Saberi Parya, McCuistian Caravella, Agnew Emily, Wootton Angie R, Legnitto Packard Dominique A, Dawson-Rose Carol, Johnson Mallory O, Gruber Valerie A, Neilands Torsten B
Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA.
Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.
Telemed Rep. 2021 Jan 7;2(1):14-25. doi: 10.1089/tmr.2020.0014. eCollection 2021.
Substance use and mental health are two barriers to engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV (YLWH). The consequences of suboptimal adherence in YLWH are increased risk of HIV transmission and a future generation of immunodeficient adults with drug-resistant virus. The Youth to Telehealth and Texting for Engagement in Care (Y2TEC) study was a pilot randomized crossover trial that examined the feasibility and acceptability of a novel video-counseling series and accompanying text messages aimed at mental health, substance use, and HIV care engagement for YLWH. The intervention consisted of twelve 20-30-min weekly video-counseling sessions focused on identifying and addressing barriers to HIV care, mental health, and substance use challenges. Participants completed quantitative surveys at baseline, 4 months, and 8 months. Feasibility and acceptability were evaluated using prespecified benchmarks. Fifty YLWH aged 18-29 years living in the San Francisco Bay Area were enrolled. Eighty-six percent and 75% of participants were retained at 4 and 8 months, respectively. A total of 455 (76%) video-counseling sessions were completed. In 82% of sessions, participants responded that they strongly agreed/agreed with this statement: "I felt heard, understood, and respected by the counselor." In 81% of sessions, participants responded that they strongly agreed/agreed with this statement: "Overall, today's session was right for me." At baseline, among participants reporting mental health challenges, only 10% noted having ever received mental health services, and among those who reported substance use challenges, ∼19% reported ever receiving substance use services. After 4 months of the Y2TEC intervention, participants reported slightly higher ART adherence and HIV knowledge, decreased depression and anxiety, and reduced stigma related to mental health and substance use. The Y2TEC intervention using video-counseling and text messaging was feasible and acceptable for YLWH. ClinicalTrials.gov ID: NCT03681145.
物质使用和心理健康是感染艾滋病毒的青年和年轻成年人（YLWH）接受治疗以及坚持抗逆转录病毒疗法（ART）的两大障碍。YLWH依从性欠佳会增加艾滋病毒传播风险，并导致未来一代成年人因感染耐药病毒而出现免疫缺陷。青年参与远程医疗和短信促进治疗（Y2TEC）研究是一项试点随机交叉试验，旨在检验一个新颖的视频咨询系列以及配套短信针对YLWH心理健康、物质使用和艾滋病毒治疗参与情况的可行性和可接受性。干预措施包括每周进行12次时长20 - 30分钟的视频咨询，重点是识别和解决艾滋病毒治疗、心理健康及物质使用方面的障碍。参与者在基线、4个月和8个月时完成定量调查。使用预先设定的基准评估可行性和可接受性。招募了50名年龄在18 - 29岁、居住在旧金山湾区的YLWH。分别有86%和75%的参与者在4个月和8个月时被保留。总共完成了455次（76%）视频咨询。在82%的咨询中，参与者表示强烈同意/同意这一说法：“我感觉咨询师倾听、理解并尊重我。”在81%的咨询中，参与者表示强烈同意/同意这一说法：“总体而言，今天的咨询适合我。”在基线时，报告有心理健康问题的参与者中，只有10%表示曾接受过心理健康服务，而在报告有物质使用问题的参与者中，约19%表示曾接受过物质使用服务。经过4个月的Y2TEC干预，参与者报告的ART依从性和艾滋病毒知识略有提高，抑郁和焦虑有所减轻，与心理健康和物质使用相关的耻辱感也有所降低。对YLWH而言，采用视频咨询和短信的Y2TEC干预是可行且可接受的。临床试验注册号：NCT03681145。
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