Brief Description: Connect4Care (C4C) addresses impediments to HIV care engagement through a motivational, informative 6-domain text messaging intervention.
Further Descriptive Information: C4C offered a theory-based, bidirectional (send and receive) text messaging intervention to promote care engagement in disadvantaged individuals with high-risk HIV viremia and care disengagement. The National Institute on Drug Abuse (NIDA) funded C4C as part of Seek, Test, Treat Retain (STTR), a research initiative to explore the efficacy of an integrative text messaging intervention to promote HIV care engagement in vulnerable populations. Researchers based C4C on 5 behavioral models (Behavioral Model for Vulnerable Populations, Information, Motivation, and Behavior Skill, Health Care Empowerment, revised Stress and Coping Theory) and conducted 3 focus groups with clinic social workers and clinic patients to further inform intervention message content. C4C provided intervention text messages to target 6 domains of behavior change (improve sense of social support, ameliorate negative affect, bolster positive affect and coping, foster empowerment, support healthy behaviors, and emphasize the value of ART (Antiretroviral Therapy) adherence and persistence). C4C sent intervention text messages 3 times per-week at a user-specified time via an automated platform. To elicit user response, intervention text messages used 1 of 3 response approaches: Type 1: no response requested, Type 2: asked if user found text message helpful, or Type 3: asked if user wanted more information (sent via follow-up text). Each domain featured intervention text messages that requested each of the 3 response types.
Retention in Treatment
Young Adults (18-30)
A randomized controlled trial of a text messaging intervention to promote virologic suppression and retention in care in an urban safety-net HIV clinic: The Connect4Care (C4C) trial
Summary: Researchers recruited 230 adults with an HIV viral load >200 copies/mL (100%), a history of poor treatment retention (75%), new to clinic (14%), or a recent HIV diagnosis (11%) from a San Francisco HIV clinic to participate in a 12-month randomized controlled trial of the effect of Connect4Care (C4C) on virologic suppression and retention in care. All participants spoke English and owned a cell phone (or obtained one through study referral). Pre-randomization, participants completed a baseline survey through audio computer-assisted self-interviewing (ACASI) that included quality-of-life, technology use, ART adherence, and sexual risk behavior. Almost half of the participants had been homeless in the past 6 months (48.0%). The active control received standard care, text message appointment reminders, and once-per-month check-in text messages that requested replies. Intervention participants received standard care, text message appointment reminders, and C4C text messages 3 times per week. All participants completed repeat surveys and viral load assessments at 6 and 12 months. At 12 months, intervention and control participants did not exhibit significant differences in virologic suppression (<200 copies/mL: 50.0% intervention, 47.9% control) or care retention (appointment attendance: 63.5% intervention, 68.2% control). Text messaging response rates may allow providers to predict patient engagement and HIV outcomes; researchers observed a positive correlation between the number of replies a participant sent and positive health outcomes (independent of study arm).
Take Away: At 12 months, C4C did not appear to have a significant effect on virologic suppression or retention in care in disadvantaged individuals with HIV infection.