Journal of acquired immune deficiency syndromes (1999) · 2025
A Stepped-Wedge, Cluster-Randomized, Multisite Study of Text Messaging Plus Peer Navigation to Improve Adherence and Viral Suppression Among Youth on Antiretroviral Therapy.
Контролируемое клиническое исследованиеСтатьяМногоцентровое исследованиеРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Taiwo Babafemi O, Kuhns Lisa M, Agbaji Oche, David Agatha, Akanmu Sulaimon, Akinbami Akinyinka, Omigbodun Olayinka, Adekanmbi Folashade, Yiltok Esther, Ezemelue Priscilla, Akintan Patricia, Sodipo Olujimi, Awolude Olutosin, Kuti Kehinde, Mautin Gbenayon, Badru Titilope, Cervantes Marbella, Janulis Patrick, Okonkwor Ogochuckwu, Berzins Baiba, Garofalo Robert
Аннотация
BACKGROUND: To address the need for improved virologic suppression among youth living with HIV (YLH) on antiretroviral treatment (ART), we evaluated peer navigation plus TXTXT daily text message ART reminders.
SETTING: YLH aged 15-24 years on ART for at least 3 months at 6 research sites in 4 Nigerian cities.
METHODS: Using a stepped-wedge design, cluster 1 was nonrandomized, whereas clusters 2 and 3 were randomized to sequences of routine care (control period) and 48 weeks of the combination intervention (intervention period). The primary end point was viral suppression (HIV-1 RNA <200 copies/mL) at week 48 of the intervention. Secondary end points included adherence measured by self-report ( 90% considered adherent). Post hoc analysis assessed virologic control at <50 copies per milliliter and <1000 copies per milliliter. Generalized estimating equations determined the difference between intervention and control periods in the intention-to-treat population.
RESULTS: We enrolled 558 YLH and followed 541 over time, mean age 18 years, 53.8% female, 71.7% perinatally infected, and 38.6% virologically nonsuppressed at enrollment. For the primary end point, the intervention periods displayed a small, nonsignificant increase in viral suppression < 200 copies per milliliter [odds ratio (OR) = 1.16 (0.88-1.54), P = 0.297]. There was a significant effect of the combination intervention on virologic control <1000 copies per milliliter (OR = 1.42 [1.03-1.94], P = 0.030). Self-reported adherence also improved (OR = 2.07 [1.46-2.95], P < 0.001).
CONCLUSIONS: Peer navigation plus daily text message ART reminders demonstrated limited benefit among ART-experienced, predominantly perinatally infected YLH, with no significant effect on viral suppression below 200 copies per milliliter despite improvement in self-reported adherence.
SETTING: YLH aged 15-24 years on ART for at least 3 months at 6 research sites in 4 Nigerian cities.
METHODS: Using a stepped-wedge design, cluster 1 was nonrandomized, whereas clusters 2 and 3 were randomized to sequences of routine care (control period) and 48 weeks of the combination intervention (intervention period). The primary end point was viral suppression (HIV-1 RNA <200 copies/mL) at week 48 of the intervention. Secondary end points included adherence measured by self-report ( 90% considered adherent). Post hoc analysis assessed virologic control at <50 copies per milliliter and <1000 copies per milliliter. Generalized estimating equations determined the difference between intervention and control periods in the intention-to-treat population.
RESULTS: We enrolled 558 YLH and followed 541 over time, mean age 18 years, 53.8% female, 71.7% perinatally infected, and 38.6% virologically nonsuppressed at enrollment. For the primary end point, the intervention periods displayed a small, nonsignificant increase in viral suppression < 200 copies per milliliter [odds ratio (OR) = 1.16 (0.88-1.54), P = 0.297]. There was a significant effect of the combination intervention on virologic control <1000 copies per milliliter (OR = 1.42 [1.03-1.94], P = 0.030). Self-reported adherence also improved (OR = 2.07 [1.46-2.95], P < 0.001).
CONCLUSIONS: Peer navigation plus daily text message ART reminders demonstrated limited benefit among ART-experienced, predominantly perinatally infected YLH, with no significant effect on viral suppression below 200 copies per milliliter despite improvement in self-reported adherence.