Publications by authors named "Sylvie Naar"

54 Publications

Development of the Motivational Interviewing Coach Rating Scale (MI-CRS) for health equity implementation contexts.

Health Psychol 2021 Jul;40(7):439-449

Department of Family Medicine and Public Health Sciences, Wayne State University.

Objective: The field of implementation science emphasizes efficient and effective fidelity measurement for research outcomes and feedback to support quality improvement. This paper reports on such a measure for motivational interviewing (MI), developed with rigorous methodology and with diverse samples.

Method: Using item response theory (IRT) methods and Rasch modeling, we analyzed coded (a) recordings (n = 99) of intervention sessions in a clinical trial of African American adolescents with obesity; (b) standard patient interactions (n = 370) in an implementation science study with youth living with HIV; and (c) standard patient interactions (n = 172) in a diverse community sample.

Results: These methods yielded a reliable and valid 12-item scale on several indicators using Rausch modeling including single construct dimensionality, strong item-session maps, good rating scale functionality, and item fit after revisions. However, absolute agreement was modest. The 12 items yielded thresholds for 4 categories: beginner, novice, intermediate and advanced.

Conclusions: The 12-item Motivational Interviewing Coach Rating Scale is the first efficient and effective fidelity measure appropriate with diverse ethnic groups, with interventions that are MI only or interventions that integrate MI with other interventions, and with adolescents and families as well as adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0001064DOI Listing
July 2021

Tailored motivational interviewing (TMI): Translating basic science in skills acquisition into a behavioral intervention to improve community health worker motivational interviewing competence for youth living with HIV.

Health Psychol 2021 Jul 29. Epub 2021 Jul 29.

Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine.

Interventions to promote evidence-based practices are particularly needed for paraprofessional staff working with minority youth with HIV who have higher rates of HIV infection but lower rates of linkage and retention in care compared to older adults. Utilizing the ORBIT model for behavioral intervention development, we defined and refined a behavioral intervention for providers, Tailored Motivational Interviewing (TMI), to improve provider competence in previous studies (Phase 1a and 1b). The current study focuses on ORBIT Phase 2a-proof of concept. We hypothesized that TMI would be acceptable and feasible and would show a signal of efficacy of improving and maintaining community health worker (CHW) MI competence scores using an innovative statistical method for small N proof-of-concept studies. Longitudinal data were collected from 19 CHWs at 16 youth HIV agencies. CHWs from 8 sites were assigned to the TMI group per the cofunders request. The remaining 8 sites were randomly assigned to TMI or services as usual. MI competence was assessed at baseline and up to 15 times over 2 years. Random coefficient models were utilized to examine time trajectories of competence scores and the impact of the intervention on competence trajectories. Semistructured interviews were conducted to determine barriers and facilitators of TMI. Competence scores in the TMI group significantly increased while the scores of the control group significantly decreased. Further analysis of the intervention group demonstrated that scores significantly increased during the first 3 months after initial workshop and was sustained through the end of the study. Qualitative findings revealed insufficient time and competing priorities as perceived barriers whereas integrating MI into routine agency practices and ongoing training might facilitate implementation. Following a successful proof-of-concept, the next step is a fully randomized pilot study of TMI relative to a control condition in preparation for a stepped-wedge cluster randomized full scale trial. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0001071DOI Listing
July 2021

Barriers and facilitators to implementing a motivational interviewing-based intervention: a multi-site study of organizations caring for youth living with HIV.

AIDS Care 2021 Jul 12:1-6. Epub 2021 Jul 12.

Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA.

Understanding possible barriers and facilitators to effective implementation of evidence-based interventions to help high-risk youth prevent and manage HIV is crucial for their scale-up. This manuscript analyzes qualitative interview data collected during the early phase implementation of a motivational interviewing (MI) based intervention at 10 HIV care clinics in the United States providing services to youth. Using the Exploration-Preparation-Implementation-Sustainment (EPIS) framework to understand the implementation and the dynamic adaptation process (DAP) model to balance notions of intervention fidelity and flexibility, providers and stakeholders at each site ( = 97) were interviewed prior to implementation to gather their perspectives on organizational readiness for the intervention, as well as provider and client characteristics. The interviewers summarized their experience with rapid feedback forms (RFFs). Data extracted from the RFFs highlighted anticipated barriers to and facilitators of the proposed MI-based intervention, with the EPIS framework used to organize these findings. Study findings illustrate the inner and outer contextual factors that affect implementation and denote the points at which the MI-based intervention may be tailored to fit the unique context of a clinic while remaining faithful to the intervention's original design.
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http://dx.doi.org/10.1080/09540121.2021.1950604DOI Listing
July 2021

Tailored Motivational Interviewing (TMI): A Pilot Implementation-Effectiveness Trial to Promote MI Competence in Adolescent HIV Clinics.

AIDS Behav 2021 Jul 9. Epub 2021 Jul 9.

Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.

This brief report describes results of piloted Tailored Motivational Interviewing (TMI). Tailoring focused on site-specific training needs, target patient behaviors, and implementation facilitators and barriers that staff anticipated. Participating staff (N = 31) at two adolescent HIV clinics completed a pre-training qualitative interview (N = 27), and MI competency assessments based on three pre- and six post-training standard patient role-plays (N = 27). Results included pre- to post-training MI competence improvement (t (153) = - 4.13, p ≤ 0.001) and change in competency category distribution (X = (2, N = 155) = 15.72, p ≤ 0.001), providing initial support for the implementation of TMI in adolescent HIV clinic settings.
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http://dx.doi.org/10.1007/s10461-021-03369-8DOI Listing
July 2021

Tailored Motivational Interviewing (TMI): A Pilot Implementation-Effectiveness Trial to Promote MI Competence in Adolescent HIV Clinics.

AIDS Behav 2021 Jul 9. Epub 2021 Jul 9.

Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.

This brief report describes results of piloted Tailored Motivational Interviewing (TMI). Tailoring focused on site-specific training needs, target patient behaviors, and implementation facilitators and barriers that staff anticipated. Participating staff (N = 31) at two adolescent HIV clinics completed a pre-training qualitative interview (N = 27), and MI competency assessments based on three pre- and six post-training standard patient role-plays (N = 27). Results included pre- to post-training MI competence improvement (t (153) = - 4.13, p ≤ 0.001) and change in competency category distribution (X = (2, N = 155) = 15.72, p ≤ 0.001), providing initial support for the implementation of TMI in adolescent HIV clinic settings.
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http://dx.doi.org/10.1007/s10461-021-03369-8DOI Listing
July 2021

"Do I Have a Memory Problem? I Can't Recall": An Evaluation of Measurement Invariance in Subjective Reporting of Memory Symptoms among Persons with and without Objective HIV-Associated Memory Impairment.

J Int Neuropsychol Soc 2021 May 6:1-11. Epub 2021 May 6.

Department of Psychology, University of Houston, Houston, USA.

Objective: Memory symptoms and objective impairment are common in HIV disease and are associated with disability. A paradoxical issue is that objective episodic memory failures can interfere with accurate recall of memory symptoms. The present study assessed whether responses on a self-report scale of memory symptoms demonstrate measurement invariance in persons with and without objective HIV-associated memory impairment.

Method: In total, 505 persons with HIV completed the Prospective and Retrospective Memory Questionnaire (PRMQ). Objective memory impairment (n = 141) was determined using a 1-SD cutoff on clinical tests of episodic memory. PRMQ measurement invariance was assessed by confirmatory factor analyses examining a one-factor model with increasing cross-group equality constraints imposed on factor loadings and item thresholds (i.e., configural, weak, and strong invariance).

Results: Configural model fit indicated that identical items measured a one-factor model for both groups. Comparison to the weak model indicated that factor loadings were equivalent across groups. However, there was evidence of partial strong invariance, with two PRMQ item thresholds differing across memory impairment groups. Post hoc analyses using a 1.5-SD memory impairment cutoff (n = 77) revealed both partial weak and partial strong invariance, such that PRMQ item loadings differed across memory groups for three items.

Conclusions: The PRMQ demonstrated a robust factor structure among persons with and without objective HIV-associated memory impairment. However, on select PRMQ items, individuals with memory impairment reported observed scores that were relatively higher than their latent score, while items were more strongly associated with the memory factor in a group with greater memory impairment.
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http://dx.doi.org/10.1017/S1355617721000448DOI Listing
May 2021

Barriers and Facilitators to the Collection and Aggregation of Electronic Health Record HIV Data: An Analysis of Study Recruitment Venues Within the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN).

Eval Health Prof 2021 Jun 4;44(2):168-176. Epub 2021 Mar 4.

Maternal and Pediatric Infectious Disease Branch (MPIDB), 2511Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Washington, DC, USA.

Electronic health record (EHR) data can be leveraged for prospective cohort studies and pragmatic clinical trials, targeting youth living with HIV (YLH). Using EHRs in this manner may minimize the need for costly research infrastructure in service to lowering disease burden. This study characterizes HIV prevention and care continua variables and identifies factors likely to impede or facilitate EHR use for research and interventions. We conducted telephone-based qualitative interviews with National Experts (n = 10) and Key Stakeholders (n = 19) from subject recruitment venues (SRVs), providing care services to YLH and youth at risk for HIV. We found 17 different EHR systems being used for various purposes (e.g., workflow management and billing). Thematic content analysis of interviews highlighted six broad categories of perspectives on barriers to and facilitators of EHR use: specific variable collection, general use barriers, and facilitators, general data collection barriers and facilitators, EHRs for surveillance and research, EHRs for personnel and resource management and capture of HIV specific variables. These findings may inform implementation strategies of future studies, in which we conduct routine monitoring of the youth HIV prevention and care continua using EHRs and test an eHealth intervention.
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http://dx.doi.org/10.1177/0163278721998413DOI Listing
June 2021

Feasibility of Ethyl Glucuronide Nail Testing Biomarker for Alcohol Use Among Youth Living With HIV.

J Adolesc Health 2021 08 15;69(2):346-348. Epub 2021 Feb 15.

Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, Florida.

Purpose: We assessed the feasibility of the ethyl glucuronide biomarker (EtG) through nail sampling to measure alcohol use among youth living with HIV in the United States (YLWH, N = 183); we also evaluated concordance between this EtG biomarker and self-reported measures of alcohol use, specifically, the Alcohol Timeline Followback (TFLB) and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST).

Methods: EtG, TFLB, and ASSIST were collected at 4 points over 1 year. At baseline and 52 weeks, 78.1% and 70.1%, respectively, provided a valid (full or partial) sample.

Results: At 16 weeks, EtG was associated with ASSIST (r = .25, p < .05). At 28 weeks and 52 weeks, TFLB and ASSIST were correlated with EtG (at 28 weeks r = .23, p < .05 and r = .41, p < .01, respectively; at 52 weeks r = .34, p < .01 and r = .25, p < .05, respectively).

Conclusions: We found that nail-based EtG biomarker was feasible to measure alcohol use among YLWH; we also found concordance between EtG, TLFB, and ASSIST, supporting ongoing use of self-reported alcohol use measures with YLWH.
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http://dx.doi.org/10.1016/j.jadohealth.2020.12.134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316253PMC
August 2021

Proof of Concept for the FLEX Intervention: Feasibility of Home Based Coaching to Improve Physical Activity Outcomes and Viral Load Suppression among African American Youth Living with HIV.

J Int Assoc Provid AIDS Care 2021 Jan-Dec;20:2325958220986264

Center for Translational Behavioral Science, 12236Florida State University (FSU) College of Medicine, Tallahassee, FL, USA.

FLEX is a Motivational Interviewing, home-based coaching program that concurrently targets HIV-related and physical activity goals among African American youth living with HIV in the United States. To create and pilot test FLEX, we leveraged a 2-step exploratory sequential mixed methods design informed by the ORBIT model with initial qualitative work followed by pre-post analysis of quantitative outcomes, concluding with qualitative exit surveys. Data were evaluated pre- and 3-months post-intervention. Recruitment was 90%. Participants reported high program satisfaction and program adherence (76% completion rate). Preliminary findings indicate reductions in participants' viral loads and improvements across 4 measures of physical activity.
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http://dx.doi.org/10.1177/2325958220986264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797566PMC
July 2021

Preliminary Findings from Three Models of Motivational Interviewing Training in Jamaica.

Health Equity 2020 7;4(1):438-442. Epub 2020 Oct 7.

Florida State University (FSU), College of Medicine, Center for Translational Behavioral Science, Tallahassee, Florida, USA.

We assessed satisfaction, fidelity, retention, and implementation considerations across three models of motivational interviewing training in Jamaica to identify a promising model for resource-poor settings. We conducted -tests to assess differences in fidelity and examined qualitative data for barriers and facilitators (=52). Only 50-75% of all models' trainees completed coaching. Model 1 trainees' mean fidelity was 2.83/4.00 compared with Model 3 trainees' at 2.94/4.00 (=-0.710, confidence interval=-0.427 to 0.207, =0.483). Key barriers to completion and fidelity were lack of funding and time. We found support for continuing workshop-only trainings; we did not find that higher contact hours produced improved trainee fidelity.
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http://dx.doi.org/10.1089/heq.2020.0034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585604PMC
October 2020

Healthy Choices Intervention is Associated with Reductions in Stigma Among Youth Living with HIV in the United States (ATN 129).

AIDS Behav 2021 Apr 24;25(4):1094-1102. Epub 2020 Oct 24.

Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA.

Considering the lack of validated stigma reduction interventions for youth living with HIV (YLWH), we evaluated effects of the Healthy Choices intervention on HIV-related stigma among YLWH. We analyzed data from the Adolescent Medicine Trials Network protocol 129, multi-site randomized controlled trial, applying latent growth curve modeling with two linear slopes estimating changes in Berger's Stigma Scale pre-intervention, 16, 28, and 52 weeks post-intervention, as well as the trajectory of stigma scores over the follow-up period (N = 183). Expected value for the growth intercept was statistically significant (B = 2.53; 95% CI 2.32, 2.73; p < 0.001), as were differences in the change from baseline to 16-week follow-up (B = - 0.02; 95% CI - 0.04, 0.01; p = 0.034). Expected value of the slope factor measuring growth over the follow-up period was non-significant suggesting that stigma scores were stable from 28 to 52 weeks. Our findings warrant replication and additional research comparing effects of this intervention to counterfactual controls.
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http://dx.doi.org/10.1007/s10461-020-03071-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979460PMC
April 2021

Managing Outliers in Adolescent Food Frequency Questionnaire Data.

J Nutr Educ Behav 2021 01 1;53(1):28-35. Epub 2020 Oct 1.

Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL.

Objective: The goal of this study was to explore the impact of 5 decision rules for removing outliers from adolescent food frequency questionnaire (FFQ) data.

Design: This secondary analysis used baseline and 3-month data from a weight loss intervention clinical trial.

Participants: African American adolescents (n = 181) were recruited from outpatient clinics and community health fairs.

Variables Measured: Data collected included self-reported FFQ and mediators of weight (food addiction, depressive symptoms, and relative reinforcing value of food), caregiver-reported executive functioning, and objectively measured weight status (percentage overweight).

Analysis: Descriptive statistics examined patterns in study variables at baseline and follow-up. Correlational analyses explored the relationships between FFQ data and key study variables at baseline and follow-up.

Results: Compared with not removing outliers, using decision rules reduced the number of cases and restricted the range of data. The magnitude of baseline FFQ-mediator relationships was attenuated under all decision rules but varied (increasing, decreasing, and reversing direction) at follow-up. Decision rule use increased the magnitude of change in FFQ estimated energy intake and significantly strengthened its relationship with weight change under 2 fixed range decision rules.

Conclusions And Implications: Results suggest careful evaluation of outliers and testing and reporting the effects of different outlier decision rules through sensitivity analyses.
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http://dx.doi.org/10.1016/j.jneb.2020.08.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7855646PMC
January 2021

The Development and Preliminary Impact of CAMP Air: A Web-based Asthma Intervention to Improve Asthma Among Adolescents.

Patient Educ Couns 2021 04 15;104(4):865-870. Epub 2020 Sep 15.

3C Institute, United States.

Objective: Describe the development and preliminary impact of CAMP Air, a web-based intervention for adolescents with uncontrolled asthma.

Materials And Methods: CAMP Air was developed using an iterative process with input from stakeholders and incorporating usability testing results (n = 14 adolescents). To test CAMP Air's initial impact, 61 adolescents from two New York City public high schools (n = 37) and from clinics, community-based organizations, and third-party recruitment services (i.e., community sample; n = 24) were enrolled in a randomized pilot trial. Participants were randomized to CAMP Air (n = 30) or information-and-referral control intervention (n = 31). A point-person worked with school participants to complete CAMP Air.

Results: CAMP Air participants were satisfied with the intervention and its value for supporting self-management, completing on average 6 of 7 modules. Relative to controls, CAMP Air participants demonstrated significantly improved asthma knowledge, asthma control, night wakening and school absences, and less risk for urgent care visits. Adolescents enrolled in schools completed more modules and had significantly fewer nights woken and school absences than community enrollees.

Conclusion: CAMP Air improves asthma outcomes among adolescents with uncontrolled asthma.

Practice Implications: A web-based intervention CAMP Air is a promising intervention. When a point-person works with adolescents, CAMP Air's access and impact are improved.
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http://dx.doi.org/10.1016/j.pec.2020.09.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956908PMC
April 2021

Developmental Barriers to Couples' HIV Testing and Counseling Among Adolescent Sexual Minority Males: A Dyadic Socio-ecological Perspective.

AIDS Behav 2021 Mar 17;25(3):787-797. Epub 2020 Sep 17.

Department of Psychology, University of Rhode Island, Kingston, RI, USA.

Couples HIV Testing and Counseling (CHTC) is now a standard of care for partnered sexual minority men. While adolescent sexual minority men (ASMM; ages 15-19) face disproportionate HIV risk, the emergent nature of relationships and communication skills may present challenges to accessing and engaging in CHTC. This study utilized qualitative data from 28 ASMM recruited in 4 urban centers in the USA during the formative stage of Adolescent Trials Network study ATN-156. Participants were cis-male, HIV-negative, and in a relationship with a similarly-aged cis-male partner. Thematic analysis indicated low and high levels of commitment were barriers to CHTC. Concerns about caregiver attitudes towards HIV testing were salient. Adolescents' perception of structural barriers highlighted reliance on caregiver resources, which limited access to sexual health services. Prevention programming must address structural barriers to access encountered by adolescents. ASMM in relationships may benefit from programming that includes options for individual and dyadic participation.
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http://dx.doi.org/10.1007/s10461-020-03044-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887008PMC
March 2021

Comparative Effectiveness of Community-Based vs Clinic-Based Healthy Choices Motivational Intervention to Improve Health Behaviors Among Youth Living With HIV: A Randomized Clinical Trial.

JAMA Netw Open 2020 08 3;3(8):e2014650. Epub 2020 Aug 3.

Health Psychology and Clinical Science Program, The Graduate Center, City University of New York, New York.

Importance: Youth living with HIV make up one-quarter of new infections and have high rates of risk behaviors but are significantly understudied. Effectiveness trials in real-world settings are needed to inform program delivery.

Objective: To compare the effectiveness of the Healthy Choices intervention delivered in a home or community setting vs a medical clinic.

Design, Setting, And Participants: This randomized clinical trial was conducted from November 1, 2014, to January 31, 2018, with 52 weeks of follow-up. Participants, recruited from 5 adolescent HIV clinics in the United States, were youths and young adults living with HIV aged 16 to 24 years who were fluent in English, were currently prescribed HIV medication, had a detectable viral load, and had used alcohol in the past 12 weeks. Individuals with an active psychosis that resulted in an inability to complete questionnaires were excluded. Data were analyzed from May to December, 2019.

Interventions: Participants were randomized to receive the Healthy Choices intervention in either a home or clinic setting. Four 30-minute individual sessions based on motivational interviewing to improve (1) medication adherence and (2) drinking behavior were delivered during 10 weeks by trained community health workers. In session 1, participants chose which behavior to discuss first. Using motivational interviewing strategies, the community health worker elicited motivational language, guided the development of an individualized change plan while supporting autonomy, delivered feedback, and addressed knowledge gaps. Session 2 focused on the second target behavior. In subsequent sessions, community health workers reviewed the individualized change plan, monitored progress, guided problem solving, and helped maintain changes made.

Main Outcomes And Measures: Primary outcomes were viral load and alcohol use change trajectories during 52 weeks of follow-up. Alcohol use severity and frequency were measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) (scores range from 0 to 33, with higher scores indicating greater severity of alcohol-related problems) and number of drinks consumed each day over a 30-day period, with timeline followback.

Results: A total of 183 young people living with HIV (145 male [79.2%]; mean [SD] age, 21.4 [1.9] y) were randomized to the home setting (n = 90) or clinical setting (n = 93). Using growth-curve analysis, both groups showed declines in viral load after the intervention: among participants with available viral load information, in the home group, 12 participants (21%) had an undetectable viral load at 16 weeks, 12 (22%) at 28 weeks, and 10 (20%) at 52 weeks; in the clinic group, 16 participants (24%) had an undetectable viral load at 16 weeks, 20 (39%) at 28 weeks, and 18 (35%) at 52 weeks. However, the clinic group maintained gains, whereas those counseled at home had a significantly different and increasing trajectory during follow-up (unstandardized β = -0.07; 95% CI,-0.14 to -0.01; P = .02). A similar pattern was observed in ASSIST scores during follow-up, with reduced ASSIST scores in the clinic group (unstandardized β = -0.44; 95% CI,-0.81 to -0.07; P = .02).

Conclusions And Relevance: In this trial, the Healthy Choices intervention resulted in improvements in viral load and alcohol use over 12 months. Unexpectedly, the clinic setting outperformed home-based delivery for viral suppression. Although cross-sectional differences in ASSIST scores were nonsignificant, clinic delivery did improve the trajectory of ASSIST scores during follow-up. Thus, clinics may be the more effective site for interventions aimed at viral load reduction for young people living with HIV.

Trial Registration: ClinicalTrials.gov Identifier: NCT01969461.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.14650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450347PMC
August 2020

Adolescent Sexual Minority Males, Relationship Functioning, and Condomless Sex.

J Adolesc Health 2021 02 7;68(2):419-421. Epub 2020 Jul 7.

Department of Psychology, University of Rhode Island, Kingston, Rhode Island.

Purpose: Adolescent sexual minority males (SMMs) are at a high risk of contracting HIV through condomless sex. Many develop serious partnerships, and sex with main partners accounts for many new infections. Previous research with adolescent SMMs largely focused on relationship seriousness and found a positive association with sexual HIV risk. This study tested associations between three relationship functioning indicators and condomless sex.

Methods: Adolescent SMMs aged 15-19 years (n = 85) completed a brief online survey. Respondents rated commitment, seriousness, and satisfaction on 7-point Likert-type scales.

Results: Among adolescent SMMs who had sex in their lifetime, those who were more satisfied in their relationship were less likely to have condomless in the past 90 days (odds ratio = .56, p = .04).

Conclusions: Results support examining multiple domains of relationship functioning in this age group to identify relationship mechanisms that may serve as the target of HIV risk-reduction interventions among adolescent SMMs initiating relationships.
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http://dx.doi.org/10.1016/j.jadohealth.2020.05.052DOI Listing
February 2021

Drug Use Among Adolescents and Young Adults with Unsuppressed HIV Who Use Alcohol: Identifying Patterns of Comorbid Drug Use and Associations with Mental Health.

AIDS Behav 2020 Oct;24(10):2975-2983

Center for Translational Behavioral Research, Florida State University College of Medicine, Tallahassee, FL, USA.

Youth living with HIV (YLWH; aged 16-24) are at elevated risk of alcohol and drug use. Studies in older populations have identified patterns or profiles of multiple substance use differentially associated with mental health and anti-retroviral therapy (ART) adherence. No studies of YLWH have yet examined such patterns. A sample of 179 YLWH, reporting ART non-adherence and alcohol use, were recruited at five Adolescent Trials Network clinics in urban areas of the US between November 2014 and August 2017. Participants completed the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) to assess substance use involvement scores, and the Brief Symptom Inventory. Latent Profile Analysis identified three substance use patterns: minimal illicit drug use (15.1%), cannabis only (56.4%), and global polysubstance use (28.5%). Global polysubstance users experienced more mental health problems compared to the minimal illicit drug use group. The co-occurrence of drug use with alcohol was common among these YLWH-all of whom reported ART adherence problems-indicating the importance of interventions capable of addressing multiple substance use rather than alcohol alone.
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http://dx.doi.org/10.1007/s10461-020-02848-8DOI Listing
October 2020

Provider behaviors that predict motivational statements in adolescents and young adults with HIV: a study of clinical communication using the Motivational Interviewing framework.

AIDS Care 2020 09 17;32(9):1069-1077. Epub 2019 Oct 17.

Biostatistics and Epidemiology Research Design Core, Wayne State University School of Medicine, Detroit, Michigan, USA.

Medical care providers' use of Motivational Interviewing (MI) is linked to improved medication adherence, viral load, and associated behaviors in adolescents and young adults living with HIV. Mastering MI is difficult for busy providers; however, tailoring MI training to the specific MI communication strategies most relevant for HIV treatment context may be a strategy to increase proficiency. The present study aimed to identify communication strategies likely to elicit motivational statements among adolescent-young adult patients living with HIV. Language used by MI-exposed providers during 80 HIV medical clinic visits was transcribed and coded to characterize patient-provider communication within the MI framework. Sequential analysis, an approach to establish empirical support for the order of behavioral events, found patients were more likely to express motivational statements after provider questions phrased to elicit motivation, reflections of motivational statements, and statements emphasizing patients' decision-making autonomy. Patients were more likely to express amotivational statements when providers asked questions phrased to elicit amotivational statements or reflected amotivational language. Training providers to strategically phrase their questions and reflections to elicit change language and to emphasize patients' autonomy may be critical skills for working with adolescents and young adults living with HIV.
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http://dx.doi.org/10.1080/09540121.2019.1679709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162726PMC
September 2020

Identifying Effective Motivational Interviewing Communication Sequences Using Automated Pattern Analysis.

J Healthc Inform Res 2019 31;3(1):86-106. Epub 2018 Oct 31.

Department of Computer Science, College of Engineering, Wayne State University, Detroit, MI 48202.

Motivational Interviewing (MI) is an evidence-based strategy for communicating with patients about behavior change. Although there is strong empirical evidence linking "MI-consistent" counselor behaviors and patient motivational statements (i.e., "change talk"), the specific counselor communication behaviors effective for eliciting patient change talk vary by treatment context and, thus, are a subject of ongoing research. An integral part of this research is the sequential analysis of pre-coded MI transcripts. In this paper, we evaluate the empirical effectiveness of the Hidden Markov Model, a probabilistic generative model for sequence data, for modeling sequences of behavior codes and closed frequent pattern mining, a method to identify frequently occurring sequential patterns of behavior codes in MI communication sequences to inform MI practice. We conducted experiments with 1,360 communication sequences from 37 transcribed audio recordings of weight loss counseling sessions with African-American adolescents with obesity and their caregivers. Transcripts had been previously annotated with patient-counselor behavior codes using a specialized codebook. Empirical results indicate that Hidden Markov Model and closed frequent pattern mining techniques can identify counselor communication strategies that are effective at eliciting patients' motivational statements to guide clinical practice.
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http://dx.doi.org/10.1007/s41666-018-0037-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786498PMC
October 2018

Improving the Youth HIV Prevention and Care Cascades: Innovative Designs in the Adolescent Trials Network for HIV/AIDS Interventions.

AIDS Patient Care STDS 2019 09;33(9):388-398

Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California.

Dramatic decreases in HIV transmission are achievable with currently available biomedical and behavioral interventions, including antiretroviral therapy and pre-exposure prophylaxis. However, such decreases have not yet been realized among adolescents and young adults. The Adolescent Medicine Trials Network (ATN) for HIV/AIDS interventions is dedicated to research addressing the needs of youth at high risk for HIV acquisition as well as youth living with HIV. This article provides an overview of an array of efficient and effective designs across the translational spectrum that are utilized within the ATN. These designs maximize methodological rigor and real-world applicability of findings while minimizing resource use. Implementation science and cost-effectiveness methods are included. Utilizing protocol examples, we demonstrate the feasibility of such designs to balance rigor and relevance to shorten the science-to-practice gap and improve the youth HIV prevention and care continua.
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http://dx.doi.org/10.1089/apc.2019.0095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745528PMC
September 2019

Deep Neural Architectures for Discourse Segmentation in E-Mail Based Behavioral Interventions.

AMIA Jt Summits Transl Sci Proc 2019 6;2019:443-452. Epub 2019 May 6.

Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan.

Communication science approaches to develop effective behavior interventions, such as motivational interviewing (MI), are limited by traditional qualitative coding of communication exchanges, a very resource-intensive and time-consuming process. This study focuses on the analysis of e-Coaching sessions, behavior interventions delivered via email and grounded in the principles of MI. A critical step towards automated qualitative coding of e-Coaching sessions is segmentation of emails into fragments that correspond to MI behaviors. This study frames email segmentation task as a classification problem and utilizes word and punctuation mark embeddings in conjunction with part-of-speech features to address it. We evaluated the performance of conditional random fields (CRF) as well as multi-layer perceptron (MLP), bi-directional recurrent neural network (BRNN) and convolutional recurrent neural network (CRNN) for the task of email segmentation. Our results indicate that CRNN outperforms CRF, MLP and BRNN achieving 0.989 weighted macro-averaged F1-measure and 0.825 F1-measure for new segment detection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6568107PMC
May 2019

Testing a Motivational Interviewing Implementation Intervention in Adolescent HIV Clinics: Protocol for a Type 3, Hybrid Implementation-Effectiveness Trial.

JMIR Res Protoc 2019 Jun 7;8(6):e11200. Epub 2019 Jun 7.

Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.

Background: Motivational interviewing (MI) has been shown to effectively improve self-management for youth living with HIV (YLH) and has demonstrated success across the youth HIV care cascade-currently, the only behavioral intervention to do so. Substantial barriers prevent the effective implementation of MI in real-world settings. Thus, there is a critical need to understand how to implement evidence-based practices (EBPs), such as MI, and promote behavior change in youth HIV treatment settings as risk-taking behaviors peak during adolescence and young adulthood.

Objective: This study aims to describe the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) protocol of a tailored MI (TMI) implementation-effectiveness trial (ATN 146 TMI) to scale up an EBP in multidisciplinary adolescent HIV settings while balancing flexibility and fidelity. This protocol is part of the Scale It Up program described in this issue.

Methods: This study is a type 3, hybrid implementation-effectiveness trial that tests the effect of TMI on fidelity (MI competency and adherence to program requirements) while integrating findings from two other ATN protocols described in this issue-ATN 153 Exploration, Preparations, Implementation, Sustainment and ATN 154 Cascade Monitoring. ATN 153 guides the mixed methods investigation of barriers and facilitators of implementation, while ATN 154 provides effectiveness outcomes. The TMI study population consists of providers at 10 adolescent HIV care sites around the United States. These 10 clinics are randomly assigned to 5 blocks to receive the TMI implementation intervention (workshop and trigger-based coaching guided by local implementation teams) utilizing the dynamic wait-listed controlled design. After 12 months of implementation, a second randomization compares a combination of internal facilitator coaching with the encouragement of communities of practice (CoPs) to CoPs alone. Participants receive MI competency assessments on a quarterly basis during preimplementation, during the 12 months of implementation and during the sustainment period for a total of 36 months. We hypothesize that MI competency ratings will be higher among providers during the TMI implementation phase compared with the standard care phase, and successful implementation will be associated with improved cascade-related outcomes, namely undetectable viral load and a greater number of clinic visits among YLH.

Results: Participant recruitment began in August 2017 and is ongoing. As of mid-May 2018, TMI has 150 active participants.

Conclusions: This protocol describes the underlying theoretical framework, study design, measures, and lessons learned for TMI, a type 3, hybrid implementation-effectiveness trial, which has the potential to scale up MI and improve patient outcomes in adolescent HIV settings.

Trial Registration: ClinicalTrials.gov NCT03681912; https://clinicaltrials.gov/ct2/show/NCT03681912 (Archived by WebCite at http://www.webcitation.org/754oT7Khx).

International Registered Report Identifier (irrid): DERR1-10.2196/11200.
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http://dx.doi.org/10.2196/11200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682301PMC
June 2019

Physical Activity as a Predictor of Changes in Systolic Blood Pressure for African-American Adolescents Seeking Treatment for Obesity.

J Adolesc Health 2019 09 18;65(3):430-432. Epub 2019 Jun 18.

Division of Behavioral Sciences, Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan.

Purpose: The aim of the study was to examine changes in systolic blood pressure (SBP) and whether physical activity and obesity status predicted SBP change for African-American adolescents (n = 181) participating in a behavioral weight control trial.

Methods: Data were collected at baseline, 7 months (end-of-treatment), and 9 months (2-month follow-up).

Results: Nearly half of adolescents achieved clinically significant SBP reductions at 7 and 9 months. Significantly, fewer adolescents had elevated SBP at 7 and 9 months compared with baseline (both p < .001). Changes in percent overweight and moderate-to-vigorous activity predicted changes in SBP over time.

Conclusions: Obesity reduction and increases in moderate-to-vigorous physical activity may predict short-term, clinically meaningful reductions in SBP for African American adolescents with obesity.
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http://dx.doi.org/10.1016/j.jadohealth.2019.04.001DOI Listing
September 2019

Adolescent Male Couples-Based HIV Testing Intervention (We Test): Protocol for a Type 1, Hybrid Implementation-Effectiveness Trial.

JMIR Res Protoc 2019 Jun 7;8(6):e11186. Epub 2019 Jun 7.

Center for HIV Educational Studies and Training, Hunter College, City University of New York, New York, NY, United States.

Background: Young men who have sex with men (YMSM), particularly those who are partnered, are at unique risk for HIV. YMSM are among those at highest risk for HIV. Meanwhile, despite the fact that primary partners account for many-possibly most-new HIV infections, partnered men who have sex with men perceive themselves to be at much lower risk for HIV infection and therefore test less often than single men. In response to the risk of primary partner HIV transmission, couples HIV testing and counseling (CHTC) procedures have been developed for use in adult populations. Although promising, YMSM couples may require additional support to complete CHTC given their developmental context in which sexual and romantic relationships are relatively new, and communication skills are emergent.

Objective: The aim of this study was to test the additive benefit of adjunct treatment components tailored for YMSM, which enhance communication skills before the completion of CHTC. The intervention tests a continuum of prevention packages including assertive communication training videos and motivational interviewing focused on assisting with identification and development (MI-AID) before entering into the dyadic intervention components. This protocol is part of the Adolescent Medicine Trials Network (ATN) Scale It Up program described in this issue.

Methods: This is a comparative effectiveness trial that will be executed in 3 phases. Phase 1 will gather qualitative data related to intervention development and implementation from partnered YMSM at 4 subject recruitment venues (SRVs). Phase 2 will compare a continuum of these interventions in a pilot randomized controlled trial (RCT) at 2 SRVs. Phase 3 will compare the most successful adapted intervention package from phase 2 to CHTC as usual in a larger RCT at 4 SRVs. This phase is focused on implementation and sustainment phases of the Exploration, Preparation, Implementation, and Sustainment framework.

Results: Phase 1 data will be drawn from qualitative interviews with partnered YMSM (n=24) and staff from ATN sites (n=20). Baseline enrollment for phase 2 is expected to begin across 2 SRVs in June 2018 (n=36). In phase 2, survey data collection along with HIV and sexually transmitted infection (STI) testing will occur at baseline, and 1- and 3-month (postintervention) follow-ups. Phase 3 will begin enrollment across 4 SRVs in September 2019 (n=144) and follow-ups will occur at 1, 3, 6, and 9 months postintervention.

Conclusions: Although MI-AID, video-based assertive communication training, and CHTC have established efficacy when administered on their own, this study will be the first to evaluate the strongest adjunctive version of these interventions to address the specific developmental needs of partnered YMSM.

Trial Registration: ClinicalTrials.gov NCT03386110; http://clinicaltrials.gov/ct2/show/NCT03386110 (Archived by WebCite at http://www.webcitation.org/75mlO7GCx).

International Registered Report Identifier (irrid): DERR1-10.2196/11186.
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http://dx.doi.org/10.2196/11186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592501PMC
June 2019

Cascade Monitoring in Multidisciplinary Adolescent HIV Care Settings: Protocol for Utilizing Electronic Health Records.

JMIR Res Protoc 2019 May 30;8(5):e11185. Epub 2019 May 30.

College of Medicine, Florida State University, Tallahassee, FL, United States.

Background: Past research shows that youth living with HIV (YLH) are not as engaged in the HIV treatment cascade as other HIV-positive populations. To achieve the health benefits of rapid and widespread testing and advanced pharmacologic treatment, YLH must be fully engaged in every stage of the treatment cascade. Cascade monitoring provides an opportunity to assess the youth care cascade, including engagement in care and when youth commonly drop out of care, across 10 clinical sites in the United States. Collecting electronic health record (EHR) data for prevention and care across participant recruitment venues within the Adolescent Medicine Trials Network (ATN) allows for monitoring of the prevention and care cascades within the ATN, for comparing the ATN population to large-scale surveillance, for future integration of technology-based interventions into EHRs, and for informing ATN strategic planning.

Objective: The aim of this protocol study is to examine the trends in treatment cascade, including whether patients are receiving antiretroviral therapy, adhering to regimens, attending care appointments, and maintaining suppressed viral loads, to guide new protocol development and to facilitate community engagement. This protocol is part of the ATN Scale It Up (SIU) program described in this issue.

Methods: Deidentified EHR data of YLH, aged 15 to 24 years, will be collected annually (2017 to 2022) from 10 ATN clinical sites, resulting in patient data from 2016 to 2021. These data will be transferred and stored using Dropbox Business, a Health Insurance Portability and Accountability Act-compliant site and then analyzed by the SIU analytic core.

Results: This study was launched in December 2017 in 10 clinical sites, with 2016's EHR data due on January 31, 2017. All 10 sites electronically uploaded their EHR data. The mandatory variables requested to monitor cascade of care include date of visit, age, gender, height, weight, race, ethnicity, viral load, and International Classification of Diseases codes for other diagnosis. In total, 70% of the sites provided data for all mandatory variables. The remaining mandatory variables were manually extracted.

Conclusions: This study will provide a platform to determine how YLH across the nation progress through or drop out of the HIV treatment cascade. It will also provide a foundation for assessing impact of SIU projects on treatment cascade outcomes.

International Registered Report Identifier (irrid): DERR1-10.2196/11185.
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http://dx.doi.org/10.2196/11185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658287PMC
May 2019

Implementation Science Research Examining the Integration of Evidence-Based Practices Into HIV Prevention and Clinical Care: Protocol for a Mixed-Methods Study Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Model.

JMIR Res Protoc 2019 May 23;8(5):e11202. Epub 2019 May 23.

College of Medicine, Florida State University, Tallahassee, FL, United States.

Background: The Exploration, Preparation, Implementation, and Sustainment (EPIS) model is an implementation framework for studying the integration of evidence-based practices (EBPs) into real-world settings. The EPIS model conceptualizes implementation as a process starting with the earliest stages of problem recognition (Exploration) through the continued use of an EBP in a given clinical context (Sustainment). This is the first implementation science (IS) study of the integration of EBPs into adolescent HIV prevention and care settings.

Objective: This protocol (ATN 153 EPIS) is part of the Scale It Up program, a research program administered by the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN), described in this issue by Naar et al. The EPIS study is a descriptive study of the uptake of 4 EBPs within the Scale It Up program. The goal of EPIS is to understand the barriers and facilitators associated with the Preparation, Implementation, and Sustainment of EBPs into HIV prevention and clinical care settings.

Methods: The EPIS study is a convergent parallel mixed-methods IS study. Key implementation stakeholders, that is, clinical care providers and leaders, located within 13 ATN sites across the United States will complete a qualitative interview conducted by telephone and Web-based surveys at 3 key implementation stages. The Preparation assessment occurs before EBP implementation, Implementation occurs immediately after sites finish implementation activities and prepare for sustainment, and Sustainment occurs 1 year postimplementation. Assessments will examine stakeholders' perceptions of the barriers and facilitators to EBP implementation within their clinical site as outlined by the EPIS framework.

Results: The EPIS baseline period began in June 2017 and concluded in May 2018; analysis of the baseline data is underway. To date, 153 stakeholders have completed qualitative interviews, and 91.5% (140/153) completed the quantitative survey.

Conclusions: The knowledge gained from the EPIS study will strengthen the implementation and sustainment of EBPs in adolescent prevention and clinical care contexts by offering insights into the barriers and facilitators of successful EBP implementation and sustainment in real-world clinical contexts.

International Registered Report Identifier (irrid): DERR1-10.2196/11202.
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http://dx.doi.org/10.2196/11202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552408PMC
May 2019

Implementation Science Research Examining the Integration of Evidence-Based Practices Into HIV Prevention and Clinical Care: Protocol for a Mixed-Methods Study Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Model.

JMIR Res Protoc 2019 May 23;8(5):e11202. Epub 2019 May 23.

College of Medicine, Florida State University, Tallahassee, FL, United States.

Background: The Exploration, Preparation, Implementation, and Sustainment (EPIS) model is an implementation framework for studying the integration of evidence-based practices (EBPs) into real-world settings. The EPIS model conceptualizes implementation as a process starting with the earliest stages of problem recognition (Exploration) through the continued use of an EBP in a given clinical context (Sustainment). This is the first implementation science (IS) study of the integration of EBPs into adolescent HIV prevention and care settings.

Objective: This protocol (ATN 153 EPIS) is part of the Scale It Up program, a research program administered by the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN), described in this issue by Naar et al. The EPIS study is a descriptive study of the uptake of 4 EBPs within the Scale It Up program. The goal of EPIS is to understand the barriers and facilitators associated with the Preparation, Implementation, and Sustainment of EBPs into HIV prevention and clinical care settings.

Methods: The EPIS study is a convergent parallel mixed-methods IS study. Key implementation stakeholders, that is, clinical care providers and leaders, located within 13 ATN sites across the United States will complete a qualitative interview conducted by telephone and Web-based surveys at 3 key implementation stages. The Preparation assessment occurs before EBP implementation, Implementation occurs immediately after sites finish implementation activities and prepare for sustainment, and Sustainment occurs 1 year postimplementation. Assessments will examine stakeholders' perceptions of the barriers and facilitators to EBP implementation within their clinical site as outlined by the EPIS framework.

Results: The EPIS baseline period began in June 2017 and concluded in May 2018; analysis of the baseline data is underway. To date, 153 stakeholders have completed qualitative interviews, and 91.5% (140/153) completed the quantitative survey.

Conclusions: The knowledge gained from the EPIS study will strengthen the implementation and sustainment of EBPs in adolescent prevention and clinical care contexts by offering insights into the barriers and facilitators of successful EBP implementation and sustainment in real-world clinical contexts.

International Registered Report Identifier (irrid): DERR1-10.2196/11202.
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http://dx.doi.org/10.2196/11202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552408PMC
May 2019

Model-Based Methods to Translate Adolescent Medicine Trials Network for HIV/AIDS Interventions Findings Into Policy Recommendations: Rationale and Protocol for a Modeling Core (ATN 161).

JMIR Res Protoc 2019 Apr 16;8(4):e9898. Epub 2019 Apr 16.

Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, United States.

Background: The United States Centers for Disease Control and Prevention estimates that approximately 60,000 US youth are living with HIV. US youth living with HIV (YLWH) have poorer outcomes compared with adults, including lower rates of diagnosis, engagement, retention, and virologic suppression. With Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) support, new trials of youth-centered interventions to improve retention in care and medication adherence among YLWH are underway.

Objective: This study aimed to use a computer simulation model, the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Adolescent Model, to evaluate selected ongoing and forthcoming ATN interventions to improve viral load suppression among YLWH and to define the benchmarks for uptake, effectiveness, durability of effect, and cost that will make these interventions clinically beneficial and cost-effective.

Methods: This protocol, ATN 161, establishes the ATN Modeling Core. The Modeling Core leverages extensive data-already collected by successfully completed National Institutes of Health-supported studies-to develop novel approaches for modeling critical components of HIV disease and care in YLWH. As new data emerge from ongoing ATN trials during the award period about the effectiveness of novel interventions, the CEPAC-Adolescent simulation model will serve as a flexible tool to project their long-term clinical impact and cost-effectiveness. The Modeling Core will derive model input parameters and create a model structure that reflects key aspects of HIV acquisition, progression, and treatment in YLWH. The ATN Modeling Core Steering Committee, with guidance from ATN leadership and scientific experts, will select and prioritize specific model-based analyses as well as provide feedback on derivation of model input parameters and model assumptions. Project-specific teams will help frame research questions for model-based analyses as well as provide feedback regarding project-specific inputs, results, sensitivity analyses, and policy conclusions.

Results: This project was funded as of September 2017.

Conclusions: The ATN Modeling Core will provide critical information to guide the scale-up of ATN interventions and the translation of ATN data into policy recommendations for YLWH in the United States.
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http://dx.doi.org/10.2196/resprot.9898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488956PMC
April 2019

Outcomes From a Sequential Multiple Assignment Randomized Trial of Weight Loss Strategies for African American Adolescents With Obesity.

Ann Behav Med 2019 08;53(10):928-938

Department of Nutrition and Food Science, Wayne State University, Detroit, MI.

Background: Minority adolescents are at highest risk for obesity and extreme obesity; yet, there are few clinical trials targeting African American adolescents with obesity.

Purpose: The purpose of the study was to develop an adaptive family-based behavioral obesity treatment for African American adolescents using a sequential multiple assignment randomized trial (SMART) design.

Methods: Fit Families was a SMART where 181 African American adolescents (67% female) aged 12-17 were first randomized to office-based versus home-based behavioral skills treatment delivered from a Motivational Interviewing foundation. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based behavioral skills treatment or contingency management with voucher-based reinforcement for adolescent weight loss and for caregiver adherence to the program. All interventions were delivered by community health workers. The primary outcome was treatment retention and percent overweight.

Results: All adolescents reduced percent overweight by -3.20%; there were no significant differences in percent overweight based on treatment sequence. Adolescents receiving home-based delivery in Phase 1 and contingency management in Phase 2 completed significantly more sessions than those receiving office-based treatment and continued skills without CM (M = 8.03, SD = 3.24 and M = 6.62, SD = 2.95, respectively). The effect of contingency management was strongest among older and those with lower baseline confidence. Younger adolescents experienced greater weight reductions when receiving continued skills (-4.90% compared with -.02%).

Conclusions: Behavioral skills training can be successfully delivered to African American adolescents with obesity and their caregivers by community health workers when using a home-based service model with incentives. More potent interventions are needed to increase reductions in percent overweight and may need to be developmentally tailored for younger and older adolescents.
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http://dx.doi.org/10.1093/abm/kaz003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736439PMC
August 2019

Adolescent HIV Healthcare Providers' Competencies in Motivational Interviewing Using a Standard Patient Model of Fidelity Monitoring.

AIDS Behav 2019 Oct;23(10):2837-2839

Center for Translational Behavioral Medicine, Florida State University, Tallahassee, FL, USA.

The goal of this project is to describe adolescent HIV care providers' competence in Motivational Interviewing (MI) using a standard patient interaction model of fidelity assessment. Providers (N = 151) at 11 clinics completed monthly MI role plays. The MI Coach Rating Scale was utilized to assess MI skill. Despite mean differences in baseline MI ability by provider type (medical providers, psychologists/social workers, other), when examined together, only clinic had a significant main effect. Aspects of the clinic environment may have a greater impact on providers' baseline MI ability than their job type. Future research should continue to explore these clinic factors.
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http://dx.doi.org/10.1007/s10461-019-02445-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732046PMC
October 2019
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