Professor of Medicine (Infectious Diseases) and of Epidemiology (Microbial Diseases); Affiliated Faculty, Yale Institute for Global Health; Director, Yale Center for Clinical and Community Research, Department of Medicine; Director, HIV in Prisons Program, Infectious Diseases; Director, Community Health Care Van, Intersection of Infectious Diseases and Substance Use Disorders/Addiction Medicine; Academic Icon Professor of Medicine, University of Malaya-Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine
Project SMART
Antiretroviral therapy (ART) is effective at lowering HIV-related mortality and reducing transmission among people living with HIV (PLH). Substance use disorders, especially cocaine use disorders (CUDs) greatly reduce ART adherence and persistence on treatment. Because stimulants like CUDs are not amenable to medication-assisted therapy and directly administered antiretroviral therapy is costly and unwieldy in most settings, evidence-based interventions are urgently needed to improve ART adherence and persistence in PLWH with co-occurring CUDs. We are conducting the first qualitative research to assess the acceptability and feasibility of implementing mHealth interventions followed by a pilot feasibility study to examine the effect of mHealth tools on ART adherence.
The specific aims of Project SMART are:
(1) to conduct qualitative assessments using focus groups of PLH who use cocaine and healthcare providers that will assess the acceptability, feasibility, facilitators and barriers of implementing mHealth interventions; and will aid in developing the final design and content of both automated and clinician feedback in preparation for designing a pilot feasibility study
(2) to conduct a 12-week pilot feasibility RCT among PLH with co-occurring CUDs that will examine the impact of mHealth tools (cellular-enabled smart pill boxes and cell phones) and feedback (no feedback vs. automated feedback vs. automated + clinician feedback) on primary (ART adherence and persistence) and secondary outcomes (HIV viral suppression, cocaine use, retention in HIV care).