Interactive Voice Response Self-Monitoring (IVR-SM) for Rural Substance Users with HIV

Evaluations

• Interactive voice response self-monitoring to assess risk behaviors in rural substance users living with HIV/AIDs.

  Tucker JA, Blum ER, Xie L, Roth DL, & Simpson CA. AIDS and Behavior. 2012. 16: 432-440. PMCID: PMC3264810.

  Summary: Because of the paucity of knowledge and programs for rural patients with HIV, the authors tested an interactive voice response self-monitoring program (IRV-SM) to increase reporting and reduce engagement in HIV risk behaviors. HIV-positive patients receiving care at a rural clinic were screened for alcohol use, illicit drug use, and sexual activity with a partner. Patients reporting substance use and sexual activity were eligible for participation in the study (n=54). All participants had access to the daily IVR-SM calls for either 4 or 10 weeks. To analyze the data reported in the daily IVR calls, participants were divided into several groups. The authors compared participants who used the IVR system (“callers”), to those who never used the system (“non-callers”). Compared to non-callers, callers were more likely to have received medical HIV treatment for a long duration, identify as homosexual, and be younger. Additionally, participants were grouped according to the frequency of calls. Participants who completed more than 70% of daily calls were considered “frequent”, while participants who completed fewer calls were considered “infrequent”. Frequent callers were significantly more likely than infrequent callers to report diminished social support. Overall, IVR-SM calls were completed on 50% of study days. Participants completing more IVR-SM calls reported greater decreases in risky sexual activity and drug use. The odds of reporting risky sexual activity decreased by 3% per IVR-SM call, while the odds of reporting drug use decreased by 1% per IVR-SM call. Alcohol use was unrelated to IVR-SM calls.

  Take Away: This pilot demonstrated that completing daily interactive voice response self-monitoring calls is associated with decreased illicit drug use and risky sexual activity for rural patients with HIV.

• Agreement between prospective interactive voice response telephone reporting and structured recall reports of risk behaviors in rural substance users living with HIV/AIDs.

  Simpson CA, Xie L, Blum ER, & Tucker JA. Psychology of Addictive Behaviors. 2011. 25(1): 185-190. PMCID: PMC4082985.

  Summary: To evaluate the data quality of the interactive voice response self-monitoring system (IVR-SM) the authors compared the data from IVR calls reported in the Tucker (2012) study to data elicited from a structured recall report. Self-reported data from daily IVR-SM calls was compared to data from the Timeline Follow Back (TLFB) assessment for all 54 participants. The TLFB is a structured recall report that participants completed monthly. On both the TLFB and the IVR-SM calls, participants were asked about their daily alcohol use, drug use, money expenditures on substances, and sexual activity. There was excellent agreement between the TLFB and the IVR-SM reports on days of alcohol use and sexual activity. IVR-SM and TLFB data reports were in agreement on alcohol use for 79% of days, and sexual practices for 77% of days. TLFB and IVR-SM reports were not in good agreement on days of drug use or money spent on drugs or alcohol. Daily reports of drug use and financial expenditures were significantly higher than the TLFB reports.

  Take Away: Self-reported data collected using daily IVR-SM calls or monthly TLFB assessments elicit equivalent information on alcohol use and sexual activity. Daily IVR-SM calls may elicit more complete information on financial expenditures and drug use.

• Utility of interactive voice response system to assess antiretroviral pharmacotherapy adherence among substance users living with HIV/AIDS in the rural south.

  Tucker JA, Simpson CA, Huang J, Roth DL, & Stewart KE. AIDS Patient Care and STDs. 2013. 27(5): 280-286. PMCID: PMC3651686.

  Summary: This study analyzed the medication adherence data collected during the Tucker (2012) study of an interactive voice response self-monitoring system (IVR-SM) for patients with HIV. The authors were interested in examining characteristics of study participants related to HIV medication adherence. The authors also examined feasibility of using weekly questions about medication adherence versus daily questions. In this analysis, only participants calling the IVR-SM program (n=44) were included in the analysis. Daily reports of medication adherence were compared to questions asking about medication adherence in the past 4 or 7 days. Results showed that 68% of participants reported being adherent to medications during at least 95% of days. Patients who were not adherent to medications were more likely to be using substances at baseline, to have received HIV medical care for a long duration, and to be non-adherent to the daily IVR-SM calls. There were no significant differences in reports of medication adherence when comparing questions asking participants to recall the past day, 4 days, or 7 days. Although participants reported greater medication adherence in the 7-day recall question, this difference lacked statistical significance.

  Take Away: Several patient characteristics were related to increased risk for medication non-adherence, including substance use and receiving HIV medical care for an extended duration. Patient recall for past week medication adherence appears to be accurate, when compared to daily recall.