The International journal on drug policy · 2026
Feasibility and acceptability of peer navigator-led directly-observed-therapy to promote concordance with antiretroviral therapy among criminal legal system-involved individuals.
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Ackerman Maxwell F, Riback Lindsey R, Zhang Chenshu, Robinson Darren, Antigua Jordy Rojas, Goldberger Abigail, Linder Micaela, Ricard Nilda, Day Ronald, Fox Aaron D, Akiyama Matthew J
Аннотация
BACKGROUND: People with HIV (PWH) face barriers to achieving viral suppression following incarceration including challenges navigating complex healthcare systems, accessing HIV specialists, substance use disorders (SUDs), and limited social support. Peer navigators (PNs) can improve care engagement post-incarceration, but in-person meetings may be burdensome.
METHODS: We recruited PWH with a history of SUD from an urban reentry organization to assess the feasibility, acceptability, and preliminary effectiveness associated with a pilot of PN services coupled with mobile directly observed therapy (mDOT). PN services included HIV education, SUD counseling, and a smartphone for mDOT. Participants uploaded daily mDOT video concordance logs and received virtual and in-person support from the PN. Participants followed up with research staff monthly for 6 months.
RESULTS: Among 18 participants, 17 identified as men, 10 as Black, and 6 as Hispanic. At baseline, 10 reported substance use in the past 30 days, most commonly cannabis (9/18), alcohol (7/18), and heroin/fentanyl (3/18). Regarding feasibility, 72% were engaged with PN services at six months, 48% retained their smartphone, and 33% completed >2/3 of expected mDOT video concordance logs. Across all interactions with the PN, the most common interactions were for social support (23%), inquiring about mDOT video concordance (20%), and HIV care management (18%). Regarding satisfaction with the PN and the app, most reported that PN interactions helped them accomplish the changes they want (89%).
CONCLUSIONS: Most participants remained engaged with PN and reported high satisfaction with PN. Though satisfaction with the mDOT application was high, sustained mDOT participation remained low due to modest phone retention, unfamiliarity with smartphones, and competing priorities. Further investigation of mDOT implementation is warranted.
METHODS: We recruited PWH with a history of SUD from an urban reentry organization to assess the feasibility, acceptability, and preliminary effectiveness associated with a pilot of PN services coupled with mobile directly observed therapy (mDOT). PN services included HIV education, SUD counseling, and a smartphone for mDOT. Participants uploaded daily mDOT video concordance logs and received virtual and in-person support from the PN. Participants followed up with research staff monthly for 6 months.
RESULTS: Among 18 participants, 17 identified as men, 10 as Black, and 6 as Hispanic. At baseline, 10 reported substance use in the past 30 days, most commonly cannabis (9/18), alcohol (7/18), and heroin/fentanyl (3/18). Regarding feasibility, 72% were engaged with PN services at six months, 48% retained their smartphone, and 33% completed >2/3 of expected mDOT video concordance logs. Across all interactions with the PN, the most common interactions were for social support (23%), inquiring about mDOT video concordance (20%), and HIV care management (18%). Regarding satisfaction with the PN and the app, most reported that PN interactions helped them accomplish the changes they want (89%).
CONCLUSIONS: Most participants remained engaged with PN and reported high satisfaction with PN. Though satisfaction with the mDOT application was high, sustained mDOT participation remained low due to modest phone retention, unfamiliarity with smartphones, and competing priorities. Further investigation of mDOT implementation is warranted.