. AIDS Educ Prev. 1998;10(3):278–92.PubMed Stokes JP, Peterson JL. Homophobia, self-esteem, and risk for HIV among African American men who have sex with men. AIDS Educ Prev. 1998;10(3):278–92.PubMed
11.
Zurück zum Zitat Boone MR, Cook SH, Wilson PA. Sexual identity and HIV status influence the relationship between internalized stigma and psychological distress in black gay and bisexual men. AIDS Care. 2016;28(6):764–70.CrossRef Boone MR, Cook SH, Wilson PA. Sexual identity and HIV status influence the relationship between internalized stigma and psychological distress in black gay and bisexual men. AIDS Care. 2016;28(6):764–70.CrossRef
12.
Zurück zum Zitat Tanney MR, Naar King S, Murphy DA, Parsons JT, Janisse H, Team ATNP. Multiple risk behaviors among youth living with human immunodeficiency virus in five U.S. cities. J Adolesc Health. 2010; 46(1):11–6. Tanney MR, Naar King S, Murphy DA, Parsons JT, Janisse H, Team ATNP. Multiple risk behaviors among youth living with human immunodeficiency virus in five U.S. cities. J Adolesc Health. 2010; 46(1):11–6.
13.
Zurück zum Zitat Preisser JS, Lohman KK, Rathouz PJ. Performance of weighted estimating equations for longitudinal binary data with drop-outs missing at random. Stat Med. 2002;21(20):3035–54.CrossRef Preisser JS, Lohman KK, Rathouz PJ. Performance of weighted estimating equations for longitudinal binary data with drop-outs missing at random. Stat Med. 2002;21(20):3035–54.CrossRef
14.
Zurück zum Zitat Muessig KE, LeGrand S, Horvath KJ, Bauermeister JA, Hightow-Weidman LB. Recent mobile health interventions to support medication adherence among HIV-positive MSM. Curr Opin HIV AIDS. 2017;12(5):432–41.CrossRef Muessig KE, LeGrand S, Horvath KJ, Bauermeister JA, Hightow-Weidman LB. Recent mobile health interventions to support medication adherence among HIV-positive MSM. Curr Opin HIV AIDS. 2017;12(5):432–41.CrossRef
15.
Zurück zum Zitat Muessig KE, Nekkanti M, Bauermeister J, Bull S, Hightow-Weidman LB. A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care. Curr HIV/AIDS Rep. 2015;12(1):173–90. Muessig KE, Nekkanti M, Bauermeister J, Bull S, Hightow-Weidman LB. A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care. Curr HIV/AIDS Rep. 2015;12(1):173–90.
16.
Zurück zum Zitat Mulawa MI, LeGrand S, Hightow-Weidman LB. eHealth to enhance treatment adherence among youth living with HIV. Curr HIV/AIDS Rep. 2018;15(4):336–49.CrossRef Mulawa MI, LeGrand S, Hightow-Weidman LB. eHealth to enhance treatment adherence among youth living with HIV. Curr HIV/AIDS Rep. 2018;15(4):336–49.CrossRef
17.
Zurück zum Zitat Hightow-Weidman LB, Muessig KE, Bauermeister J, Zhang C, LeGrand S. Youth, technology, and HIV: recent advances and future directions. Curr HIV/AIDS Rep. 2015;12(4):500–15.CrossRef Hightow-Weidman LB, Muessig KE, Bauermeister J, Zhang C, LeGrand S. Youth, technology, and HIV: recent advances and future directions. Curr HIV/AIDS Rep. 2015;12(4):500–15.CrossRef
18.
Zurück zum Zitat Hightow-Weidman LB, Muessig KE, Bauermeister JA, LeGrand S, Fiellin LE. The future of digital games for HIV prevention and care. Curr Opin HIV AIDS. 2017;12(5):501–7.CrossRef Hightow-Weidman LB, Muessig KE, Bauermeister JA, LeGrand S, Fiellin LE. The future of digital games for HIV prevention and care. Curr Opin HIV AIDS. 2017;12(5):501–7.CrossRef
19.
Zurück zum Zitat Young SD, Cumberland WG, Lee SJ, Jaganath D, Szekeres G, Coates T. Social networking technologies as an emerging tool for HIV prevention: a cluster randomized trial. Ann Intern Med. 2013;159(5):318–24.CrossRef Young SD, Cumberland WG, Lee SJ, Jaganath D, Szekeres G, Coates T. Social networking technologies as an emerging tool for HIV prevention: a cluster randomized trial. Ann Intern Med. 2013;159(5):318–24.CrossRef
20.
Zurück zum Zitat Harper GW, Fernandez IM, Bruce D, Hosek SG, Jacobs RJ, Adolescent medicine trials network for HIVAI. The role of multiple identities in adherence to medical appointments among gay/bisexual male adolescents living with HIV. AIDS Behav. 2013;17(1):213–23. Harper GW, Fernandez IM, Bruce D, Hosek SG, Jacobs RJ, Adolescent medicine trials network for HIVAI. The role of multiple identities in adherence to medical appointments among gay/bisexual male adolescents living with HIV. AIDS Behav. 2013;17(1):213–23.
21.
Zurück zum Zitat LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, et al. Epic allies: development of a gaming app to improve antiretroviral therapy adherence among young HIV-positive men who have sex with men. JMIR Serious Games. 2016;4(1):e6.CrossRef LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, et al. Epic allies: development of a gaming app to improve antiretroviral therapy adherence among young HIV-positive men who have sex with men. JMIR Serious Games. 2016;4(1):e6.CrossRef
22.
Zurück zum Zitat LeGrand S, Muessig KE, Platt A, Soni K, Egger JR, Nwoko N, et al. Epic allies, a Gamified mobile phone app to improve engagement in care, antiretroviral uptake, and adherence among young men who have sex with men and young transgender women who have sex with men: protocol for a randomized controlled trial. JMIR Res Protoc. 2018;7(4):e94.CrossRef LeGrand S, Muessig KE, Platt A, Soni K, Egger JR, Nwoko N, et al. Epic allies, a Gamified mobile phone app to improve engagement in care, antiretroviral uptake, and adherence among young men who have sex with men and young transgender women who have sex with men: protocol for a randomized controlled trial. JMIR Res Protoc. 2018;7(4):e94.CrossRef
23.
Zurück zum Zitat Hightow-Weidman L, Muessig K, Egger JR, LeGrand S, Platt A. Predictors of condomless anal intercourse in young HIV-positive men who have sex with men with detectable viral loads. J Adolesc Health. 2020. Hightow-Weidman L, Muessig K, Egger JR, LeGrand S, Platt A. Predictors of condomless anal intercourse in young HIV-positive men who have sex with men with detectable viral loads. J Adolesc Health. 2020.
24.
Zurück zum Zitat Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Roy Stat Soc. 1995;57(1):289–300. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Roy Stat Soc. 1995;57(1):289–300.
25.
Zurück zum Zitat Yelland LN, Salter AB, Ryan P. Performance of the modified Poisson regression approach for estimating relative risks from clustered prospective data. Am J Epidemiol. 2011;174(8):984–92.CrossRef Yelland LN, Salter AB, Ryan P. Performance of the modified Poisson regression approach for estimating relative risks from clustered prospective data. Am J Epidemiol. 2011;174(8):984–92.CrossRef
26.
Zurück zum Zitat Bloom HS. Accounting for No-shows in experimental evaluation designs. Eval Rev. 1984;8(2):225–46.CrossRef Bloom HS. Accounting for No-shows in experimental evaluation designs. Eval Rev. 1984;8(2):225–46.CrossRef
27.
Zurück zum Zitat Simmons RA, Egger JR. A CACE for assessing non-compliance: addressing non-compliance in randomised controlled trials. BJOG. 2019;126(13):1558–9.CrossRef Simmons RA, Egger JR. A CACE for assessing non-compliance: addressing non-compliance in randomised controlled trials. BJOG. 2019;126(13):1558–9.CrossRef
28.
Zurück zum Zitat White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377–99.CrossRef White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377–99.CrossRef
29.
Zurück zum Zitat Sullivan TR, White IR, Salter AB, Ryan P, Lee KJ. Should multiple imputation be the method of choice for handling missing data in randomized trials? Stat Methods Med Res. 2018;27(9):2610–26.CrossRef Sullivan TR, White IR, Salter AB, Ryan P, Lee KJ. Should multiple imputation be the method of choice for handling missing data in randomized trials? Stat Methods Med Res. 2018;27(9):2610–26.CrossRef
30.
Zurück zum Zitat Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications. Stat Med. 1991;10(4):585–98.CrossRef Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications. Stat Med. 1991;10(4):585–98.CrossRef
31.
Zurück zum Zitat Schulz KF, Altman DG, Mohar D, Group C. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010;63(8):834–40.CrossRef Schulz KF, Altman DG, Mohar D, Group C. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010;63(8):834–40.CrossRef
32.
Zurück zum Zitat Hightow-Weidman LB, Bauermeister JA. Engagement in mHealth behavioral interventions for HIV prevention and care: making sense of the metrics. Mhealth. 2020;6:7.CrossRef Hightow-Weidman LB, Bauermeister JA. Engagement in mHealth behavioral interventions for HIV prevention and care: making sense of the metrics. Mhealth. 2020;6:7.CrossRef
33.
Zurück zum Zitat Hightow-Weidman LB, LeGrand S, Muessig KE, Simmons RA, Soni K, Choi SK, et al. A randomized trial of an online risk reduction intervention for young black MSM. AIDS Behav. 2018. Hightow-Weidman LB, LeGrand S, Muessig KE, Simmons RA, Soni K, Choi SK, et al. A randomized trial of an online risk reduction intervention for young black MSM. AIDS Behav. 2018.
34.
Zurück zum Zitat Franklin VL, Greene A, Waller A, Greene SA, Pagliari C. Patients’ engagement with “Sweet Talk” - a text messaging support system for young people with diabetes. J Med Internet Res. 2008;10(2):e20.CrossRef Franklin VL, Greene A, Waller A, Greene SA, Pagliari C. Patients’ engagement with “Sweet Talk” - a text messaging support system for young people with diabetes. J Med Internet Res. 2008;10(2):e20.CrossRef
35.
Zurück zum Zitat Crutzen R, de Nooijer J, Brouwer W, Oenema A, Brug J, de Vries NK. Strategies to facilitate exposure to internet-delivered health behavior change interventions aimed at adolescents or young adults: a systematic review. Health Educ Behav. 2011;38(1):49–62.CrossRef Crutzen R, de Nooijer J, Brouwer W, Oenema A, Brug J, de Vries NK. Strategies to facilitate exposure to internet-delivered health behavior change interventions aimed at adolescents or young adults: a systematic review. Health Educ Behav. 2011;38(1):49–62.CrossRef
36.
Zurück zum Zitat Bauermeister JA, Golinkoff JM, Muessig KE, Horvath KJ, Hightow-Weidman LB. Addressing engagement in technology-based behavioural HIV interventions through paradata metrics. Curr Opin HIV AIDS. 2017;12(5):442–6.CrossRef Bauermeister JA, Golinkoff JM, Muessig KE, Horvath KJ, Hightow-Weidman LB. Addressing engagement in technology-based behavioural HIV interventions through paradata metrics. Curr Opin HIV AIDS. 2017;12(5):442–6.CrossRef
37.
Zurück zum Zitat Eysenbach G. The law of attrition. J Med Internet Res. 2005;7(1):e11.CrossRef Eysenbach G. The law of attrition. J Med Internet Res. 2005;7(1):e11.CrossRef
38.
Zurück zum Zitat Fernandez MI, Harper GW, Hightow-Weidman LB, Kapogiannis BG, Mayer KH, Parsons JT, et al. Research priorities to end the adolescent HIV epidemic in the United States: viewpoint. JMIR Res Protoc. 2021;10(1):e22279.CrossRef Fernandez MI, Harper GW, Hightow-Weidman LB, Kapogiannis BG, Mayer KH, Parsons JT, et al. Research priorities to end the adolescent HIV epidemic in the United States: viewpoint. JMIR Res Protoc. 2021;10(1):e22279.CrossRef
40.
Zurück zum Zitat Davison KK, Lawson CT. Do attributes in the physical environment influence children's physical activity? A review of the literature. Int J Behav Nutr Phys Activity. 2006; 3(19). Davison KK, Lawson CT. Do attributes in the physical environment influence children's physical activity? A review of the literature. Int J Behav Nutr Phys Activity. 2006; 3(19).
41.
Zurück zum Zitat Lee S, Kapogiannis BG, Allison S. Improving the youth HIV prevention and care continuums: the adolescent medicine trials network for HIV/AIDS interventions. JMIR Res Protoc. 2019;8(3):e12050.CrossRef Lee S, Kapogiannis BG, Allison S. Improving the youth HIV prevention and care continuums: the adolescent medicine trials network for HIV/AIDS interventions. JMIR Res Protoc. 2019;8(3):e12050.CrossRef
42.
Zurück zum Zitat Kacanek D, Huo Y, Malee K, Mellins CA, Smith R, Garvie PA, et al. Nonadherence and UNSUPPRESSED viral load across adolescence among US youth with perinatally acquired HIV. AIDS. 2019;33(12):1923–34.CrossRef Kacanek D, Huo Y, Malee K, Mellins CA, Smith R, Garvie PA, et al. Nonadherence and UNSUPPRESSED viral load across adolescence among US youth with perinatally acquired HIV. AIDS. 2019;33(12):1923–34.CrossRef
43.
Zurück zum Zitat MacDonellJacques-Tiura KKAJ, Naar S, Fernandez MI, Team ATNP. Predictors of self-reported adherence to antiretroviral medication in a multisite study of ethnic and racial minority HIV-positive youth. J Pediatr Psychol. 2016;41(4):419–28.CrossRef MacDonellJacques-Tiura KKAJ, Naar S, Fernandez MI, Team ATNP. Predictors of self-reported adherence to antiretroviral medication in a multisite study of ethnic and racial minority HIV-positive youth. J Pediatr Psychol. 2016;41(4):419–28.CrossRef
Metadaten
Titel
Epic Allies: A Gamified Mobile App to Improve Engagement in HIV Care and Antiretroviral Adherence among Young Men Who have Sex with Men
verfasst von
Lisa Hightow-Weidman
Kathryn E. Muessig
Joseph R. Egger
Alyssa Vecchio
Alyssa Platt
Publikationsdatum
19.03.2021
Verlag
Springer US
Erschienen in
AIDS and Behavior / Ausgabe 8/2021
Print ISSN: 1090-7165
Elektronische ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-021-03222-y

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