scholarly journals Event-Level Association Between Daily Alcohol Use and Same-Day Nonadherence to Antiretroviral Therapy Among Young Men Who Have Sex With Men and Trans Women Living With HIV: Intensive Longitudinal Study

10.2196/22733 ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. e22733
Author(s):  
Caitlin Marie Turner ◽  
Dillon Trujillo ◽  
Victory Le ◽  
Erin C Wilson ◽  
Sean Arayasirikul
Keyword(s):  
Antiretroviral Therapy ◽  
Alcohol Use ◽  
San Francisco ◽  
Text Messaging ◽  
Hiv Care ◽  
Targeted Interventions ◽  
Young Msm ◽  
Trans Women ◽  
Sex With Men ◽  
Living With Hiv

Background Young trans women (TW) and men who have sex with men (MSM) are disproportionately impacted by HIV. Optimizing adherence to antiretroviral therapy (ART) is one mechanism by which public health experts aim to achieve favorable HIV health outcomes while reducing disease transmission. However, alcohol use is prevalent among young TW and MSM and threatens optimal adherence. In addition, the daily variations in alcohol use and ART adherence and their association with each other are poorly understood, warranting more appropriate methodological approaches, such as analysis of ecological momentary assessment (EMA) data. Objective The aim of this analysis is to characterize the association between daily alcohol use and same-day ART nonadherence captured by an EMA study of young MSM and TW living with HIV in San Francisco. Methods Young MSM and TW enrolled in the Health eNav digital HIV care navigation intervention were included in the analytic sample (N=113). Data on alcohol and ART use were collected by daily EMA surveys administered via text messaging and were analyzed over 30 days of follow-up. A multivariable mixed-effects logistic regression model adjusting for baseline sociodemographic characteristics was specified to investigate whether daily alcohol use was associated with same-day ART nonuse. Results Daily alcohol use was associated with higher same-day ART nonuse. On average, participants drank alcohol on 15.20 (SD 8.93) days and used ART on 15.19 (SD 10.16) days out of 30 days. Daily alcohol use was associated with 1.89 (95% CI 1.14-3.15) times the adjusted odds of same-day ART nonuse for each participant. Conclusions Results are consistent with other analyses of daily alcohol and ART use and underscore the importance of individually targeted interventions that are sensitive to each participant’s dynamic risk environment. International Registered Report Identifier (IRRID) RR2-10.2196/16406

scholarly journals Event-Level Association Between Daily Alcohol Use and Same-Day Nonadherence to Antiretroviral Therapy Among Young Men Who Have Sex With Men and Trans Women Living With HIV: Intensive Longitudinal Study (Preprint)

2020 ◽  
Author(s):  
Caitlin Marie Turner ◽  
Dillon Trujillo ◽  
Victory Le ◽  
Erin C Wilson ◽  
Sean Arayasirikul
Keyword(s):  
Antiretroviral Therapy ◽  
Alcohol Use ◽  
San Francisco ◽  
Text Messaging ◽  
Hiv Care ◽  
Targeted Interventions ◽  
Young Msm ◽  
Trans Women ◽  
Sex With Men ◽  
Living With Hiv

BACKGROUND Young trans women (TW) and men who have sex with men (MSM) are disproportionately impacted by HIV. Optimizing adherence to antiretroviral therapy (ART) is one mechanism by which public health experts aim to achieve favorable HIV health outcomes while reducing disease transmission. However, alcohol use is prevalent among young TW and MSM and threatens optimal adherence. In addition, the daily variations in alcohol use and ART adherence and their association with each other are poorly understood, warranting more appropriate methodological approaches, such as analysis of ecological momentary assessment (EMA) data. OBJECTIVE The aim of this analysis is to characterize the association between daily alcohol use and same-day ART nonadherence captured by an EMA study of young MSM and TW living with HIV in San Francisco. METHODS Young MSM and TW enrolled in the Health eNav digital HIV care navigation intervention were included in the analytic sample (N=113). Data on alcohol and ART use were collected by daily EMA surveys administered via text messaging and were analyzed over 30 days of follow-up. A multivariable mixed-effects logistic regression model adjusting for baseline sociodemographic characteristics was specified to investigate whether daily alcohol use was associated with same-day ART nonuse. RESULTS Daily alcohol use was associated with higher same-day ART nonuse. On average, participants drank alcohol on 15.20 (SD 8.93) days and used ART on 15.19 (SD 10.16) days out of 30 days. Daily alcohol use was associated with 1.89 (95% CI 1.14-3.15) times the adjusted odds of same-day ART nonuse for each participant. CONCLUSIONS Results are consistent with other analyses of daily alcohol and ART use and underscore the importance of individually targeted interventions that are sensitive to each participant’s dynamic risk environment. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT RR2-10.2196/16406

scholarly journals Psychosocial Determinants of HIV Stigma among Men Who Have Sex with Men in San Francisco, California

2021 ◽  
Vol 18 (15) ◽  
pp. 8031
Author(s):  
Dharma N. Bhatta ◽  
Jennifer Hecht ◽  
Shelley N. Facente
Keyword(s):  
Mental Health ◽  
San Francisco ◽  
Age Groups ◽  
Hiv Stigma ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Adjusted Risk ◽  
Sex With Men ◽  
Living With Hiv

Background: Stigma and discrimination are major challenges faced by people living with HIV (PLWH), and stigma continues to be prevalent among PLWH. We conducted a cross-sectional study of 584 men who have sex with men (MSM) living with HIV between July 2018 and December 2020, designed to better understand which demographic and behavioral characteristics of MSM living with HIV in San Francisco, California are associated with experience of stigma, so that programs and initiatives can be tailored appropriately to minimize HIV stigma’s impacts. Methods: This analysis was conducted with data from San Francisco AIDS Foundation (SFAF) encompassing services from multiple different locations in San Francisco. Data about the level of HIV-related stigma experienced were collected through a single question incorporated into programmatic data collection forms at SFAF as part of the client record stored in SFAF’s electronic health record. We performed linear regression to determine the associations between self-reported experiences of HIV stigma and other characteristics among MSM living with HIV. Results: HIV stigma was low overall among MSM living with HIV who are actively engaged in HIV care in San Francisco; however, it was significantly higher for the age groups of 13–29 years (adjusted risk difference (ARD): 0.251, 95% CI: 0.012, 0.489) and 30–49 years (ARD: 0.205, 95% CI: 0.042, 0.367) when compared to the age group of 50 years and older, as well as people who were homeless (ARD: 0.844, 95% CI: 0.120, 1.568), unstably housed (ARD: 0.326, 95% CI: 0.109, 0.543) and/or having mental health concerns (ARD: 0.309, 95% CI: 0.075, 0.544), controlling for race, injection history, and viral load. Conclusions: These findings highlight an opportunity to develop culturally, socially, and racially appropriate interventions to reduce HIV stigma among MSM living with HIV, particularly for younger men and those struggling with housing stability and/or mental health.

scholarly journals Efficacy and Impact of Digital HIV Care Navigation in Young People Living With HIV in San Francisco, California: Prospective Study (Preprint)

2020 ◽  
Author(s):  
Sean Arayasirikul ◽  
Caitlin Turner ◽  
Dillon Trujillo ◽  
Victory Le ◽  
Erin C Wilson
Keyword(s):  
Primary Care ◽  
Young People ◽  
San Francisco ◽  
Text Messaging ◽  
Hiv Care ◽  
Computer Assisted ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Living With Hiv

BACKGROUND Young people are disproportionately impacted by HIV infection and exhibit poor HIV care continuum outcomes. Mobile health (mHealth) interventions are promising approaches to meet the unique needs of young people living with HIV. Youth-focused interventions are needed to improve HIV care continuum outcomes. OBJECTIVE This study assessed the preliminary efficacy and impact of a digital HIV care navigation intervention among young people living with HIV in San Francisco. Health electronic navigation (eNavigation or eNav) is a 6-month, text message–based, digital HIV care navigation intervention, in which young people living with HIV are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. METHODS This study had a single-arm, prospective, pre-post design. The analysis included 120 young men who have sex with men or transwomen living with HIV aged between 18 and 34 years. We analyzed self-reported sociobehavioral information pre- and postintervention at baseline and 6 months, which was collected using computer-assisted self-interviewing surveys. We characterized the sample and built generalized estimating equation (GEE) models to assess differences in HIV care continuum outcomes at baseline and 6 months. RESULTS The characteristics according to the intervention completion status were not different from those of the overall sample. The mean age of the participants was 27.75 years (SD 4.07). Most participants (103/120, 85.8%) identified as men, and the sample was racially/ethnically diverse. At baseline, majority (99/120, 82.5%) of the participants had recently received primary HIV care, yet this was more likely in those who completed the intervention than in those who did not (54/60, 90% vs 45/60, 75%; χ<sup>2</sup><sub>1</sub>=4.68, <i>P</i>=.03). More than half of the sample reported taking antiretroviral therapy (92/120, 76.7%) and having an undetectable viral load (65/120, 54.2%). The 6-month follow-up surveys were completed by 73.3% (88/120) of participants, and these participants were not characteristically different from the overall sample at baseline. GEE models indicated that participants had increased odds of viral suppression at 6 months as compared with baseline. No relevant additive or multiplicative interactions were noted on comparing outcome effects over time according to intervention completion. CONCLUSIONS Digital HIV care navigation fills a critical gap in public health and HIV care systems, making these systems more responsive and accountable to the needs of the most vulnerable individuals. Our intervention bridges the time between primary care visits with interactive, tailored, personalized, and peer-delivered social support; information; and motivational interviewing to scaffold behavioral change. This study is part of the next wave of system-informed mHealth intervention research that will offer potentially disruptive solutions to traditional in-person delivered interventions and improve the health of the most vulnerable individuals. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16406

scholarly journals WYZ: Results of a pilot study of a mobile health application for engagement in care and antiretroviral therapy adherence among youth and young adults living with HIV (Preprint)

2020 ◽  
Author(s):  
Parya Saberi ◽  
Nadra E. Lisha ◽  
Xavier A. Erguera ◽  
Estie S. Hudes ◽  
Mallory O. Johnson ◽  
...  
Keyword(s):  
Young Adults ◽  
Antiretroviral Therapy ◽  
San Francisco ◽  
Mobile Health ◽  
Pilot Trial ◽  
Hiv Care ◽  
Art Adherence ◽  
Engagement In Care ◽  
Youth And Young Adults ◽  
Living With Hiv

BACKGROUND Youth are globally recognized as being vulnerable to HIV. Younger age has been correlated with worse health outcomes. Mobile health (mHealth) delivered interventions have the potential to meet youth where they are, using a device they already access. OBJECTIVE Using pre-defined benchmarks, we sought to evaluate the feasibility and acceptability of WYZ, an mHealth application, for improved engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV (YLWH). WYZ was designed and developed with input from YLWH using a Human-Centered Design approach and based on the Information, Motivation, Behavioral Skills framework to address common barriers to care and ART adherence among YLWH. METHODS We recruited YLWH (18–29 years old) in the San Francisco Bay Area to take part in a six-month pilot trial. Their participation included completing a baseline and exit survey and participating in seven phone check-ins about their use of WYZ. RESULTS YLWH (N= 79) reported high levels of feasibility and acceptability with WYZ use. We met pre-defined benchmarks for recruitment, mean log-ins per week, tracking ART adherence, posting chat topics, and app crashes reported. Ease of app download, install, and set up, as well as comfort with security, privacy, and anonymity were highly rated. Additionally, participants reported high satisfaction for a research project that was remotely conducted. Participants used the app for shorter timeframes compared to the pre-defined benchmarks. CONCLUSIONS We noted high feasibility and acceptability with WYZ. Further research to examine the efficacy of WYZ will enable YLWH and their providers to make informed decisions when using, recommending, and prescribing it for improved engagement in HIV care and ART adherence. CLINICALTRIAL NCT03587857

scholarly journals Digital HIV Care Navigation for Young People Living With HIV in San Francisco, California: Feasibility and Acceptability Study

10.2196/16838 ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. e16838 ◽  
Author(s):  
Dillon Trujillo ◽  
Caitlin Turner ◽  
Victory Le ◽  
Erin C Wilson ◽  
Sean Arayasirikul
Keyword(s):  
Young People ◽  
San Francisco ◽  
Text Messaging ◽  
Text Message ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Engagement In Hiv Care ◽  
Living With Hiv ◽  
High Engagement

Background HIV continues to be a public health challenge adversely affecting youth and young adults, as they are the fastest-growing group of new HIV infections in the United States and the group with the poorest health outcomes among those living with HIV. HIV prevention science has turned to mobile health as a novel approach to reach and engage young people living with HIV (YPLWH) experiencing barriers to HIV care. Objective This study aimed to assess the feasibility and acceptability of a text message–based HIV care navigation intervention for YPLWH in San Francisco. Health eNavigation is a 6-month text message–based HIV care navigation where YPLWH are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. Digital HIV care navigation included delivery of the following through SMS text messaging: (1) HIV care navigation, (2) health promotion and education, (3) motivational interviewing, and (4) social support. Methods We evaluated the feasibility and acceptability of a text message–based HIV care navigation intervention among YPLWH. We assessed feasibility using quantitative data for the overall sample (N=120) to describe participant text messaging activity during the intervention. Acceptability was assessed through semistructured, in-depth interviews with a subsample of 16 participants 12 months after enrollment. Interviews were audio-recorded, transcribed, and analyzed using grounded theory. Results Overall, the text message–based HIV care navigation intervention was feasible and acceptable. The majority of participants exhibited medium or high levels of engagement (50/120 [41.7%] and 26/120 [21.7%], respectively). Of the majority of participants who were newly diagnosed with HIV, 63% (24/38) had medium to high engagement. Similarly, among those who were not newly diagnosed, 63% (52/82) had medium to high engagement. The majority of participants found that the intervention added value to their lives and improved their engagement in HIV care, medication adherence, and viral suppression. Conclusions Text message–based HIV care navigation is a potentially powerful tool that may help bridge the gaps for linkage and retention and improve overall engagement in HIV care for many YPLWH. Our results indicate that participation in text message–based HIV care navigation is both feasible and acceptable across pervasive structural barriers that would otherwise hinder intervention engagement.

scholarly journals Text Messaging to Improve Linkage, Retention, and Health Outcomes among HIV-positive Young Transgender Women: Protocol for a Randomized Controlled Trial (Text Me, Girl!) (Preprint)

2018 ◽  
Author(s):  
Cathy J. Reback ◽  
Jesse B. Fletcher ◽  
Anne E. Fehrenbacher ◽  
Kimberly Kisler
Keyword(s):  
Health Outcomes ◽  
Text Messaging ◽  
Text Message ◽  
Transgender Women ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Intervention Delivery ◽  
Trans Women ◽  
Living With Hiv

BACKGROUND Many transgender women in the U.S. experience numerous cofactors for HIV acquisition and transmission, including increased rates of homelessness, alcohol and drug use, high rates of sex work, as well as non-prescribed hormone injections and/or medically unsupervised soft-tissue filler injections, HIV risk factors specific to this population. In addition, trans women face discrimination and social/economic marginalization more intense and deleterious than that experienced by lesbian, gay, or bisexual individuals, further worsening health outcomes. Although little research has been done specifically on young trans women under the age of 35 years old, existing evidence suggests even further elevated rates of homelessness, substance use, and engagement in HIV transmission risk behaviors relative to their older trans women and non-trans young adult counterparts. Young trans women living with HIV experience a range of barriers that challenge their ability to be successfully linked and retained in HIV care. OBJECTIVE Text Me, Girl! was a randomized controlled trial to assess the impact of a 90-day, theory-based, transgender-specific, text-messaging intervention designed to improve HIV-related health outcomes along the HIV Care Continuum among young (18 to 34 years) transgender women (N=130) living with HIV/AIDS. METHODS Participants were randomized into either Group A) Immediate Text Message Intervention Delivery (ID: n=61); or, Group B) Delayed Text Message Intervention Delivery (DD: n=69) whereby participants were delivered the text-messaging intervention after a 90-day delay period. Over the course of the 90-day intervention, participants received 270 theory-based text messages that were targeted, tailored, and personalized specifically for young transgender women living with HIV. Participants received three messages per day in real-time within a 10-hour gradual and automated delivery system. The text-message content was scripted along the HIV Care Continuum and based on Social Support Theory, Social Cognitive Theory, and Health Belief Model. The desired outcome of Text Me, Girl! was virological suppression. RESULTS Recruitment began on November 18, 2016 and the first participant was enrolled on December 16, 2016; enrollment closed on May 31, 2018. Intervention delivery ended on November 30, 2018, and follow-up evaluations concluded on August 31, 2019. Primary outcome analyses began immediately following the conclusion of the follow-up evaluations. CONCLUSIONS Text messaging is the ideal communication platform for engaging young trans women in HIV care because it is easily accessible, private, portable, and inexpensive. Text Me, Girl! aimed to improve HIV Care Continuum outcomes among young trans women by providing culturally responsive text messages to promote linkage, retention, and adherence with the ultimate goal of achieving viral suppression. The Text Me, Girl! text message library is readily scalable and can be adapted for other hard-to-reach populations.

scholarly journals Social Inequity and Structural Barriers to Completion of Ecological Momentary Assessments for Young Men Who Have Sex With Men and Trans Women Living With HIV in San Francisco (Preprint)

2018 ◽  
Author(s):  
Caitlin M Turner ◽  
Sean Arayasirikul ◽  
Dillon Trujillo ◽  
Victory Lê ◽  
Erin C Wilson
Keyword(s):  
San Francisco ◽  
Basic Needs ◽  
Young Men ◽  
Structural Barriers ◽  
Social Inequity ◽  
Young Msm ◽  
Sex With Men ◽  
Ecological Momentary ◽  
Living With Hiv

BACKGROUND Ecological momentary assessments (EMAs) administered via text messaging facilitate real-time data collection. With widespread cell phone access, EMAs are becoming more available to even the most disenfranchised communities, such as those living with HIV. However, structural barriers disproportionately burden young men who have sex with men (MSM) and trans women (TW) living with HIV and threaten participation in HIV research. OBJECTIVE We aim to identify structural barriers to completing EMA text surveys nested within a digital HIV care intervention for young MSM and TW living with HIV in San Francisco. METHODS A total of 10,800 EMA text messages were delivered daily over 90 days to 120 participants enrolled in the Health eNav intervention (2017-2018) at the San Francisco Department of Public Health. EMA surveys inquired about participants’ daily affect, sexual behaviors, substance use, and treatment adherence. Survey completion was calculated after 30, 60, and 90 days of follow-up. We described characteristics of nonstarters (those who provided less than four complete responses to the first seven EMA surveys) and analyzed structural correlates of days to first weeklong or more EMA survey noncompletion using multivariable Cox proportional hazards regression. Qualitative interviews were used to evaluate the acceptability of EMA surveys. RESULTS Participants completed 4384 of 10,800 (40.59%) EMA surveys. Completion of 70% or more of EMA surveys was attained by 56 of 120 participants (46.7%) at 30 days of follow-up, 40/120 (33.3%) at 60 days of follow-up, and 30/120 (25.0%) by the end of the 90-day study period. Twenty-eight participants (23.3%) were identified as nonstarters, and were more likely to be recently incarcerated (prevalence ratio [PR] 2.3, 95% CI 1.3-4.4), forego basic needs for HIV medications (PR 2.4, 95% CI 1.3-4.5), and be diagnosed with HIV in the last year (PR 2.2, 95% CI 1.1-4.1). Adjusting for nonstarters, young MSM and TW living in temporary/transitional housing (adjusted hazard ratio [aHR] 1.8, 95% CI 1.1-3.0), foregoing HIV medications to afford basic needs (aHR 1.7, 95% CI 1.1-2.7), and having less than a college education (aHR 3.5, 95% CI 1.4-9.0) had greater hazard of weeklong or more EMA survey noncompletion. Overall, there was high acceptability of the EMA surveys. CONCLUSIONS Although access to and use of technology is increasingly ubiquitous, this analysis demonstrates persisting gaps in EMA completion by socioeconomic factors such as incarceration, education level, housing, and competing needs for young MSM and TW living with HIV in San Francisco. Moreover, those recently diagnosed with HIV were more likely to experience an immediate drop-off in completing EMA surveys. EMAs are feasible for individuals not experiencing social inequity and structural barriers. HIV prevention technologies addressing these barriers and leveraging similar methodology may prove effective for young MSM and TW living with HIV.

scholarly journals Addressing HIV care, mental health and substance use among youth and young adults in the Bay Area: description of an intervention to improve information, motivation and behavioural skills

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042713
Author(s):  
Caravella McCuistian ◽  
Angie R Wootton ◽  
Dominique Legnitto-Packard ◽  
Valerie A. Gruber ◽  
Carol Dawson-Rose ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Young Adults ◽  
San Francisco ◽  
Text Messaging ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Bay Area ◽  
Youth Living With Hiv ◽  
Living With Hiv

ObjectiveYouth represent a population disparately impacted by the HIV epidemic. With most new HIV diagnoses occurring among adolescents and young adults, novel approaches to address this disparity are necessary. The objective of the current study was to describe the Youth to Telehealth and Text to Improve Engagement in Care (Y2TEC) intervention, which aims to fill this gap. The Y2TEC intervention (trial registration NCT03681145) offers an innovative approach to improve HIV treatment engagement among youth living with HIV by focusing on treatment barriers related to mental health and substance use. This allows for a holistic approach to providing culturally informed intervention strategies for this population.Participants and settingThe Y2TEC intervention was developed for youth with HIV in the large metropolitan area of the San Francisco Bay Area. The Y2TEC intervention was developed based on formative interdisciplinary research and is grounded in the information–motivation–behavioural skills model.ResultsThe intervention includes 12 sessions each lasting 20–30 minutes, which are delivered through videoconferencing and accompanying bidirectional text messaging. The intervention sessions are individualised, with session dosage in each major content area determined by participant’s level of acuity.ConclusionsThe Y2TEC intervention is well positioned to help decrease HIV-related disparities in youth living with HIV through its innovative use of video-counselling technologies and an integrated focus on HIV, mental health and substance use.

Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression among Young People Living with HIV (Preprint)

2021 ◽  
Author(s):  
Sean Arayasirikul ◽  
Caitlin M Turner ◽  
Dillon Trujillo ◽  
Jarett Maycott ◽  
Erin C Wilson
Keyword(s):  
Mental Health ◽  
Viral Load ◽  
Young People ◽  
Text Messaging ◽  
Viral Suppression ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Social Inequities ◽  
Sex With Men ◽  
Living With Hiv

BACKGROUND The HIV epidemic has revealed considerable disparities in health among sexual and gender minorities of color within the Unites States, disproportionately affecting men who have sex with men (MSM) and trans women. Social inequities further disadvantage those with intersectional identities through homophobia, anti-trans discrimination, and racism, shaping not only those at-risk for HIV infection, but also HIV prevention and care outcomes. Digital interventions have great potential to address barriers and improve HIV care among MSM and trans women; however, efficacy of digital HIV care interventions vary and need further examination. OBJECTIVE This study assessed 12-month efficacy of a 6-month digital HIV care navigation intervention among young people living with HIV (YPLWH) in San Francisco We examined dose-response relationships between intervention exposure (e.g. text messaging) and viral suppression and mental health. Health electronic navigation (eNavigation or eNav) is a 6-month, text message-based, digital HIV care navigation intervention, in which YPLWH are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. METHODS This study had a single-arm, prospective, pre-post design. Eligibility criteria for the study included: identifying as a man who has sex with men or a trans woman; being between the ages of 18 and 34 years; and being newly diagnosed with HIV or not being engaged/retained in HIV care or having a detectable viral load. We assessed and analyzed sociodemographic, intervention exposure, and HIV care and mental health outcome data for participants who completed the 6-month Health eNav intervention. We assessed all outcomes using generalized estimating equations (GEE) to account for within-subjects correlation, and marginal effects of texting engagement on all outcomes were calculated over the entire 12-month study period. Finally, we specified an interaction between texting engagement and time to evaluate the effects of texting engagement on outcomes. RESULTS Over the entire 12-month study period showed that every one-text increase in engagement was associated with an increased odds of undetectable viral load (adjusted odds ratio, aOR = 1.01, 95% CI = 1.00 – 1.02, p = 0.03). We found that mean negative mental health experiences decreased significantly at 12 months compared to baseline for every one-text increase in engagement (coefficient on interaction term: 0.97, 95%CI = 0.96-0.99, p < 0.01). CONCLUSIONS Digital care navigation interventions like Health eNavigation may be a critical component in the health delivery service system as the digital safety net for those whose social vulnerability is exacerbated in times of crisis, disasters, or global pandemics due to multiple social inequities. We found that increased engagement in a digital HIV care navigation intervention helped to improve viral suppression and mental health – intersecting, co-morbid conditions – 6-months after the intervention concluded. Digital care navigation may be a promising, effective, sustainable, and scalable intervention. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16406

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