Positive Strategies to Enhance Problem-Solving Skills (STEPS): A pilot randomized, controlled trial of a multicomponent, technology-enhanced, customizable antiretroviral adherence intervention for HIV-infected adolescents and young adults

Matthew J. Mimiaga, Laura M. Bogart, Idia B. Thurston, Christopher M. Santostefano, Elizabeth F. Closson, Margie R. Skeer, Katie B. Biello, Steven Safren

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Adolescents are disproportionately impacted by HIV in the United States. Optimal effects from antiretroviral therapy (ART) can be achieved through stringent adherence to a daily medication regimen; for adolescents, this may be interrupted due to complex barriers unique to this age group. We previously conducted formative qualitative interviews with HIV-infected adolescents to identify key barriers facing adolescents regarding ART adherence and potential strategies to address these barriers. These data were used to inform an ART adherence intervention designed to overcome difficulties unique to HIV-infected adolescents (e.g., internalized stigma and HIV-related shame, disclosure to sexual partners, social life, and extracurricular activities at school, etc.). The resulting intervention - "Positive Strategies To Enhance Problem-solving Skills (Positive STEPS)" - combines five individual counseling sessions with daily text message reminders. We conducted a pilot randomized controlled trial of the intervention against a standard of care control and report on the feasibility of procedures and participant acceptability of the intervention in terms of content, structure, and format. ART adherence was measured in both arms through Medication Event Monitoring System pill caps and self-report. Feasibility and acceptability of the Positive STEPS intervention was evidenced by 90% retention for the intervention sessions; 100% completion of the four-month assessment; and positive responses on postintervention evaluation forms (all intervention participants rated Positive STEPS as "acceptable" or "very acceptable") and brief exit interviews. At the 4-month assessment visit, the change in ART adherence among the intervention group [mean change score = 13%, standard deviation (SD) = 29.5] was significantly higher compared with the standard of care group (mean change score = -26%, SD = 26.0; Cohen's d effect size = 1.43, confidence interval = 0.17-2.49, p = 0.02). Future testing of the intervention in a fully powered randomized controlled trial to determine efficacy is warranted.

Original languageEnglish (US)
Pages (from-to)21-24
Number of pages4
JournalAIDS Patient Care and STDs
Volume33
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Young Adult
Randomized Controlled Trials
HIV
Technology
Standard of Care
Text Messaging
Interviews
Therapeutics
Shame
Sexual Partners
Disclosure
Self Report
Counseling
Age Groups
Confidence Intervals

Keywords

  • adherence
  • adolescents
  • ART
  • HIV
  • technology
  • text messaging

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Positive Strategies to Enhance Problem-Solving Skills (STEPS) : A pilot randomized, controlled trial of a multicomponent, technology-enhanced, customizable antiretroviral adherence intervention for HIV-infected adolescents and young adults. / Mimiaga, Matthew J.; Bogart, Laura M.; Thurston, Idia B.; Santostefano, Christopher M.; Closson, Elizabeth F.; Skeer, Margie R.; Biello, Katie B.; Safren, Steven.

In: AIDS Patient Care and STDs, Vol. 33, No. 1, 01.01.2019, p. 21-24.

Research output: Contribution to journalArticle

Mimiaga, Matthew J. ; Bogart, Laura M. ; Thurston, Idia B. ; Santostefano, Christopher M. ; Closson, Elizabeth F. ; Skeer, Margie R. ; Biello, Katie B. ; Safren, Steven. / Positive Strategies to Enhance Problem-Solving Skills (STEPS) : A pilot randomized, controlled trial of a multicomponent, technology-enhanced, customizable antiretroviral adherence intervention for HIV-infected adolescents and young adults. In: AIDS Patient Care and STDs. 2019 ; Vol. 33, No. 1. pp. 21-24.
@article{f87a6cee02024e6ab2b7b064e42f90d9,
title = "Positive Strategies to Enhance Problem-Solving Skills (STEPS): A pilot randomized, controlled trial of a multicomponent, technology-enhanced, customizable antiretroviral adherence intervention for HIV-infected adolescents and young adults",
abstract = "Adolescents are disproportionately impacted by HIV in the United States. Optimal effects from antiretroviral therapy (ART) can be achieved through stringent adherence to a daily medication regimen; for adolescents, this may be interrupted due to complex barriers unique to this age group. We previously conducted formative qualitative interviews with HIV-infected adolescents to identify key barriers facing adolescents regarding ART adherence and potential strategies to address these barriers. These data were used to inform an ART adherence intervention designed to overcome difficulties unique to HIV-infected adolescents (e.g., internalized stigma and HIV-related shame, disclosure to sexual partners, social life, and extracurricular activities at school, etc.). The resulting intervention - {"}Positive Strategies To Enhance Problem-solving Skills (Positive STEPS){"} - combines five individual counseling sessions with daily text message reminders. We conducted a pilot randomized controlled trial of the intervention against a standard of care control and report on the feasibility of procedures and participant acceptability of the intervention in terms of content, structure, and format. ART adherence was measured in both arms through Medication Event Monitoring System pill caps and self-report. Feasibility and acceptability of the Positive STEPS intervention was evidenced by 90{\%} retention for the intervention sessions; 100{\%} completion of the four-month assessment; and positive responses on postintervention evaluation forms (all intervention participants rated Positive STEPS as {"}acceptable{"} or {"}very acceptable{"}) and brief exit interviews. At the 4-month assessment visit, the change in ART adherence among the intervention group [mean change score = 13{\%}, standard deviation (SD) = 29.5] was significantly higher compared with the standard of care group (mean change score = -26{\%}, SD = 26.0; Cohen's d effect size = 1.43, confidence interval = 0.17-2.49, p = 0.02). Future testing of the intervention in a fully powered randomized controlled trial to determine efficacy is warranted.",
keywords = "adherence, adolescents, ART, HIV, technology, text messaging",
author = "Mimiaga, {Matthew J.} and Bogart, {Laura M.} and Thurston, {Idia B.} and Santostefano, {Christopher M.} and Closson, {Elizabeth F.} and Skeer, {Margie R.} and Biello, {Katie B.} and Steven Safren",
year = "2019",
month = "1",
day = "1",
doi = "10.1089/apc.2018.0138",
language = "English (US)",
volume = "33",
pages = "21--24",
journal = "AIDS Patient Care and STDs",
issn = "1087-2914",
publisher = "Mary Ann Liebert Inc.",
number = "1",

}

TY - JOUR

T1 - Positive Strategies to Enhance Problem-Solving Skills (STEPS)

T2 - A pilot randomized, controlled trial of a multicomponent, technology-enhanced, customizable antiretroviral adherence intervention for HIV-infected adolescents and young adults

AU - Mimiaga, Matthew J.

AU - Bogart, Laura M.

AU - Thurston, Idia B.

AU - Santostefano, Christopher M.

AU - Closson, Elizabeth F.

AU - Skeer, Margie R.

AU - Biello, Katie B.

AU - Safren, Steven

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Adolescents are disproportionately impacted by HIV in the United States. Optimal effects from antiretroviral therapy (ART) can be achieved through stringent adherence to a daily medication regimen; for adolescents, this may be interrupted due to complex barriers unique to this age group. We previously conducted formative qualitative interviews with HIV-infected adolescents to identify key barriers facing adolescents regarding ART adherence and potential strategies to address these barriers. These data were used to inform an ART adherence intervention designed to overcome difficulties unique to HIV-infected adolescents (e.g., internalized stigma and HIV-related shame, disclosure to sexual partners, social life, and extracurricular activities at school, etc.). The resulting intervention - "Positive Strategies To Enhance Problem-solving Skills (Positive STEPS)" - combines five individual counseling sessions with daily text message reminders. We conducted a pilot randomized controlled trial of the intervention against a standard of care control and report on the feasibility of procedures and participant acceptability of the intervention in terms of content, structure, and format. ART adherence was measured in both arms through Medication Event Monitoring System pill caps and self-report. Feasibility and acceptability of the Positive STEPS intervention was evidenced by 90% retention for the intervention sessions; 100% completion of the four-month assessment; and positive responses on postintervention evaluation forms (all intervention participants rated Positive STEPS as "acceptable" or "very acceptable") and brief exit interviews. At the 4-month assessment visit, the change in ART adherence among the intervention group [mean change score = 13%, standard deviation (SD) = 29.5] was significantly higher compared with the standard of care group (mean change score = -26%, SD = 26.0; Cohen's d effect size = 1.43, confidence interval = 0.17-2.49, p = 0.02). Future testing of the intervention in a fully powered randomized controlled trial to determine efficacy is warranted.

AB - Adolescents are disproportionately impacted by HIV in the United States. Optimal effects from antiretroviral therapy (ART) can be achieved through stringent adherence to a daily medication regimen; for adolescents, this may be interrupted due to complex barriers unique to this age group. We previously conducted formative qualitative interviews with HIV-infected adolescents to identify key barriers facing adolescents regarding ART adherence and potential strategies to address these barriers. These data were used to inform an ART adherence intervention designed to overcome difficulties unique to HIV-infected adolescents (e.g., internalized stigma and HIV-related shame, disclosure to sexual partners, social life, and extracurricular activities at school, etc.). The resulting intervention - "Positive Strategies To Enhance Problem-solving Skills (Positive STEPS)" - combines five individual counseling sessions with daily text message reminders. We conducted a pilot randomized controlled trial of the intervention against a standard of care control and report on the feasibility of procedures and participant acceptability of the intervention in terms of content, structure, and format. ART adherence was measured in both arms through Medication Event Monitoring System pill caps and self-report. Feasibility and acceptability of the Positive STEPS intervention was evidenced by 90% retention for the intervention sessions; 100% completion of the four-month assessment; and positive responses on postintervention evaluation forms (all intervention participants rated Positive STEPS as "acceptable" or "very acceptable") and brief exit interviews. At the 4-month assessment visit, the change in ART adherence among the intervention group [mean change score = 13%, standard deviation (SD) = 29.5] was significantly higher compared with the standard of care group (mean change score = -26%, SD = 26.0; Cohen's d effect size = 1.43, confidence interval = 0.17-2.49, p = 0.02). Future testing of the intervention in a fully powered randomized controlled trial to determine efficacy is warranted.

KW - adherence

KW - adolescents

KW - ART

KW - HIV

KW - technology

KW - text messaging

UR - http://www.scopus.com/inward/record.url?scp=85059433427&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059433427&partnerID=8YFLogxK

U2 - 10.1089/apc.2018.0138

DO - 10.1089/apc.2018.0138

M3 - Article

C2 - 30601059

AN - SCOPUS:85059433427

VL - 33

SP - 21

EP - 24

JO - AIDS Patient Care and STDs

JF - AIDS Patient Care and STDs

SN - 1087-2914

IS - 1

ER -