Addressing Antiretroviral Therapy Nonadherence for Youth With HIV via a Technology-Enhanced Community Nursing...

Adherence to antiretroviral treatment (ART) among youth with HIV (YHIV) is critical for viral suppression (VS) and optimal outcomes. Many YHIV face barriers to engaging in standard-of-care (SOC) clinic-based interactions, compromising adherence.

TECH2CHECK was a randomized controlled trial of a technology-enhanced community health nursing (CHN) intervention designed to address ART adherence versus SOC (#NCT03600103) conducted 2018-2024 in youth-serving HIV clinics in high-burden locales (Baltimore, Maryland, Washington DC, Jacksonville, Florida). Eligible participants, YHIV 12-25 years, prescribed ART, with viral load > 20 copies/ml, were randomized to CHN versus SOC. The intervention involved five unincentivized CHN visits over 24 weeks addressing adherence barriers, drawing monitor labs, and triage for urgent care needs, supplemented by the eMocha smartphone application with customized care reminders, adherence questions, and video upload for directly observed ART. The primary outcome was VS at 6, 12, and 18 months. Generalized linear mixed models with logistic regression analyses were performed to compare group differences in the proportions of subjects with VS at 6, 12, and 18 months postrandomization.

Seventy six YHIV were randomized (38 CHN, 38 SOC) across three sites; 64% male, 66% nonperinatal, 92% Black, median age 23.0 years. The median VL at enrollment was 119 copies/ml (interquartile range 34-2907); 26% had not been engaged in clinical care in >6 months. Per-protocol study visit completion rates were 77%, 94%, 95%, 96%, and 100% at the 1, 3, 6, 12, and 18-month visits, respectively. Completion rates for the unincentivized CHN visits were 77% (2 weeks), 78% (6 weeks), 81% (10 weeks), 95% (14 weeks), and 91% (26 weeks). Viral suppression tended to be higher in the intervention versus SOC at 6 (57% vs. 38%), 12 (43% vs. 30%), and 18 (75% vs. 33%) months postrandomization, although these differences were not statistically significant.

TECH2CHECK demonstrated high feasibility, visit completion rates, including unincentivized CHN visits, and high VS rates, though the latter must be interpreted with caution as it was not statistically significant. This alternate paradigm of care may benefit YHIV who are at-risk for adverse outcomes.