Short communicationA novel mHealth application for improving HIV and Hepatitis C knowledge in individuals with opioid use disorder: A pilot study
Introduction
Rates of opioid use disorder (OUD) have reached epidemic proportions in the US (Birnbaum et al., 2011; Clausen et al., 2009; Rudd et al., 2016). Of particular concern is the disproportionate prevalence of human immunodeficiency virus (HIV) and Hepatitis C (HCV) among individuals with OUD. Untreated OUD has been associated with unprecedented recent outbreaks of HIV and HCV (CDC, 2015, 2016; Dunn et al., 2016; Wang et al., 2011). Infectious disease risks among individuals with OUD and other substance use disorders stems from engaging in risky drug use and sexual behaviors (e.g., sharing injection equipment, having unprotected sex, trading sex for drugs). Efforts to improve HIV and HCV knowledge in this population are critical for reducing the individual and societal consequences associated with infectious disease. Educational interventions are a widely-used approach and have been associated with improvements in HIV- and HCV-related knowledge (Arain et al., 2016), decreasing self-reported risk behaviors (Copenhaver et al., 2006; Meader et al., 2010), and improved utilization of HIV and HCV screening and treatment services (Lubega et al., 2013; Marinho et al., 2016). Despite this, several features have limited their widespread use. The interventions have often been delivered across multiple lengthy sessions and relied on delivery by trained peer, staff, or health care professionals (Shah and Abu-Amara, 2013). These factors can increase cost and time burdens associated with education delivery. Staff-delivered assessments and interventions may also be less appealing to some individuals due to potential concerns regarding confidentiality or perceived judgment around the sensitive behaviors being assessed.
The recent development of mobile health (mHealth) platforms may hold promise for overcoming this limitation. mHealth interventions use portable computerized devices to extend the reach of health care by permitting delivery of monitoring, education, point-of-care diagnostics and treatment beyond the confines of the medical office (Boyer et al., 2010). The limited studies to date examining the utility of mHealth approaches for improving HIV and HCV knowledge suggest this approach may be promising (Aronson et al., 2017; Catalani et al., 2013; Festinger et al., 2016; Niakan et al., 2017). We recently adapted a single-visit, therapist-delivered educational intervention, which was developed and shown by our group in prior studies to improve HIV and HCV knowledge in illicit drug abusers (Dunn et al., 2013; Heil et al., 2005; Herrmann et al., 2013), for automated delivery using an iPad platform. We report here on our initial examination of this novel mHealth application for improving HIV and HCV knowledge among individuals seeking but waitlisted for opioid agonist maintenance.
Section snippets
Parent study
The HIV + HCV educational intervention was delivered as part of a 12-week randomized trial investigating the initial efficacy of interim buprenorphine dosing for reducing illicit opioid use and other risk behaviors during delays to community treatment. To be eligible for the study, participants had to be >18 years old, meet Diagnostic and Statistical Manual criteria for OUD, provide an opioid-positive urine specimen, and be waitlisted for opioid agonist treatment. The study was approved by the
Participant characteristics
At study intake, 64% and 36% of participants reported heroin or prescription opioids as their primary opioid of abuse, respectively (see supplementary material). Fifty-six percent of participants endorsed the intravenous (IV) route as their primary route of opioid administration, 80% endorsed a lifetime history of IV drug use, and 40% reported a history of opioid overdose. Of those reporting a lifetime history of overdose, 89% had experienced multiple overdoses. Among participants with a
Discussion
There is a critical need to reduce infectious disease transmission among individuals with OUD. HIV and HCV risk among this sample of waitlisted adults with OUD was considerable with 80% of participants reporting a history of IV drug use, 56% identifying IV as their primary route, 30% having shared a needle or syringe and 56% reporting a history of unprotected sex. Participants’ baseline levels of HIV and HCV knowledge (69% and 65% accuracy, respectively) were generally consistent with prior
Funding
This study was supported by National Institutes of Health research (R34DA037385) and training (T32DA007242) grants. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Contributors
Authors SC Sigmon and TA Ochalek conceptualized and conducted the study. SH Heil and ST Higgins provided ongoing scientific consultation regarding the topic area. GJ Badger conducted study analyses. All authors have reviewed and contributed to the study manuscript and approve of the final article.
Conflict of interest
The authors have no conflicts to declare.
Acknowledgements
The authors would like to thank Andrew C. Meyer, PhD, Bryce Hruska, PhD, Jacob Pusey, BS, Shoshana Aronowitz, RN, Betsy Bahrenburg, RN, Megan Detweiler, RN, and Theresa Krainz, RN for assistance with the randomized trial.
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