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Posted on Jun 3, 2014 in Conference | 0 comments

Socially Optimized Learning in Virtual Environments (SOLVE): Developing, Evaluating, and Disseminating A Game HIV Prevention Intervention Nationally Over the Web

Lynn C. Miller, PhD1, John L. Christensen2, Paul Robert Appleby3, Stephen John Read3, Stacy Marsella3, Charisse Corsbie-Massay4, Carlos Godoy3, Mei Si5, Janeane Anderson3, David Jeong3, Mina Park3

1Professor, USC Annenberg School for Communication and Journalism & Department of Psychology; 2University of Connecticut; 3University of Southern California; 4Syracuse University; 5Rensselaer Polytechnic Institute

Journal MTM 3:1S:4, 2014

DOI: 10.7309/jmtm.3.1S.2


Young men (18–24) who have sex with men (YMSM) are at high risk for contracting HIV. Most existing HIV prevention interventions focus on changing intervening cognitive and deliberative processes or outcomes (e.g., beliefs, norms, self-efficacy, intentions) to change behavior. Many MSM, however, guided by contextual cues in emotionally arousing scenarios, make more automatic risky decisions they later regret. One emotion in a sexual narrative that might precipitate more automatic risky choices for young MSM may be shame (e.g., in one’s sexual desires). But, HIV prevention interventions are not designed to reduce MSM’s shame. SOLVE (Socially Optimized Learning in Virtual Environments), as demonstrated by an NIAID-funded randomized control trial, used a sex-positive game to reduce MSM’s shame, increase traditional immediate cognitive outcomes, and reduce unprotected anal intercourse for young Black, Latino, and White MSM (18–24) over 3 months. Could interactive interventions be delivered more broadly over the web? In prior CHRP funded work, a SOLVE interactive video (IAV) intervention was streamed over the web throughout California. However, an IAV approach limits the amount of user interaction, risk challenges users receive, and intervention tailoring to MSM’s decisions. This is addressed using a nationally deliverable 3D animated intelligent agents/interactive digital storytelling game in UNITY. MSM design their own characters, make choices for them on dates and sexual interactions, and are scaffolded by the user character’s virtual future self (participant’s older chosen self-character) to enhance self-regulation when risky. The NIMH-funded SOLVE-IT game development process for young MSM is discussed. Preliminary results from a 6-month randomized controlled trial conducted nationally, over the web, are promising.

*A similar abstract was published in a previous version of your journal.

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Posted on Jun 3, 2014 in Conference | 0 comments

Innovative Use of Technology for HIV Prevention and Care: Evidence, Challenges and the Way Forward

Sean Young, PhD, MS1, Jason Chiu, MS1

1Department of Family Medicine, University of California, Los Angeles

Journal MTM 3:1S:1–3, 2014

DOI: 10.7309/jmtm.3.1S.1


Use of mobile technologies for HIV prevention and care is no longer a promise, but a reality. From 2006 to 2009, a simple search of technology-related HIV studies yielded 1,147 results on PubMed and 274 results on PsycINFO. The number of technology-related HIV studies grew substantially in the next four years, as from 2010 to 2013 there were 1629 on PubMed and 407 studies on PsycINFO. These findings suggest a surge of interest in the field of technology use in HIV prevention and care research.

In response to this growth, the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) at the University of California, Los Angeles (UCLA) hosted the “Innovative Use of Technology for HIV Prevention and Care: Evidence, Challenges and the Way Forward” conference on January 23rd, 2014. Bringing together interdisciplinary researchers, community practitioners, clinicians, policy makers, technologists, and representatives from governmental and funding agencies, the conference sought to establish a collaborative framework for individuals to share their knowledge and experience in technology-based HIV prevention and care with each other.

Although the conference included information on different types of technologies, there was a particular emphasis on the role of mobile technology in HIV prevention and care. Popular mobile technologies are typically described as belonging to one or more the following categories: 1) cell phones, 2) native and cloud-based applications, 3) social media, and 4) mobile websites. Individuals differ in the way they use mobile technologies to communicate with each other, making it important to study the various ways in which mobile technologies can be used for HIV prevention and care. For example, cell phones facilitate multiple forms of communication, such as phone calls, short message services (SMS)/texts, and multimedia messaging services (e.g. video and picture texts)1. In the U.S., Youth (ages 18 to 29) communicate with each other predominately through SMS2, and recent HIV interventions targeting youth have utilized SMS to reduce substance use and increase HIV testing3,4.

The recent explosion in the use of social media can have a tremendous impact on HIV research, because these technologies can serve as platforms not only to reach a large number of at risk individuals but also to gather data on the behaviors of these individuals. Social media is defined as technologies, platforms, and services that enable individuals to engage in communication from one-to-one, one-to-many, and many-to-many5. In 2013, 73% of adults and 80% of teens used some form of social media6,7. There are many different types of social media, including 1) social networking sites (e.g. Facebook and MySpace), 2) blogs (e.g. Word Press or Tumblr), 3) microblogs of real-time communication (e.g. Twitter), 4) forum/bulletin boards (e.g. WebMD and Yahoo Answers), 5) social games (e.g. FarmVille and Mafia Wars), 6) media sharing (e.g. YouTube and Instagram), and 7) geosocial networking (e.g. Grindr and Jack’d). There exist different patterns of social media use based on socioeconomic, regional, and language factors, and before incorporating these technologies, researchers should understand these trends and how they impact HIV risk. For example, in the U.S., racial/ethnic (African Americans and Latinos) and sexual (e.g. gay and bisexual) minority individuals were found to be the most avid social media users8,9. Moreover, many African American and Latino men who have sex with men (MSM) have also used online social networks/geosocial networking apps to meet sexual partners to avoid potential stigma10,11. Taking into account information on patterns of social media use is important in learning how to craft HIV interventions and studies using social media among at-risk groups.

This conference served as an opportunity to introduce individuals to the latest mobile and social media technologies, and demonstrate research on how technologies can be used to study and address HIV among at-risk communities, along with a focus on the ethical and business-related issues associated with these approaches. The objectives of the conference were: 1) to present the most recent research findings and trends in HIV/AIDS and technology, 2) to increase the capacity of participants to develop, to implement, and to evaluate effective and evidence-based HIV/AIDS interventions with technology in clinical, research and community settings, and 3) to bring together researchers, clinicians, and technologists and to foster interdisciplinary collaborations on innovative way to improve HIV/AIDS prevention among at-risk communities.

The following topics emerged from the conference that can be used as a reference for the current state of the field, including research, community-based practice, and ethical considerations: 1) Social media and mobile technologies are increasingly being used by HIV researchers: A number of presentations focused on the use of mobile technologies, including using them as methods for recruitment, interventions, and data collection. Because of the increasing use of social media among populations at risk for HIV and highly-affected by HIV (e.g., minority MSM), researchers should continue exploring innovative ways to make use of these technologies for HIV prevention and care. 2) Community-based organizations and clinics are receptive and interested in applying social media and mobile technologies to HIV prevention and care: We heard from clinic senior management who described their interest and enthusiasm in using mobile technologies to address disparities in HIV prevention and care. Local organizations are interested and willing to partner with academic researchers on this work. 3) The ethical considerations around using these technologies for HIV prevention and care are only beginning to be explored: Our ethics panel conversation was focused primarily on a mobile application related to individuals affected by HIV and the ethical concerns of using mobile applications for HIV prevention and care. It was an initial step in providing a conversation on this needed topic and highlighted the interest and importance in establishing guidelines12 for safety and confidentiality in technologies that might increase HIV risk, as well as those that are used for HIV prevention and care. This special issue of the journal is dedicated to providing the readers with the abstracts from the presenters of the conference.


1. Maximizing Mobile. Washington D.C.: The World Bank, 2012.

2. Duggan M. Cell Phone Activities 2013. PEW Research Center, 2013.

3. Reback C, Grant D, Fletcher J, Branson C, Shoptaw S, Bowers J, et al. Text Messaging Reduces HIV Risk Behaviors Among Methamphetamine-Using Men Who Have Sex with Men. AIDS and behavior. 2012 2012/10/01;16(7):1993–2002. English.

4. Cornelius JB, Dmochowski J, Boyer C, St. Lawrence J, Lightfoot M, Moore M. Text-Messaging-Enhanced HIV Intervention for African American Adolescents: A Feasibility Study. Journal of the Association of Nurses in AIDS Care. 2013 5//;24(6):256–67.

5. Social Media [cited 2013]. Available from:

6. Duggan M, Smith A. Social Media update 2013. Washington, D.C.: Pew Research Center, 2013.

7. Madden M, Lenhart A, Cortesi S, Gasser U, Duggan M, Smith A, et al. Teens, social media, and privacy. Washington, D.C.: Pew Research Center, 2013.

8. Smith A. Technology Trends Among People of Color. Pew Research Center, 2010.

9. Harris Interactive. Gays, Lesbians and Bisexuals Lead in Usage of Online Social Networks2007 October 24, 2008. Available from:

10. Young SD, Szekeres G, Coates T. The Relationship between Online Social Networking and Sexual Risk Behaviors among Men Who Have Sex with Men (MSM). PLoS ONE. 2013;8(5):e62271.

11. Rice E, Holloway I, Winetrobe H, Rhoades H, Barman-Adhikari A, Gibbs J, et al. Sex Risk among Young Men who have Sex with Men who use Grindr, a Smartphone Geosocial Networking Application. Journal of AIDS & Clinical Research. 2012;3.

12. Young, SD. Recommended guidelines for using social networking for HIV prevention research. AIDS and Behavior. 2012; 16(7), 1743–5.

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Posted on Dec 12, 2013 in Conference | 0 comments

A Feasibility Study of Smart-Phone Application on Breast Self-Examination in Korea

Jaesung Heo, MD1, Mison Chun, MD, PhD1, Ki Young Lee, PhD2, Young-Taek Oh, MD, PhD1, O kyu Noh, MD, PhD1, Rae Woong Park, MD, PhD2,3,4

1Department of Radiation Oncology, Ajou University School of Medicine, Republic of Korea; 2Department of BiomedicalInformatics, Ajou University School of Medicine, Republic of Korea; 3Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics & Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America; 4Center for Pharmacoepidemiololgy Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America

Journal MTM 2:4S:19, 2013

DOI: 10.7309/jmtm.2.4S.16


Background Breast cancer patients who founded in early stage have a good prognosis. Females who practice breast self-examination (BSE) are usually diagnosed at an earlier stage than those who do not.

Aims The purpose of this study was to develop a smart-phone application to encourage BSE, and to evaluate the effects of mobile intervention in terms of improving breast self-examination behavior.

Methods A developed smart-phone application had several functions including a BSE date alarm, a reminder to encourage mother and daughter to practice BSE together, BSE record, and educational video clips. Females aged 19 and over were enrolled and two series of questionnaires were carried out (before and after using the application) between July and September 2012.

Results Forty five subjects (age 29.5 ± 5.9 years) were enrolled in the study. Of 45 participants, 28 (62.2%) had practiced BSE, and only one of these was carried out at the appropriate time, based on the results of the baseline survey. After using the application, the number of participants practicing BSE increased from 28 to 32 (62.2% to 71.1%; p = 0.503). In subgroup analysis (age <30 years), the number of participants using BSE increased from 8 to 18 (36.4% to 81.8%; p = 0.002), and the number of those using it at the appropriate time improved from 1 to 15 (2.2% to 33.3%, p <0.001).

Conclusions In female younger than 30 years, the developed smart-phone application increased BSE practice. To confirm the long-term effect of the mobile application and overcome difference in smart phone usage, further studies must be carried out.

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Posted on Dec 5, 2013 in Conference | 0 comments

Feasibility of Text Messaging to Improve Oral Anti-Cancer Adherence in older Cancer Patients

Sandra Spoelstra,PhD, RN1, Barbara Given,PhD, RN, FAAN1, Alla Sikorskii,PhD3,

Constantinos Coursaris,PhD4, Atreyee Majumder,MD3, Monica Schueller,BA1,

Kimberly Ridenour,Nurse Scholar1, Michele Wormser,Nurse Scholar1, Charles W. Given,PhD2

1College of Nursing; 2Family Medicine; 3Department of Probability and Statistics; 4Department of Communication at

Michigan State University, East Lansing, MI

Journal MTM 2:4S:1, 2013

DOI: 10.7309/jmtm.2.4S.1


Background More than 50 oral chemotherapy agents in pill form are on the market, with projections that in 3 years, 25% of cancer treatment will be in pill form. For oral agents to achieve a therapeutically effective level for cancer treatment, patients must strictly adhere to the regimen. However, adherence is often less than 80%, which may be inadequate for treating the cancer. There are more than 285 million wireless subscribers in the US with an estimated 67.5% of adults owning cell phones and 98% of those phones having text messaging capability. A recent review of 12 trials on interventions for disease prevention or management found that text messaging improved health behaviors.

Purpose There are multiple mobile applications and smart phone products to prompt medication adherence, however, few have examined if these prompts improve medication adherence. Adherence is critical among cancer patients who are older and less likely to text message. The cancer medications can be costly, as much as $800 per pill, and only effective if taken as prescribed. Adherence is complicated by complexity of the dosing and the duration of the prescriptions. Therefore, the purpose of this study is to test the feasibility, usability, and satisfaction with text messages to improve symptoms from side effects of treatment and adherence to oral chemotherapy agents.

Methods A 10-week, 2-group, prospective trial will enroll 76 patients from cancer centers to examine a 3-week text message intervention to promote oral agent adherence and management of symptoms from side effects of treatment. Descriptive statistics, generalized linear modeling, and generalized estimating equations will be used for analysis.

Results Enrollment is underway and preliminary findings on characteristics, feasibility of text message intervention and its influence on adherence rates will be presented.

Conclusion Text messages can easily be tailored to a specific oral agent regimen, making this intervention usable for simple or more complex dosing. Further, delivering the text messages on cell phones makes this intervention readily accessible. Likewise, it is the first study to enroll a cohort of patients who are newly prescribed oral agents. Past research has demonstrated that adherence levels begin to decline 2 months after the initiation of therapy. Therefore, this research could inform initiation of care, where patterns of behavior could be established and carried out through the entire treatment regimen. This type of novel intervention also has the potential to transform and impact other ill populations that require adherence to a medication regimen.

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Posted on Dec 5, 2013 in Conference | 0 comments

A comparison of two text message-based intervention studies for health promotion in Cape Town, South Africa: The lessons learnt

Yan Lau 1, Kirsty Brittain 1, Damian Hacking 1, Avital Cassidy 1, Hanne Haricharan 1, Marion Heap 1

1Health and Human Rights Programme, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, South Africa

Journal MTM 2:4S:16, 2013

DOI: 10.7309/jmtm.2.4S.13


According to the World Bank, there are 128 mobile subscriptions per 100 people in South Africa as of 2011. Cellphones are therefore viewed as having considerable potential for health promotion. However, evaluations of interventions and evidence of effectiveness are still limited in developing countries. Two separate trilingual (isiXhosa, Afrikaans and English) short-message-service (SMS) interventions that took place from 2012 to 2013 in Cape Town are evaluated.

The SMS campaigns aimed to increase health knowledge by disseminating health information via SMS. Specifically, each study involved sending SMSes to participants to provide them with information regarding how to control hypertension and how to be healthy during pregnancy, respectively. The hypertension campaign was conducted with hypertensive patients at a Community Health Centre, while the antenatal campaign was with pregnant women attending a Midwife Obstetric Unit. Facility staff guided the preparation and checked the health promotion content of both campaigns.

There were 223 and 206 participants at baseline in the hypertension and antenatal campaigns respectively. Both studies used mixed research methods of a randomised control trial followed by a focus group. Participants were randomised either to be sent SMSes (experiment group) or not (control group). Intervention in the hypertension campaign involved sending 5 SMSes per week for 16 weeks. The pattern of dissemination was different in the antenatal campaign: SMSes were staggered according to the week of pregnancy at the time of recruitment into the study. The total number of SMSes sent to all those in the experiment group was 101.

34.53% and 46.60% of the participants were lost to follow-up (LTFU) in the hypertension and antenatal campaign respectively. There was no differential LTFU in either study. At the end of the antenatal campaign, there were no significant differences in the level of knowledge (assessed by nine questions) between the experiment and the control group (all p > 0.05). Similar results emerged in the hypertension campaign. Despite no significant improvements in knowledge, both campaigns’ participants (experiment group) reported high levels of behavioural change. Participants in both focus groups remarked that the SMSes acted as reminders or “light bulbs”.

SMSes appear to be more effective at improving motivation than increasing knowledge, although objective measures to verify behavioural change could not be obtained in either campaign. Further research is needed to investigate how health knowledge can be improved via mHealth interventions, particularly in populations of low socioeconomic status where high rates of LTFU are a reality.

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Posted on Dec 5, 2013 in Conference | 0 comments

There’s an App for That! Promoting Antiretroviral Medication Adherence in Rural Georgia: The Music for Health Project

Marcia Holstad 1, Igho Ofotokun 1, Eugene Farber 1, Drenna Waldrop-Valverde 1, Steven Logwood 2, Rajiv Hira 1, Derek Jobe 1, Modupe Adewuyi 1, Maya Bauman 1, Howard Pope 1, Julie Zuniga 1

1Emory University, Atlanta, GA; 2Positive Records – Groovy Pyramid, Los Angeles, CA

Journal MTM 2:4S:18, 2013

DOI: 10.7309/jmtm.2.4S.15

Consistent high levels of adherence to antiretroviral drug therapy (ART) are needed to sustain undectable viral loads (VL) in persons living with HIV/AIDS (PLWH). The result is improved health and prevention of HIV transmission. Rural dwelling PLWH encounter barriers such as low health care resources, transportation, poverty, stigma, and depression that contribute to adherence challenges. The goal of the Music for Health smartphone app is to use technology to improve adherence to ART. The app consists of a music program called the LIVE Network that includes animated music videos specially developed and tailored for PLWH, a manual with web links, and a pill count survey. The program is designed to educate, motivate, and increase self-confidence in rural PLWH to adhere to ART. We are conducting a randomized controlled clinical trial to study the efficacy of this app compared to an equivalent educational app in 240 rural PLWH in Georgia. Eligibility criteria include: HIV infected, initiating ART for the first time or changing a regimen due to side effects or ART drug resistance, ≥18 years of age, English speaking, and willing to complete study activities. Once randomized at baseline, each participant will receive a smartphone loaded with the appropriate app and will have a supervised listening/viewing session. They will receive regular text message reminders to use the app and for monthly unannounced pill counts. Pill counts will also be collected via smart phone. All participants will be followed up at 3, 6, 9 months using computerized interviews, hair samples for ART drug levels, and lab values extracted from medical records. The app was pre-tested in 3 focus groups conducted in 3 different rural counties. Nine men and 4 women participated; 10 (77%) were African American. All reviewed the app and provided feedback. Only one person did not own a mobile phone and 7 (54%) owned a smart phone. After coaching all were able to use the smart phone and app. All songs and videos were rated ≥ 7 on a scale of 0 to 10 and 5 songs had a median score of 10. Participants found the songs relevant and many thought songs addressed a situation they were currently experiencing: “This is my first year living with HIV, so songs like that I can relate to… dealing with issues and questions that I have in my own head… that I don’t talk to people about.” Videos were edited to incorporate changes requested by the participants. Study recruitment will begin in 2014. If successful this app could transform the delivery of HIV adherence self-management care by overcoming barriers in this vulnerable group.

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