Cell Phone Support Helps Lower Stress, Depression, Substance Use in Young Adults With HIV
Cell phone support includes adherence reminders and frequent, short phone calls from adherence facilitators.
The use of cell phone support has led to significantly reduced reports of depression, stress, and the use of illicit substances among adolescents and young adults living with HIV, according to a study published in AIDS and Behavior. Cell phone support was also linked with greater self-efficacy compared with usual care.
This study included 37 participants (age 20.43±2.57 years) who were HIV-positive, 19 of whom received intervention and 18 of whom received usual care. Individuals in the intervention arm received cell phone support calls from an adherence facilitator. The intervention group reported significantly lower levels of perceived stress at weeks 12 and 48 (P =.02), and the mixed model showed significant decreases in stress over time (entry to 24 weeks, P <.05; entry to 48 weeks, P =.02). Self-efficacy for adherence showed improvement at week 12 (P =.04), but not afterward and the mixed models showed no significant changes.
Depression was lower among the intervention group at week 24 (P =.02), but the mixed effect model revealed no significant difference over time between groups. Reports of substance use indicated significantly lower use among the treatment arm at weeks 12 (P <.05), 24 (P <.05), and 48 (P =.02), and with adjustments for substance use at baseline, the treatment group reported substance abuse that was significantly reduced compared with controls for the whole study (P =.02). Healthcare visits did not differ between the 2 groups over time.
Most participants were African American (70.3%) and male (62.2%); 46% had contracted HIV perinatally, and 54% contracted it behaviorally. The intervention and usual care groups did not show significant demographic differences at baseline, and all had a history of poor adherence to antiretroviral therapy. Stress was measured using the 4-item shortened version of the Perceived Stress Scale, and researchers assessed coping using the Adolescent Coping Orientation for Problem Experiences. A 6-item scale (Self-Efficacy for Health Promotion and Risk Reduction) was used to assess each individual's confidence in their medication. Motivation was measured by Rollnick's Readiness Ruler, depression by the Brief Symptom Inventory, and substance use by the Alcohol, Smoking, and Substance Involvement Screening Test.
The study researchers concluded that, "[participants] receiving [cell phone support] reported significant decreases in perceived stress, depression, and illicit substance use, and increases in self-efficacy during at least one study assessment period, in comparison to participants receiving usual care. Future research using a larger sample should test for mediators of treatment efficacy to further characterize how cell phone interventions impact adherence."
Sayegh CS, MacDonell KK, Clark LF, et al. The impact of cell phone support on psychosocial outcomes for youth living with HIV nonadherent to antiretroviral therapy [published online June 12, 2018]. AIDS Behav. doi: 10.1007/s10461-018-2192-4