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Use of Technology to Address Substance Use in the Context of HIV: A Systematic Review

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Substance users are at elevated risk for HIV. HIV researchers, particularly at the intersection of HIV and substance use, have requested new methods to better understand and address this important area. New technologies, such as social media and mobile applications, are increasingly being used as research tools in studies on HIV and substance use. These technologies have the potential to build on existing recruitment methods, provide new and improved intervention methods, and introduce novel ways of monitoring and predicting new HIV cases. However, little work has been done to review and broadly explore the types of studies being conducted on the use of technologies to address HIV and substance use. This systematic literature review identified studies on this topic between 2005 and 2015. We identified 33 studies on this topic after excluding studies that did not fit inclusion criteria. Studies were either observational (n = 24) or interventional (n = 9), with the majority being pilot studies exploring the feasibility of using these new technologies to study HIV and substance use. We discuss the implications of this work along with limitations and recommendations for future research on this topic.
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HIV AND TECHNOLOGY (J SIMONI AND K HORVATH, SECTION EDITORS)
Use of Technology to Address Substance Use in the Context
of HIV: A Systematic Review
Sean D. Young
1
&Dallas Swendeman
2
&Ian W. Holloway
3
&Cathy J. Reback
4
&
Uyen Kao
5
Published online: 16 October 2015
#Springer Science+Business Media New York 2015
Abstract Substance users are at elevated risk for HIV. HIV
researchers, particularly at the intersection of HIV and sub-
stance use, have requested new methods to better understand
and address this important area. New technologies, such as
social media and mobile applications, are increasingly being
used as research tools in studies on HIV and substance use.
These technologies have the potential to build on existing
recruitment methods, provide new and improved intervention
methods, and introduce novel ways of monitoring and
predicting new HIV cases. However, little work has been done
to review and broadly explore the types of studies being con-
ducted on the use of technologies to address HIV and sub-
stance use. This systematic literature review identified studies
on this topic between 2005 and 2015. We identified 33 studies
on this topic after excluding studies that did not fit inclusion
criteria. Studies were either observational (n=24) or interven-
tional (n=9), with the majority being pilot studies exploring
the feasibility of using these new technologies to study HIV
and substance use. We discuss the implications of this work
along with limitations and recommendations for future re-
search on this topic.
Keywords Technologies .HIV .Substance use .Social
media .Mobile apps
Introduction
Substance use is strongly linked to HIV, making it an impor-
tant area of concern for HIV researchers. The HIV Cost and
Service Utilization Study (HSCUS) in the U.S. revealed that
40 % of individuals living with HIV disclosed they used ille-
gal drugs in the past year [1]. Globally, it is believed that more
than 3 million injection drug users are HIV positive [2].
Thirty-two percent (32 %) of all frequent non-injection drug
users and 40 % of MSM who are injection drug users in the
U.S. are HIV positive [3].
Two populations, both independent and overlapping, that are
at high risk for HIV acquisition and transmission are men who
have sex with men (MSM) and substance users. MSM are
disproportionately at risk for contracting HIV [4]. In
particular, African American and Latino MSM are at
increased risk for HIV [5]. According to a CDC study focused
on MSM, 28 % of non-Latino Blacks and 18 % of Latinos were
infected compared to 16 % of non-Latino White MSM [6].
Taken together, it is important to address the increased risk for
HIV among MSM, especially African Americans and Latinos.
Technology usage in the past decade has increased signif-
icantly among the general population as well as more specif-
ically among groups with and at high risk for HIV [7,8].
This article is part of the Topical Collection on HIV and Technology
*Sean D. Young
sdyoung@mednet.ucla.edu
1
UCLA Department of Family Medicine, University of California
Institute for Prediction Technology, 10880 Wilshire Blvd Suite 1800,
Los Angeles, CA 90049, USA
2
UCLA Department of Psychiatry and Biobehavioral Sciences,
UCLA Center for HIV Identification, Prevention, and Treatment
Services, Los Angeles, CA, USA
3
Department of Social Welfare, UCLA Luskin School of Public
Affairs, Los Angeles, CA, USA
4
Friends Research Institute, Inc., David Geffen School of Medicine,
Integrated Substance Abuse Programs, Semel Institute for
Neuroscience and Human Behavior, University of California, Los
Angeles, Los Angeles, CA, USA
5
UCLA Department of Family Medicine, UCLA Center for HIV
Identification, Prevention, and Treatment Services, Los Angeles, CA,
USA
Curr HIV/AIDS Rep (2015) 12:462471
DOI 10.1007/s11904-015-0295-3
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Such initiatives can facilitate real-time problem solving between patients and health care providers when medication, health, or other issues arise; remind clients to take medications, attend appointments, and take care of their health; and demonstrate that "somebody cares" [7,15,16]. More recently, mHealth initiatives have aimed to address substance use as well as optimize and expand treatment for substance use and HIV [17][18][19][20][21][22]. Notably, there is a paucity of evidence of mobile phone use for health and mHealth interventions for Indigenous people living with or at risk of HIV, including those using drugs [10]. ...
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Background Social media technologies offer new approaches to HIV prevention and promotion of testing. We examined the efficacy of the Harnessing Online Peer Education (HOPE) social media intervention to increase HIV testing among men who have sex with men (MSM) in Peru. Methods In this cluster randomised controlled trial, Peruvian MSM from Greater Lima (including Callao) who had sex with a man in the past 12 months, were 18 years of age or older, were HIV negative or serostatus unknown, and had a Facebook account or were willing to create one (N=556) were randomly assigned (1:1) by concealed allocation to join intervention or control groups on Facebook for 12 weeks. For the intervention, Peruvian MSM were trained and assigned to be HIV prevention mentors (peer-leaders) to participants in Facebook groups. The interventions period lasted 12 weeks. Participants in control groups received an enhanced standard of care, including standard offline HIV prevention available in Peru and participation in Facebook groups (without peer leaders) that provided study updates and HIV testing information. After accepting a request to join the groups, continued participation was voluntary. Participants also completed questionnaires on HIV risk behaviours and social media use at baseline and 12 week follow-up. The primary outcome was the number of participants who received a free HIV test at a local community clinic. The facebook groups were analysed as clusters to account for intracluster correlations. This trial is registered with ClinicalTrials.gov, number NCT01701206. Findings Of 49 peer-leaders recruited, 34 completed training and were assigned at random to the intervention Facebook groups. Between March 19, 2012, and June 11, 2012, and Sept 26, 2012, and Dec 19, 2012, 556 participants were randomly assigned to intervention groups (N=278) or control groups (N=278); we analyse data for 252 and 246. 43 participants (17%) in the intervention group and 16 (7%) in the control groups got tested for HIV (adjusted odds ratio 2·61, 95% CI 1·55–4·38). No adverse events were reported. Interpretation Development of peer-mentored social media communities seemed to be an efficacious method to increase HIV testing among high-risk populations in Peru. Results suggest that the HOPE social media intervention could improve HIV testing rates among MSM in Peru.
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Mobile health (mHealth) interventions to promote antiretroviral therapy (ART) adherence have shown promise; however, among persons living with HIV who abuse methamphetamine (MA), effective tailoring of content to match the expressed needs of this patient population may be necessary. This study aimed (1) to understand patient perspectives of barriers and facilitators of ART adherence among people with HIV who use MA, and (2) to obtain feedback on the thematic content of an mHealth intervention in order to tailor the intervention to this subgroup. Two separate focus groups, each with 10 HIV+/MA+ individuals, were conducted. Transcribed audio recordings were qualitatively analyzed to identify emergent themes. Inter-rater reliability of themes was high (mean Kappa = .97). Adherence barriers included MA use, misguided beliefs about ART adherence, memory and planning difficulties, social barriers and perceived stigma, and mental heath issues. Facilitators of effective ART adherence were cognitive compensatory strategies, promotion of well-being, health-care supports, adherence education, and social support. Additionally, the focus groups generated content for reminder text messages to be used in the medication adherence intervention. This qualitative study demonstrates the feasibility of using focus groups to derive patient-centered intervention content to address the health challenge at hand in targeted populations.