Personalized Text Messages to Improve Antiretroviral Treatment (ART) Adherence in HIV+ Methamphetamine Users

Methamphetamine (METH) is a debilitating and frequently abused substance that is often
comorbid with HIV infection. HIV+ persons with current METH abuse or dependence (HIV+/METH+)
have several characteristics, in addition to their substance use, that make them
particularly susceptible to nonadherence to antiretroviral treatment (ART) including
elevated rates of neurocognitive impairment, co-occurrence of psychiatric disorders, and
unstable living situations. The investigators propose an intervention development study
designed to address these potential mechanisms of nonadherence with the following Specific
Aims: 1) To further develop and refine a personalized, automated, real-time, mobile phone,
text messaging intervention (iTAB) designed to improve adherence to ART medications among
HIV+/METH+ persons; 2) To evaluate the acceptability and effectiveness of a brief
psychoeducation plus text messaging intervention (iTAB) as compared to psychoeducation alone
(CTRL) for the improvement of objectively measured medication adherence among HIV+/METH+
persons; and 3) To examine predictors of within-person trajectories of nonadherence using
the longitudinal data collected over the study. In order to realize these aims, the
investigators will leverage the infrastructure of two unique UCSD resources increasing
likelihood of study success, impact, and innovation: 1) the Translational Methamphetamine
AIDS Research Center (TMARC), which is a NIDA-funded center that focuses on the combined
effects of METH and HIV infection, and 2) the California Institute for Telecommunications
and Information Technology (Calit2), which conducts research on state-of-the-art wireless
means of health promotion. Initially, the investigators will refine the iTAB intervention to
ensure that it is user-centered and tailored to the needs of HIV+/METH+ persons via focus
groups and rapid prototyping. Once refined, the proposed iTAB intervention will use text
messages that are automated, scalable, personalized, interactive, flexible, and motivating.
The investigators will assess the acceptability and effectiveness of iTAB in improving
objectively measured adherence (i.e., MEMS caps) over a 6-week period via a pilot RCT with
40 HIV+/METH+ assigned to the iTAB intervention and 20 HIV+/METH+ assigned to a
psychoeducational control. Predictors of nonadherence including frequency of METH use,
neuropsychological impairment, and mood will be examined to determine whether iTAB is better
able to compensate for these factors associated with nonadherence as compared to CTRL.
Further refinement to the iTAB intervention will be made in order to pursue a large-scale
R01 using our tailored intervention.