Browsing by Author "Legrand, Sara"
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- ItemAchieving HIV risk reduction through HealthMpowerment.org, a user-driven eHealth intervention for young Black men who have sex with men and transgender women who have sex with men.(2015-01-16) Muessig, Kathryn E; Baltierra, Nina B; Pike, Emily C; Legrand, Sara; Hightow-Weidman, Lisa BYoung Black men who have sex with men and transgender women who have sex with men YBMSM TW are at disproportionate risk for HIV and other sexually transmitted infections HIV STI HealthMpowerment org HMP is a mobile phone optimised online intervention that utilises behaviour change and gaming theories to reduce risky sexual behaviours and build community among HIV positive and negative YBMSM TW The intervention is user driven provides social support and utilises a point reward system A four week pilot trial was conducted with a diverse group of 15 YBMSM TW During exit interviews participants described how HMP components led to behaviour changes such as asking partners sexual history increased condom use and HIV STI testing The user driven structure interactivity and rewards appeared to facilitate sustained user engagement and the mobile platform provided relevant information in real time Participants described the reward elements of exceeding their previous scores and earning points toward prizes as highly motivating HMP showed promise for being able to deliver a sufficient intervention dose and we found a trend toward higher dose received and more advanced stages of behaviour change In this pilot trial HMP was well accepted and demonstrates promise for translating virtual intervention engagement into actual behaviour change to reduce HIV risk behaviours
- ItemeHealth to Enhance Treatment Adherence Among Youth Living with HIV.(0000-00-00) Mulawa, Marta I; Legrand, Sara; Hightow-Weidman, Lisa BPURPOSE OF REVIEW Multiple reviews have examined eHealth mHealth interventions to address treatment adherence including those focusing on youth living with HIV YLWH This review synthesizes results of prior reviews and recent studies last 5 years to provide a path forward for future research acknowledging both lessons learned and gaps to be addressed RECENT FINDINGS Recent studies provide further evidence for the feasibility and acceptability of technology based HIV interventions Formative research of more comprehensive smartphone applications and pilot studies of computer delivered interventions provide additional guidance on YLWH s preferences for intervention components and show promising preliminary efficacy for impacting treatment adherence Expanding access to technology among YLWH in the United States US and globally supports the continued focus on eHealth mHealth interventions as a means to reduce disparities in clinical outcomes Future research should lend greater focus to implementation and scale up of interventions through the use of adaptive treatment strategies that include costing analyses measuring and maximizing engagement fostering information sharing between researchers and building upon sustainable platforms
- ItemEpic Allies, a Gamified Mobile Phone App to Improve Engagement in Care, Antiretroviral Uptake, and Adherence Among Young Men Who Have Sex With Men and Young Transgender Women Who Have Sex With Men: Protocol...(0000-00-00) Legrand, Sara; Muessig, Kathryn E; Platt, Alyssa; Soni, Karina; Egger, Joseph R; Nwoko, Nkechinyere; McNulty, Tobias; Hightow-Weidman, Lisa BBACKGROUND In the United States young men who have sex with men YMSM and transgender women who have sex with men YTWSM bear a disproportionate burden of prevalent and incident HIV infections Once diagnosed many YMSM and YTWSM struggle to engage in HIV care adhere to antiretroviral therapy ART and achieve viral suppression Computer based interventions including those focused on behavior change are recognized as effective tools for engaging youth OBJECTIVE The purpose of the study described in this protocol is to evaluate the efficacy of Epic Allies a theory based mobile phone app that utilizes game mechanics and social networking features to improve engagement in HIV care ART uptake ART adherence and viral suppression among HIV positive YMSM and YTWSM The study also qualitatively assesses intervention acceptability perceived impact and sustainability METHODS This is a two group active control randomized controlled trial of the Epic Allies app YMSM and YTWSM aged 16 to 24 inclusive with detectable HIV viral load are randomized 1 1 within strata of new to care newly entered HIV medical care 12 months of baseline visit or ART nonadherent first entered HIV medical care 12 months before baseline visit to intervention or control conditions The intervention condition addresses ART adherence barriers through medication reminders and adherence monitoring tracking of select adherence related behaviors eg alcohol and marijuana use an interactive dashboard that displays the participant s adherence related behaviors and provides tailored feedback encouragement messages from other users daily HIV ART educational articles and gamification features eg mini games points badges to increase motivation for behavior change and app engagement The control condition features weekly phone based notifications to encourage participants to view educational information in the control app Follow up assessments are administered at 13 26 and 39 weeks for each arm The primary outcome measure is viral suppression Secondary outcome measures include engagement in care ART uptake ART adherence and psychosocial barriers to engagement in care and ART adherence including psychological distress stigma and social support RESULTS Baseline enrollment began in September 2015 and was completed in September 2016 n 146 and assessment of intervention outcomes continued through August 2017 Results for primary and secondary outcome measures are expected to be reported in ClinicalTrials gov by April 30 2018 CONCLUSIONS If successful Epic Allies will represent a novel adherence intervention for a group disproportionately impacted by HIV in the United States Adherent patients would require less frequent clinic visits and experience fewer HIV related secondary infections thereby reducing health care costs and HIV transmission Epic Allies could easily be expanded and adopted for use among larger populations of YMSM and YTWSM other HIV positive populations and for those diagnosed with other chronic diseases such as diabetes and hypertension TRIAL REGISTRATION ClinicalTrials gov NCT02782130 https clinicaltrials gov ct2 show NCT02782130 Archived by Webcite at http www webcitation org 6yGODyerk
- ItemEvaluating Response Time in Zanzibar's Malaria Elimination Case-Based Surveillance-Response System.(0000-00-00) Khandekar, Eeshan; Kramer, Randall; Ali, Abdullah S; Al-Mafazy, Abdul-Wahid; Egger, Joseph R; Legrand, Sara; Mkali, Humphrey R; McKay, Michael; Ngondi, Jeremiah MAs countries transition toward malaria elimination malaria programs rely on surveillance response systems which are often supported by web and mobile phone based reporting tools Such surveillance response systems are interventions for elimination making it important to determine if they are operating optimally A metric to measure this by is timeliness This study used a mixed methods approach to investigate the response time of Zanzibar s malaria elimination surveillance response system Malaria Case Notification Malaria case notification uses both passive and reactive case detections supported by a mobile phone based reporting tool called Coconut Surveillance Using data obtained from RTI International and the Zanzibar Malaria Elimination Program ZAMEP analysis of summary statistics was conducted to investigate the association of response time with geography and time series techniques were used to investigate trends in response time and its association with the number of reported cases Results indicated that response time varied by the district in Zanzibar 0 6 6 05 days and that it was not associated with calendar time or the number of reported cases Survey responses and focus groups with a cadre of health workers district malaria surveillance officers shed light on operational challenges faced during case investigation such as incomplete health records and transportation issues which stem from deficiencies in aspects of ZAMEP s program management These findings illustrate that timely response for malaria elimination depends on effective program management despite the automation of web based or mobile phone based tools For surveillance response systems to work optimally malaria programs should ensure that optimal management practices are in place
- ItemA Gamified Smartphone App to Support Engagement in Care and Medication Adherence for HIV-Positive Young Men Who Have Sex With Men (AllyQuest): Development and Pilot Study.(0000-00-00) Hightow-Weidman, Lisa; Muessig, Kathryn; Knudtson, Kelly; Srivatsa, Mala; Lawrence, Ellena; Legrand, Sara; Hotten, Anna; Hosek, SybilBACKGROUND HIV disproportionately impacts young men who have sex with men YMSM who experience disparities across the HIV care continuum Addressing antiretroviral therapy ART adherence among YMSM is an urgent public health priority Technology based interventions particularly mobile health platforms can provide tailored adherence interventions and allow YMSM to engage and connect with others OBJECTIVE The objective of this study was to describe the development of AllyQuest a novel theoretically based smartphone app designed to improve engagement in care and ART adherence and social support among HIV positive YMSM METHODS AllyQuest was built on an established platform for patient engagement that embeds social networking and fundamental game mechanics such as challenges points and rewards A medication tracker provides reminders to promote ART adherence via personalized adherence strategies that are user and context specific a calendar allows for reflection on adherence over time After iterative development with input from two youth advisory boards usability testing was conducted to assess app functionality comprehension of the educational content use of intervention features and overall impressions of app relevance and appeal A 28 day pilot trial was conducted with 20 HIV YMSM to evaluate intervention feasibility and acceptability RESULTS Mean age of participants was 21 8 years range 19 24 and 95 19 20 of the participants were nonwhite The mean time of app use was 158 4 min SD 114 1 with a range of 13 to 441 min There was a mean of 21 2 days of use out of a total possible 28 days There were 222 posts to the daily discussion social wall Feasibility and acceptability ratings were high Overall participants found the app easy to use and navigate not intrusive and had few reported technical issues Higher levels of app usage were positively correlated with HIV self management outcomes and there was a statistically significant PUnder 05 positive association between the number of days logged into the app and knowledge and confidence in ability to reliably take HIV medications CONCLUSIONS AllyQuest represents a new highly scalable solution that is well suited to meet the specific prevention and care needs of HIV YMSM The development of this intervention is both timely and vital given the urgency of the ongoing HIV epidemic among YMSM
- ItemHealthMpowerment.org: Building Community Though a Mobile-Optimized, Online Health Promotion Intervention.(2015-01-15) Hightow-Weidman, Lisa B; Muessig, Kathryn E; Pike, Emily C; Legrand, Sara; Baltierra, Nina; Rucker, Alvin Justin; Wilson, PatrickBackground Both young Black men who have sex with men as well as young Black transgender women YBMSM TW continue to experience a significant increase in HIV incidence HealthMpowerment org HMP is a mobile phone optimized online intervention for both YBMSM TW to build community and facilitate supportive relationships Methods To assess the feasibility acceptability and preliminary outcomes a 1 month pilot trial of HMP among 15 YBMSM TW was conducted Results Retention was 100 Mean age was 26 years 60 were HIV infected 87 earned Under 21 000 and 67 were uninsured Despite the small sample size and limited intervention length statistically significant improvements were seen in social support p 012 social isolation p 050 and depressive symptoms p 045 Conclusion The HMP pilot trial demonstrated feasibility and acceptability Given the burden of the epidemic among YBMSM TW there is an imperative to develop test and scale up culturally appropriate interventions to both prevent HIV acquisition and limit onward transmission
- ItemIf you build it will they come? Addressing social isolation within a technology-based HIV intervention for young black men who have sex with men.(2014-06-19) Legrand, Sara; Muessig, Kathryn E; Pike, Emily C; Baltierra, Nina; Hightow-Weidman, Lisa BThe rate of HIV infections among young black men who have sex with men YBMSM continues to rise at an alarming pace YBMSM are particularly vulnerable to social isolation and a lack of social support due to experiences with racism and homophobia which may have implications for sexual risk behaviors The purpose of this study was to explore perceptions of social isolation and sense of community among YBMSM the need for and receptivity to social networking features designed to reduce social isolation and build community within an Internet and mobile phone based primary and secondary HIV prevention intervention for YBMSM and to identify strategies to develop these features Focus groups were conducted with 22 YBMSM aged 20 30 years at three sites in North Carolina Data from the focus groups were thematically analyzed using NVivo Feelings of social isolation and lack of a sense of community were strongly endorsed by participants with homophobia lack of opportunities for social engagement and a focus on sex rather than friendship in interpersonal relationships with other YBMSM cited as contributing factors Participants were receptive to a social networking intervention designed to reduce social isolation and build community Recommendations offered by participants to increase acceptability and usability of such features included availability of information about healthy relationships the ability to connect with other YBMSM and health care providers and ensuring the site had ongoing facilitation by the study team as well as monitoring for inappropriate content The development of a social networking feature of an HIV prevention intervention may present an opportunity to reduce social isolation build community and reduce risky sexual behaviors among YBMSM The findings from this study are being used to inform the development of a social networking feature for an existing Internet and mobile phone based primary and secondary HIV prevention intervention for YBMSM
- ItemMobile phone applications for the care and prevention of HIV and other sexually transmitted diseases: a review.(2013-01-07) Muessig, Kathryn E; Pike, Emily C; Legrand, Sara; Hightow-Weidman, Lisa BBACKGROUND Mobile phone applications apps provide a new platform for delivering tailored human immunodeficiency virus HIV and sexually transmitted disease STD prevention and care OBJECTIVE To identify and evaluate currently available mobile phone apps related to the prevention and care of HIV and other STDs METHODS We searched the Apple iTunes and Android Google Play stores for HIV STD related apps excluding apps that exclusively targeted industry providers and researchers Each eligible app was downloaded tested and assessed for user ratings and functionality as well as 6 broad content areas of HIV prevention and care HIV STD disease knowledge risk reduction safer sex condom promotion HIV STD testing information resources for HIV positive persons and focus on key populations RESULTS Search queries up to May 2012 identified 1937 apps Of these 55 unique apps met the inclusion criteria 12 for Android 29 for iPhone and 14 for both platforms Among these apps 71 provided disease information about HIV STDs 36 provided HIV STD testing information or resources 29 included information about condom use or assistance locating condoms and 24 promoted safer sex Only 6 apps 11 covered all 4 of these prevention areas Eight apps 15 provided tools or resources specifically for HIV STD positive persons Ten apps included information for a range of sexual orientations 9 apps appeared to be designed for racially ethnically diverse audiences and 15 apps featured interactive components Apps were infrequently downloaded median 100 500 downloads and not highly rated average customer rating 3 7 out of 5 stars CONCLUSIONS Most available HIV STD apps have failed to attract user attention and positive reviews Public health practitioners should work with app developers to incorporate elements of evidence based interventions for risk reduction and improve app inclusiveness and interactivity
- ItemPutting prevention in their pockets: developing mobile phone-based HIV interventions for black men who have sex with men.(2013-04-09) Muessig, Kathryn E; Pike, Emily C; Fowler, Beth; Legrand, Sara; Parsons, Jeffrey T; Bull, Sheana S; Wilson, Patrick A; Wohl, David A; Hightow-Weidman, Lisa BYoung black men who have sex with men MSM bear a disproportionate burden of HIV Rapid expansion of mobile technologies including smartphone applications apps provides a unique opportunity for outreach and tailored health messaging We collected electronic daily journals and conducted surveys and focus groups with 22 black MSM age 18 30 at three sites in North Carolina to inform the development of a mobile phone based intervention Qualitative data was analyzed thematically using NVivo Half of the sample earned under 11 000 annually All participants owned smartphones and had unlimited texting and many had unlimited data plans Phones were integral to participants lives and were a primary means of Internet access Communication was primarily through text messaging and Internet on line chatting social networking sites rather than calls Apps were used daily for entertainment information productivity and social networking Half of participants used their phones to find sex partners over half used phones to find health information For an HIV related app participants requested user friendly content about test site locators sexually transmitted diseases symptom evaluation drug and alcohol risk safe sex sexuality and relationships gay friendly health providers and connection to other gay HIV positive men For young black MSM in this qualitative study mobile technologies were a widely used acceptable means for HIV intervention Future research is needed to measure patterns and preferences of mobile technology use among broader samples
- ItemSmartphone-Based Contingency Management Intervention to Improve Pre-Exposure Prophylaxis Adherence: Pilot Trial.(0000-00-00) Mitchell, John T; Legrand, Sara; Hightow-Weidman, Lisa B; McKellar, Mehri S; Kashuba, Angela Dm; Cottrell, Mackenzie; McLaurin, Tony; Satapathy, Goutam; McClernon, F JosephBACKGROUND Pre exposure prophylaxis PrEP provides a strong preventative benefit to individuals at risk for HIV While PrEP adherence is highly correlated with its efficacy adherence rates are variable both across and within persons OBJECTIVE The objective of this study was to develop and pilot test a smartphone based intervention known as mSMART that targets PrEP adherence mSMART provides contingency management in the form of monetary incentives for daily PrEP adherence based on a real time adherence assessment using a camera based medication event monitoring tool as well as medication reminders PrEP education individualized behavioral strategies to address PrEP adherence barriers and medication adherence feedback METHODS This was a 4 week open label phase I trial in a community sample of young men who have sex with men already on PrEP N 10 RESULTS Although adherence composite scores corresponding to PrEP biomarkers indicated that 90 9 10 of the sample already had an acceptable baseline adherence in the protective range by the end of the 4 week period the scores improved for 30 3 10 of the sample adherence did not worsen for any participants Participants reported mean PrEP adherence rates of 91 via daily entries in mSMART At the end of the 4 week period participants indicated acceptable ratings of satisfaction usability and willingness to recommend mSMART to others There were no technical difficulties associated with smartphone compatibility user misunderstandings about mSMART features that interfered with daily use or study attrition CONCLUSIONS This study is the first to apply contingency management to PrEP adherence Findings indicated that mSMART is feasible and acceptable Such an adherence intervention administered via a user friendly smartphone app can allow for widespread dissemination Future efficacy trials are needed TRIAL REGISTRATION ClinicalTrials gov NCT02895893 https clinicaltrials gov ct2 show NCT02895893 Accessed by Webcite at http www webcitation org 72JskjDJq
- Item"Stay strong! keep ya head up! move on! it gets better!!!!": resilience processes in the healthMpowerment online intervention of young black gay, bisexual and other men who have sex with men.(0000-00-00) Barry, Megan C; Threats, Megan; Blackburn, Natalie A; Legrand, Sara; Dong, Willa; Pulley, Deren V; Sallabank, Greg; Harper, Gary W; Hightow-Weidman, Lisa B; Bauermeister, Jose A; Muessig, Kathryn EOverlapping stigmas related to sexual minority race ethnicity and HIV status pose barriers to HIV prevention and care and the creation of supportive social networks for young Black gay bisexual and other men who have sex with men GBMSM A risk based approach to addressing the HIV epidemic focuses on what is lacking and reinforces negative stereotypes about already marginalized populations In contrast a strengths based approach builds on Black GBMSM s existing strengths recognizing the remarkable ways in which they are overcoming barriers to HIV prevention and care HealthMpowerment HMP is an online mobile phone optimized intervention that aimed to reduce condomless anal intercourse and foster community among young Black GBMSM age 18 30 Applying a resilience framework we analyzed 322 conversations contributed by 48 HMP participants 22 48 living with HIV on the intervention website These conversations provided a unique opportunity to observe and analyze dynamic interpersonal resilience processes shared in response to stigma discrimination and life challenges experienced by young Black GBMSM We utilized an existing framework with four resilience processes and identified new subthemes that were displayed in these online interactions 1 Exchanging social support occurred through sharing emotional and informational support 2 Engaging in health promoting cognitive processes appeared as reframing self acceptance endorsing a positive outlook and agency and taking responsibility for outcomes 3 Enacting healthy behavioral practices clustered into modeling sex positive norms reducing the risk of acquiring or transmitting HIV and living well with HIV 4 Finally empowering other gay and bisexual youth occurred through role modeling promoting self advocacy and providing encouragement Future online interventions could advance strengths based approaches within HIV prevention and care by intentionally building on Black GBMSM s existing resilience processes The accessibility and anonymity of online spaces may provide a particularly powerful intervention modality for amplifying resilience among young Black GBMSM
- ItemTesting the Efficacy of a Social Networking Gamification App to Improve Pre-Exposure Prophylaxis Adherence (P3: Prepared, Protected, emPowered): Protocol for a Randomized Controlled Trial.(0000-00-00) Legrand, Sara; Knudtson, Kelly; Benkeser, David; Muessig, Kathryn; Mcgee, Andrew; Sullivan, Patrick S; Hightow-Weidman, LisaBACKGROUND HIV prevalence is high among young men who have sex with men YMSM and young transgender women who have sex with men YTWSM particularly among minorities Despite its proven efficacy and safety the uptake of and adherence to pre exposure prophylaxis PrEP among YMSM and YTWSM is currently limited To date evidence based interventions to promote and sustain PrEP adherence have been limited and not shown to be highly efficacious Given the widespread adoption of smartphones mobile apps can be utilized to increase PrEP adherence for many YMSM and YTWSM OBJECTIVE The study consists of a formative research phase to develop an app based intervention P3 Prepared Protected emPowered to increase PrEP adherence and a randomized controlled trial RCT to test its efficacy P3 is a mobile app built on an established health platform which includes social networking and game based components to encourage PrEP adherence among YMSM and YTWSM P3 includes all P3 features plus adherence counseling delivered via two way text messaging short message service SMS through the app METHODS The formative research phase includes usability testing to assess users comprehension of P3 s educational content understanding and use of intervention features and overall impressions of app functionality followed by app refinements A subsequent field trial will identify and resolve any remaining technical challenges A three arm RCT P3 P3 and standard of care will then be conducted at 6 iTech subject recruitment venues to assess intervention efficacy and to conduct a comparison of costs to deliver the 2 intervention arms RESULTS This is an ongoing research project with initial results from the formative work expected in 2020 and those from the RCT in 2021 CONCLUSIONS P3 aims to provide an engaging interactive experience that is highly appealing for the target population leveraging technology already heavily integrated into the lives of young people and thus meeting users needs in a familiar stimulating way If efficacious P3 could be a sustainable easily disseminated lower cost PrEP intervention for YMSM and YTWSM Further the research aims to determine the processes that are essential to developing and implementing future health related gamification interventions TRIAL REGISTRATION ClinicalTrials gov NCT03320512 https clinicaltrials gov ct2 show NCT03320512 Archived by WebCite at http www webcitation org 74OVZkICl INTERNATIONAL REGISTERED REPORT IDENTIFIER IRRID DERR1 10 2196 10448
- ItemUniversity of North Carolina/Emory Center for Innovative Technology (iTech) for Addressing the HIV Epidemic Among Adolescents and Young Adults in the United States: Protocol and Rationale for Center D...(0000-00-00) Hightow-Weidman, Lisa B; Muessig, Kathryn; Rosenberg, Eli; Sanchez, Travis; Legrand, Sara; Gravens, Laura; Sullivan, Patrick SBACKGROUND Over a fifth of all new HIV infections in the United States occur among persons aged 13 24 years with most of these diagnoses occurring among gay and bisexual males 81 While the epidemic of HIV in the United States has leveled off for many age groups the annual number of new HIV diagnoses among young men who have sex with men YMSM 13 24 years old remains high Traditional approaches to continuum improvement for youth have been insufficient and targeted interventions are urgently needed for young people at risk for or infected with HIV Interventions delivered through mobile health technology represent a promising approach for improving outcomes in this population Mobile phones have nearly reached saturation among youth making mobile technology a particularly promising tool for reaching this population OBJECTIVE The University of North Carolina Emory Center for Innovative Technology iTech is a National Institutes of Health cooperative agreement as part of the Adolescent Medicine Trials Network for HIV AIDS Interventions iTech aims to impact the HIV epidemic by conducting innovative interdisciplinary research on technology based interventions across the HIV prevention and care continuum for adolescents and young adults in the United States particularly YMSM by providing the following 1 evaluation of novel approaches to identifying youth with undiagnosed HIV infections 2 evaluation of multilevel combination prevention approaches particularly relevant to gender and sexual minority youth facing co occurring health risks 3 evaluation of uptake of and adherence to biomedical prevention modalities and 4 evaluation of interventions designed to promote or optimize engagement in care and antiretroviral therapy adherence in HIV positive youth to optimize viral load suppression METHODS iTech brings together multidisciplinary experts in the fields of adolescent HIV treatment and prevention development and evaluation of technology based interventions HIV surveillance and epidemiology and intervention design and evaluation This initiative will support 8 efficacy trials and 2 exploratory projects each led by 2 principal investigators Taken together the studies address all of the key steps of the HIV prevention and care continuum for youth in the United States Each proposal uses technology in a scientifically rigorous and innovative way to access engage and impact at risk or infected youth Nine iTech subject recruitment venues are spread across 8 US cities Three cores management analytic and technology support all iTech activities and form the research network s infrastructure facilitating all aspects of study implementation and evaluation RESULTS Formative work has already begun on many of the above mentioned iTech trials We expect the first randomized controlled trials to begin in mid 2018 Additional details can be found in the individual intervention protocol papers in this issue CONCLUSIONS Through its comprehensive research portfolio iTech aims to effectively advance HIV prevention and care for youth through technology based youth relevant interventions that maximize adaptability and sustainability REGISTERED REPORT IDENTIFIER RR1 10 2196 10365