Adherence Interventions for HIV Youth Via Text & Cell Phone - Sequential Multiple Assignment Randomized Trial (SMART)

The study will consist of two points of randomization. The first step involves randomization of participants to receive either CPS or SMS using a 1:1 allocation ratio. Both intervention conditions will receive 3 months of intervention (i.e., 12 weeks of CPS or SMS).

The second step involves a stratified randomization in blocks with 8 possible intervention trajectories. Within each condition, participants are categorized into two groups - responders with VL<200 (Rsp) and non-responders with VL ≥200 (NRsp). Responders in the CPS condition will be randomly assigned to receive either 3 months of CPS tapered (CPS-T) intervention followed by standard care (SC) or only SC. Similarly, responders in the SMScondition will be randomly assigned to receive either 3 months of SMS tapered (SMS-T) intervention followed by SC or only SC. Non-responders in both CPS and SMS conditions will be randomly assigned to receive either 3 months of incentivized CPS (CPS-I) followed by 3 months of CPS-T and 3 months of SC or 3 months of incentivized SMS (SMS-I) followed by 3 months of SMS-T and 3 months of SC.

Inclusion criteria

• HIV diagnosis
• Viral load ≥ 200 copies/mL within 3 months prior to enrollment or self-reported adherence ≤ 80%
• ART medication regimen prescribed minimum of 3 months prior to eligibility VL or self-reported adherence
• Sole owner of device capable of sending/receiving calls and text messages
• Willingness to permit research team to communicate with their HIV care provider team

Exclusion criteria

• Mental, physical, or emotional capacity prevents completion of protocol as written
• Inability to understand written/spoken English
• Concurrent participant in any adherence behavioral research intervention