Tailored Video Doctor Intervention May Benefit Certain PLWH

After introducing a highly tailored video doctor intervention to a group of people living with HIV (PLWH), authors of a study published in Journal of Acquired Immune Deficiency Syndrome found it may help men with HIV achieve viral suppression, and younger and older patients achieve HIV care retention.

The group was made up of 799 participants with a mean (SD) age of 44.9 (12.8) years, and most participants were male (76%) or Black (76%).

The study was conducted at 4 regionally and demographically diverse HIV primary care clinics in the United States, with 1 in the northeast region, 1 in the south central region, and 2 in the southeast region.

Participants were required to have received care at 1 of these participating clinics and meet at least 1 of the following subcriteria:

• had a most recent viral load (VL) laboratory result of at least 200 copies/mL
• were new to care within the past 12 months
• were out of care, defined as their last attended clinic appointment being more than 12 months before baseline

There was nearly equal representation from each of the 4 sites. Additionally, 56% of PLWH in the study had VL suppression at baseline, and 42% were new to care.

Participants were randomized to receive either the Positive Health Check (PHC) intervention or continue with standard of care (SOC).

PHC is a highly tailored, interactive digital intervention drawing from the Information-Behavioral-Motivation Model, the Transtheoretical Model, motivational interviewing, and other health behavior theories, and consists of 7 core components.

The first component is participant-reported tailoring questions. These include 4 demographic questions delivered by a video nurse, and the patient responses are used to tailor the patient’s path through the intervention. There are also 17 questions delivered by a video doctor, which provide tailored information for 6 domains: treatment readiness, medication adherence, retention in care (RIC), sexual risk reduction, mother-to-child transmission, and injection drug use. Based on patient responses, PLWH using PHC receive tailored content and behavior change tips in the 6 domains.

There are also 4 video doctor options, varying by race (Black or White) and sex (female or male). PHC also provided a library of autogenerated responses and questions patients could choose from, a handout showing the behavior change tips and questions, and a microsite with extra information and resources on HIV care.

At baseline, 56% of participants in both groups were virally suppressed, and 57% were virally suppressed at follow-up, with equal proportions of participants with VL suppression between the 2 groups at follow-up (P = 1.000).

VL suppression also did not vary significantly between the 2 groups for any of the subgroups evaluated. Subgroups were divided by age, sex, race, HIV primary care clinic, and the 3 subcriteria.

However, adjusted results of a priori defined subgroup analyses suggested PHC resulted in male participants achieving VL suppression at the 12-month assessment point.

“This finding extends previous research and meta-analyses that point to the potential importance of digital interventions to enhance HIV outcomes and the use of video doctors, specifically,” the authors said. “We may have found differences for male participants because of their greater numbers in the study sample and thus there was greater power to detect statistically significant differences among them.”

In the full sample analysis, there were no significant differences seen in RIC between groups in the sample as a whole. However, in subgroup analyses, PLWH in the intervention group had statistically significantly better RIC compared with the SOC group at 1 site.

Among older participants, defined as aged between 60 and 81 years, PLWH in the PHC arm had better RIC based on the PHC-defined and visit gap measures compared with PLWH in the SOC arm. Similarly, among younger participants, defined as aged between 18 and 29 years, proportionally fewer PLWH in the intervention arm had a visit gap compared with the control arm.

“Given the adaptability, effectiveness, and feasibility of these digitally based interventions, future research should examine whether they are effective in challenging communication contexts that may have rapidly changing evidence bases, such as COVID-19 vaccination,” the authors concluded. “As digital technology advances, the potential for video doctors to assist health systems provide better care will increase as well.”

Reference

Lewis MA, Harshbarger C, Bann C, et al. Effectiveness of an interactive, highly tailored "video doctor" intervention to suppress viral load and retain patients with HIV in clinical care: a randomized clinical trial. J Acquir Immune Defic Syndr. 2022;91(1):58-67. doi:10.1097/QAI.0000000000003045