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Qualitative results from a pilot study of an automated directly observed therapy intervention using artificial intelligence with conditional economic incentives among young adults with HIV
Wagner, D., Mancuso, N. P., Stoner, M., Smith, L., Ming, K., Patani, H., Sukhija-Cohen, A. C., Granados, Y., Napierala, S., & Saberi, P. (2025). Qualitative results from a pilot study of an automated directly observed therapy intervention using artificial intelligence with conditional economic incentives among young adults with HIV. AIDS and Behavior. https://doi.org/10.1007/s10461-025-04748-1
Digitally monitoring and supporting daily antiretroviral therapy (ART) is a promising strategy for enhanced adherence among young adults with HIV (YWH). We implemented an innovative mobile app-based intervention that included automated directly observed therapy (aDOT) using artificial intelligence, medication reminders, and conditional economic incentives (CEIs). This intervention used facial recognition to track and record YWH's daily ART adherence. CEIs were given based on daily app use. A pilot study of the aDOT + CEI app intervention was conducted among YWH ages 18-29 for 3 months. We recruited virally unsuppressed YWH from AIDS Healthcare Foundation clinics in California and Florida and conducted qualitative interviews with YWH and providers regarding the intervention's motivators, deterrents, and helpfulness. Thirteen YWH and 5 providers were interviewed. YWH found the CEIs supported their adherence; however, most YWH did not find the CEI amount sufficiently motivating. The primary motivator for consistent app use was to improve health, and the app reminders were most helpful in improving adherence. YWH desired more reassurance and explanation about app privacy features. Providers suggested incorporating the intervention into counseling for newly diagnosed patients and recommended the intervention to help facilitate viral suppression with oral ART for those interested in transitioning to long-acting injectable ART. YWH and providers found the intervention helpful in reminders to take ART and in tracking adherence. Refinements to the CEI amount may further enhance the intervention. Additional research is needed to test the efficacy of a refined aDOT + CEI intervention to improve viral suppression in a larger sample.El seguimiento digital y el apoyo a la terapia antirretroviral (TAR) diaria es una estrategia prometedora para mejorar la adherencia entre los adultos j & oacute;venes con VIH (YWH). Implementamos una innovadora intervenci & oacute;n basada en una aplicaci & oacute;n m & oacute;vil que incluy & oacute; terapia automatizada de observaci & oacute;n directa (aDOT) utilizando inteligencia artificial, recordatorios de medicamentos e incentivos econ & oacute;micos condicionales (CEI). Esta intervenci & oacute;n utiliz & oacute; el reconocimiento facial para rastrear y registrar la adherencia diaria al tratamiento antirretroviral de YWH. Los CEI se dieron en funci & oacute;n del uso diario de la aplicaci & oacute;n. Se llev & oacute; a cabo un estudio piloto de la intervenci & oacute;n de la aplicaci & oacute;n aDOT + CEI entre j & oacute;venes de 18 a 29 a & ntilde;os durante 3 meses. Reclutamos a YWH no suprimidos viralmente de las cl & iacute;nicas de AIDS Healthcare Foundation en California y Florida y realizamos entrevistas cualitativas con YWH y proveedores sobre los motivadores, los elementos disuasorios y la utilidad de la intervenci & oacute;n. Se entrevist & oacute; a trece YWH y 5 proveedores. YWH encontr & oacute; que los CEI apoyaban su adhesi & oacute;n; sin embargo, la mayor & iacute;a de los YWH no encontraron la cantidad de CEI lo suficientemente motivadora. El principal motivador para el uso constante de la aplicaci & oacute;n fue mejorar la salud, y los recordatorios de la aplicaci & oacute;n fueron m & aacute;s & uacute;tiles para mejorar la adherencia. YWH quer & iacute;a m & aacute;s tranquilidad y explicaciones sobre las funciones de privacidad de las aplicaciones. Los proveedores sugirieron incorporar la intervenci & oacute;n en el asesoramiento para los pacientes reci & eacute;n diagnosticados y recomendaron la intervenci & oacute;n para ayudar a facilitar la supresi & oacute;n viral con TAR oral para aquellos interesados en la transici & oacute;n a TAR inyectable de acci & oacute;n prolongada. YWH y los proveedores encontraron que la intervenci & oacute;n fue & uacute;til para recordar que se debe tomar el tratamiento antirretroviral y para hacer un seguimiento de la adherencia. Los refinamientos en el monto de la CEI pueden mejorar a & uacute;n m & aacute;s la intervenci & oacute;n. Se necesita investigaci & oacute;n adicional para probar la eficacia de una intervenci & oacute;n refinada de aDOT + CEI para mejorar la supresi & oacute;n viral en una muestra m & aacute;s grande.
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