Technology Youth

Food Insecurity and Unmet Needs Among Youth and Young Adults Living with HIV in the San Francisco Bay Area

Investigators: Christian Reeder, Torsten B. Neilands, Kartika Palar, Parya Saberi

CAPS faculty Parya Saberi and Torsten Neilands collaborated with Christian Reeder and Kartika Palar to examine food insecurity and unmet subsistence needs and their association with antiretroviral therapy adherence among youth and young adults living with HIV (YLWH). 

Results from a cross-sectional survey of 101 YLWH (aged 18-29 years) found that approximately 51.7% of participants experienced at least one unmet subsistence need (difficulty finding enough to eat [36.6%], clothing [22.8%], place to sleep [21.8%], place to wash [17.8%], and bathroom [15.8%]), and 64.2% reported being food insecure. For every additional unmet need, the risk of very good/excellent adherence was reduced by 15% (RR = .85; 95% CI = .72-.99; p-value = .04). The risk of very good/excellent adherence was lowered by 39% (RR = .61; 95% CI = .43-.87; p-value = .005) among food insecure youth, compared with those who were food secure.
 

Comparing Mobile Health Strategies to Improve Pre-exposure Prophylaxis Use (PrEP) for HIV Prevention

Investigators: Al Liu, Janet Myers, Kim Koester 

Comparing Mobile Health Strategies to Improve Preexposure Prophylaxis Use (PrEP) for HIV Prevention Investigators: Al Liu, Janet Myers, Kim Koester.

Researchers compared the effectiveness of two mobile health (mHealth) strategies—PrEPmate and DOT Diary—across different theoretical models and intervention components designed to support PrEP adherence and continuation. Both strategies have shown promise, but patients, providers, and health system administrators currently lack evidence to determine which approach is most effective for supporting PrEP use among diverse patient populations. The study compared the effectiveness of PrEPmate versus DOT Diary when implemented in public health clinics and community health centers, which deliver significant volumes of PrEP to English- and Spanish-speaking African American and Latinx men who have sex with men and transgender individuals. These clinics face challenges with low and disparate levels of adherence and continuation.

Based on data from the demographically diverse, sexually active study cohort, researchers found that (a) PrEP adherence remained high over time (75% at 6 months and 50% or more at 12 months) for both PrEPmate and Dot Diary, (b) self-reported adherence was consistently high for both groups, along with protective tenofovir-diphosphate (TFV-DP) levels measured via dried blood spots, and (c) both tools were deemed acceptable by participants.

The researchers concluded that these findings provide evidence that both PrEPmate and Dot Diary effectively support PrEP use in real-world settings.
 

Video-Counseling Intervention to Address HIV Care Engagement, Mental Health, and Substance Use Challenges: A Pilot Randomized Clinical Trial for Youth and Young Adults Living with HIV

Investigators: Parya Saberi, Caravella McCuistian, Emily Agnew, Angie R. Wootton, Dominique A. Legnitto Packard, Carol Dawson-Rose, Mallory O. Johnson, Valerie A. Gruber, and Torsten B. Neilands

Substance use (SU) and mental health (MH) hinder engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV (YLWH) and potentially lead to increased HIV transmission and a future generation of immunodeficient adults with drug-resistant virus. Parya Saberi and colleagues implemented the Youth to Telehealth and Texting for Engagement in Care (Y2TEC) study to examine the feasibility and acceptability of a novel video-counseling series and accompanying text messages, designed to identify and address barriers to HIV care, and MH and SU challenges. 

Fifty YLWH aged 18–29 enrolled and completed 455 (76%) video-counseling sessions; quantitative surveys were used to evaluate Y2TEC’s feasibility and acceptability at baseline and at 4 months (86% retained) and 8 months (75% retained). Y2TEC was feasible and acceptable with participants reporting high satisfaction with video counseling sessions (81-82%) and, at 4 months, slightly higher ART adherence and HIV knowledge, decreased depression and anxiety, and reduced stigma related to mental health and substance use. 
 

WYZ: A Mobile Health Application for Engagement in Care among Youth Living with HIV

Investigators: Parya Saberi (PI), Theodore Ruel (co-I), Torsten Neilands (co-I), Mallory Johnson (co-I), Xavier Erguera (Research Coordinator)

In the US, fewer than 6% of all youth living with HIV (YLWH) achieve HIV viral suppression. This health disparity extends to the entire HIV care continuum in that there is a strong association between younger age and later HIV diagnosis, lower engagement in care, lower levels of antiretroviral therapy (ART) adherence, and worse HIV clinical outcomes. In response to this critical public health dilemma, our research team proposed to develop a novel mobile health app to improve engagement in health care and ART adherence and to pilot test this mobile health app in 18–29-year-old YLWH. We conducted a pilot trial to assess the feasibility, acceptability, and preliminary clinical impact of the use of an app called WYZ (pronounced “wise”) among YLWH and their healthcare providers. We worked with a Youth Advisory Panel to help guide the research. 3 articles have been published as a result of this study.  

Published articles related to WYZ: DOI: 10.2196/26861
DOI: 10.3390/ijerph18084170
DOI: 10.1136/bmjopen-2019-030473 
 

Intervention to Improve Virologic Suppression Among Youth (iVY)

Investigators: Parya Saberi, Tor Neilands (co-I), Valerie Gruber (co-I), Caravella McCuistian (co-I), and Mallory Johnson (co-I), Kristin Ming (Clinical Research Supervisor), Louis Smith (Research Coordinator), Celeste Balaban (Study Counselor)

Youth and young adults living with HIV (YLWH) in the U.S. face poorer treatment outcomes, with mental health (MH) and substance use (SU) challenges worsening care engagement and health disparities. Despite the urgent need, there is a nationwide shortage of MH professionals.  

In partnership with the AIDS Healthcare Foundation and a Youth Advisory Panel, this study tests a youth-friendly, technology-based intervention in a randomized clinical trial (RCT) with 300 YLWH (18–29 years old). Participants will receive either video counseling plus an app or standard care, with outcomes assessed at 16 weeks. We aim to:  

  1. Compare HIV virologic suppression between intervention and control groups.  
  2. Evaluate MH and SU differences between groups.  
  3. Use an adaptive treatment strategy (ATS) to tailor support—intensifying counseling for non-responders or transitioning responders to app-only use.  

This fully remote study seeks to improve HIV care by addressing MH and SU barriers with a personalized approach.

Visit the IVY website.

DOI: 10.1136/bmjopen-2023-077676
 

Y2TEC: Youth to Text or Telehealth for Engagement in HIV Care

Investigators: Parya Saberi (co-PI), Carol Dawson-Rose (co-PI), Valerie Gruber (co-I), Torsten Neilands (co-I), Dominique Legnitto (Research Coordinator), Caravella McCuistian (Research Fellow), Angie Wooten (Study Social Worker)

Youth and young adults living with HIV (YLWH) face poorer health outcomes than older adults, partly due to a lack of youth-friendly care. Substance use (SU) can further impact engagement in care and adherence to HIV treatment.

This study explored whether technology—videoconferencing and text messaging—could improve healthcare experiences, address mental health (MH) and SU challenges, and enhance HIV care engagement for YLWH. We conducted 17 interviews with clinicians and staff from 8 San Francisco and Oakland clinics, identifying barriers at the system (technology access, clinic capacity), provider (privacy, comfort with tech), and youth (changing phone numbers, provider relationships) levels.

A pilot wait-list control trial tested a video-conferencing intervention with 12 counseling sessions plus text message support for resources, check-ins, and appointment reminders. Findings confirmed feasibility and acceptability, leading to six published articles. This study highlights the potential of tech-based interventions to support MH, SU, and HIV care for YLWH.

Visit the Y2TEC website.
 

Youth Ending the HIV Epidemic – Automated Directly Observed Therapy Pilot: Improving HIV Care Among Youth

Investigators: Parya Saberi, Kristin Ming (Clinical Research Supervisor), Louis Smith (Research Coordinator)

Youth and young adults living with HIV (YLWH) in the U.S. face challenges with virologic suppression and retention in care, increasing the risk of HIV transmission and long-term health issues.

This study pilots an innovative intervention combining directly observed therapy (DOT) and conditional economic incentives (CEIs) using a mobile health app with AI and facial recognition to support ART adherence.

We will:

  1. Assess the feasibility and acceptability of the automated DOT-CEI (aDOT-CEI) intervention among 30 YLWH (ages 18–29) with unsuppressed viral loads.
  2. Explore experiences of 10 YLWH using a DOT-CEI and 10 staff/providers from AIDS Healthcare Foundation (AHF) clinics to identify barriers, facilitators, and refinements for a future trial.

By enhancing ART adherence and virologic suppression, this intervention aims to reduce HIV transmission and improve health outcomes for YLWH.

DOI: 10.1371/journal.pone.0289919
DOI: 10.1097/QAI.0000000000003397
DOI: 10.1371/journal.pone.0289919