Environment and Health Group (EHG), Inc., in collaboration with a number of Boston MA and Columbia SC based organizations, seeks to enhance, test, and commercialize an individually-tailored, culturally-sensitive, positive-psychology and behavioral-economics based, mobile health intervention to promote ART adherence, increase ART self-efficacy and reduce feelings of stress burden among HIV positive African Americans age 45 and older. African Americans represent a growing portion (41%) of people living with HIV (CDC, 2012; 2014); by 2015, those age 50+ will account for half of all cases of HIV/AIDS in the U.S. (NIDA, 2012). Poor ART adherence contributes to disparities in HIV/AIDS outcomes among older African Americans. The proposed project is based on EHG's previous research with HIV+, age 50 years and older, African American adults. That research revealed personalized pill reminder text messages with positive-psychology based motivational and educational messages are effective at addressing two major barriers to ART adherence in this group: 1) memory deficits resulting from the combined effects of HIV, cognitive aging, and increased allostatic load, and 2) low motivation due to lack of ART self efficacy and negative affect. Findings showed significant improvement in ART adherence scores and marginally significant improvement in ART self- efficacy scores. While affect scores did not change, qualitative findings showed the intervention helped reduce feelings of stress burden. Supporting ART adherence is key to reducing health disparities among HIV+ African Americans. Doing so for those, age 45 and older-who are most vulnerable to cumulative, age-accelerating effects of HIV infection and allostatic load-is urgent, which is why we are lowering the age cut-off from 50 to 45 in Phase II. To date, no ART adherence support intervention has been developed for this highly-vulnerable group. The Phase II project will enhance the existing mobile intervention by offering: 1) a two-way communication capability through which participants can: i) indicate pill taken in response to pill reminders, and ii) receive a positive visual icon as behavioral-economics based reinforcement for pill taken responses; 2) live, real-time pharmacist counseling and medication support; and, 3) the addition of opt-in smoking cessation educational and motivational texts. Overall aims are to: 1) expand mhealth intervention to incorporate new Phase II features; 2) evaluate effectiveness in an RCT of HIV+ African Americans age 45 and older; and 3) prepare marketing and commercialization plans. Our long-term goal is to increase ART adherence, thus decreasing health disparities, among HIV+, African-Americans, age 45+.
According to the CDC (2013), there are approximately 215,000 African Americans in the age group of 45 and older who are living with an HIV diagnosis. Unfortunately, many African-Americans will die earlier from HIV/AIDS than their white, non-Hispanic counterparts, due in large part, to lack of adherence to Antiretroviral therapy (ART). The proposed mhealth intervention seeks to increase ART adherence among HIV+ African- Americans, who are over the age of 45, thus improving health outcomes and reducing disparities in this group.
