Epic Allies HIV ART Adherence Intervention

Implementation of effective interventions for HIV care engagement is necessary to raise the percentage of people living with HIV/Acquired Immunodeficiency Syndrome (AIDS) who are virally suppressed and in continuous care. The ultimate goal of this study is to assess the effectiveness of a mobile phone app that utilizes game mechanics and social networking features to improve engagement in care, and ART uptake and adherence among HIV-positive YMSM and trans women who have sex with men. The high mobile phone ownership among adolescent and young adults supports using intervention tools based in these familiar available technologies. If successful, Epic Allies would be clinically attractive, as adherent patients would require less frequent clinic visits and experience fewer HIV-related secondary infections and financially attractive, as reducing clinic visits and secondary infections. Epic Allies could also greatly impact public health as ART adherence reduces HIV infectivity and subsequently reduces HIV transmission.

This is a two-arm randomized-controlled trial (RCT). All subjects will be randomized either to the intervention arm and receive the Epic Allies intervention branch of the app or to the control arm and receive the phone-based notifications only control branch of the app. Randomization will occur in a 1:1 ratio within each of the two groups (new-to-care and ART-non-adherent) separately, with an equal number of subjects in the intervention and control arms. During the 26-week intervention phase, intervention arm subjects will receive the daily adherence reminders they set up through Epic Allies with tailored feedback for encouragement and reinforcement. Intervention arm subjects will have 24-hour access to all features of Epic Allies. The control arm subjects will receive weekly phone-based notifications to encourage them to view educational information presented in the app. Subjects will attend study visits at Week 13 (during intervention phase), Week 26 (end of intervention phase), and Week 39 (post-intervention phase). In-depth qualitative app satisfaction interviews with a subset of intervention arm subjects will also be conducted to evaluate acceptability of the app and its potential to improve engagement in care, uptake of ART, and ART adherence. Outcome measures will include engagement in care, ART uptake, ART adherence, viral load (VL) change, and VL suppression. The in-depth qualitative app satisfaction interview will assess intervention impact, acceptability, and long-term sustainability.

Inclusion criteria

To be considered eligible for enrollment, an individual must meet all the criteria listed below.

• Ages 16 years and 0 days through 24 years and 364 days, inclusive, at the time of signed informed consent or assent with parental/legal guardian permission, if applicable;
• Assigned male sex at birth, is of any gender identity, and self-reports a desire to engage or is engaging in sex with men;
• Has documentation of a VL collected within the 12 weeks prior to the Baseline visit that is greater than the LLD for the assay used to test the specimen;
• Be either:

• New-to-care: Newly entered HIV medical care within the 12 months prior to the Baseline visit; or
• ART-non-adherent: First entered HIV medical care more than 12 months prior to the Baseline visit;
• Has reliable daily access to an Android- or iOS-based smartphone with a data plan;
• Is able to speak and read English;
• Is willing and able to provide signed informed consent or assent; and
• Parent or legal guardian is willing to provide permission, if applicable.

Exclusion criteria

To be considered eligible for enrollment, an individual must not meet any of the criteria listed below.

• Presence of active serious psychiatric symptoms (e.g., active hallucinations, thought disorder) that would impair the individual's ability to provide true informed consent/assent or complete the baseline CAPI survey*;
• Visibly distraught (e.g., suicidal, homicidal, exhibiting violent behavior) at the time of consent/assent or the baseline CAPI survey*;
• Intoxicated or under the influence of alcohol or other substances to such an extent that in the opinion of the study staff, the ability to give true informed/assent is impaired*; or
• At the time of the baseline CAPI survey, intoxicated or under the influence of alcohol or other substances to such an extent that in the opinion of the study staff, the subject's ability to understand and answer the questions may be impaired or negatively impact the integrity of the research data*.

• NOTE: If consent/assent is obtained prior to enrollment and the Baseline visit date, assessment for these exclusion criteria must be performed again prior to administration of the baseline CAPI survey. If any are present during the Baseline visit, the subject cannot be enrolled; do not administer the CAPI survey. Reassessment of eligibility and enrollment may take place at a later date per the discretion of the treating clinician.