Wagner L Danielle, Mancuso Noah, Stoner Marie C D, Smith Louis, Ming Kristin, Patani Henna, Sukhija-Cohen Adam C, Granados Yancy, Napierala Sue, Saberi Parya
Women's Global Health Imperative, RTI International, Berkeley, CA, USA.
Women's Global Health Imperative, RTI International, Atlanta, GA, USA.
AIDS Behav. 2025 May 10. doi: 10.1007/s10461-025-04748-1.
Digitally monitoring and supporting daily antiretroviral therapy (ART) is a promising strategy for enhanced adherence among young adults with HIV (YWH). We implemented an innovative mobile app-based intervention that included automated directly observed therapy (aDOT) using artificial intelligence, medication reminders, and conditional economic incentives (CEIs). This intervention used facial recognition to track and record YWH's daily ART adherence. CEIs were given based on daily app use. A pilot study of the aDOT + CEI app intervention was conducted among YWH ages 18-29 for 3 months. We recruited virally unsuppressed YWH from AIDS Healthcare Foundation clinics in California and Florida and conducted qualitative interviews with YWH and providers regarding the intervention's motivators, deterrents, and helpfulness. Thirteen YWH and 5 providers were interviewed. YWH found the CEIs supported their adherence; however, most YWH did not find the CEI amount sufficiently motivating. The primary motivator for consistent app use was to improve health, and the app reminders were most helpful in improving adherence. YWH desired more reassurance and explanation about app privacy features. Providers suggested incorporating the intervention into counseling for newly diagnosed patients and recommended the intervention to help facilitate viral suppression with oral ART for those interested in transitioning to long-acting injectable ART. YWH and providers found the intervention helpful in reminders to take ART and in tracking adherence. Refinements to the CEI amount may further enhance the intervention. Additional research is needed to test the efficacy of a refined aDOT + CEI intervention to improve viral suppression in a larger sample.
数字监测和支持每日抗逆转录病毒疗法（ART）是提高艾滋病毒感染青年（YWH）依从性的一项有前景的策略。我们实施了一项基于移动应用程序的创新干预措施，其中包括使用人工智能的自动直接观察疗法（aDOT）、服药提醒和有条件经济激励（CEI）。该干预措施使用面部识别来跟踪和记录YWH的每日ART依从情况。根据每日应用程序使用情况给予CEI。对18至29岁的YWH进行了为期3个月的aDOT + CEI应用程序干预的试点研究。我们从加利福尼亚州和佛罗里达州的艾滋病医疗基金会诊所招募了病毒载量未得到抑制的YWH，并就干预措施的激励因素、阻碍因素和帮助作用与YWH及提供者进行了定性访谈。共访谈了13名YWH和5名提供者。YWH发现CEI有助于他们坚持治疗；然而，大多数YWH认为CEI的金额激励作用不足。持续使用应用程序的主要动机是改善健康，应用程序提醒对提高依从性最有帮助。YWH希望获得更多关于应用程序隐私功能的保证和解释。提供者建议将该干预措施纳入对新诊断患者的咨询中，并推荐该干预措施，以帮助那些有兴趣过渡到长效注射用ART的患者通过口服ART实现病毒抑制。YWH和提供者发现该干预措施有助于提醒服用ART并跟踪依从情况。对CEI金额进行调整可能会进一步增强干预效果。需要进行更多研究，以在更大样本中测试改进后的aDOT + CEI干预措施改善病毒抑制的疗效。
