Bioengineer.org | Mobile app reduces detectable HIV viral load in men using stimulants

Bioengineer.org news story

In a remote randomised controlled trial published in eClinicalMedicine, researchers found that a mobile health application designed to support antiretroviral therapy adherence significantly lowered the odds of detectable HIV-1 viral load at six months among sexual minority men with HIV who also screened positive for a stimulant use disorder. The study enrolled 286 participants from the continental United States and randomised them to either the Supporting Treatment Adherence for Resilience and Thriving (START) application or a website control condition providing referrals to care resources. The primary outcome was detectable viral load, defined as more than 300 copies per millilitre, measured using remote blood samples collected at baseline, six months, and 12 months. The findings indicate that the digital intervention primarily prevented virologic rebound, a key factor in maintaining viral suppression for individuals at high risk of treatment disengagement.

The research addresses a significant gap in digital health evidence, where prior studies have shown moderate improvements in self-reported adherence but inconsistent effects on objective biomarkers. While randomised controlled trials in lower- and middle-income countries have demonstrated that bidirectional text messaging can reduce detectable viral load, evidence for key populations facing disproportionate challenges, such as sexual minority men using stimulants, remained limited. The use of methamphetamine and other stimulants is a prominent driver of the HIV epidemic, with up to one in three sexual minority men who acquire HIV in the United States reporting persistent methamphetamine use. These individuals often experience greater difficulties with adherence, increasing the likelihood of detectable viral load and potentiating onward transmission risk. The START application was designed to address these barriers by integrating positive psychological intervention skills to improve adherence irrespective of whether participants were ready to reduce stimulant use.

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