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Linguistic and Cultural Adaptation of a Computer-Based Counseling Program (CARE+ Spanish) to Support HIV Treatment Adherence and Risk Reduction for People Living With HIV/AIDS: A Randomized Controlled Trial.

Publication ,  Journal Article
Kurth, AE; Chhun, N; Cleland, CM; Crespo-Fierro, M; Parés-Avila, JA; Lizcano, JA; Norman, RG; Shedlin, MG; Johnston, BE; Sharp, VL
Published in: J Med Internet Res
July 13, 2016

BACKGROUND: Human immunodeficiency virus (HIV) disease in the United States disproportionately affects minorities, including Latinos. Barriers including language are associated with lower antiretroviral therapy (ART) adherence seen among Latinos, yet ART and interventions for clinic visit adherence are rarely developed or delivered in Spanish. OBJECTIVE: The aim was to adapt a computer-based counseling tool, demonstrated to reduce HIV-1 viral load and sexual risk transmission in a population of English-speaking adults, for use during routine clinical visits for an HIV-positive Spanish-speaking population (CARE+ Spanish); the Technology Acceptance Model (TAM) was the theoretical framework guiding program development. METHODS: A longitudinal randomized controlled trial was conducted from June 4, 2010 to March 29, 2012. Participants were recruited from a comprehensive HIV treatment center comprising three clinics in New York City. Eligibility criteria were (1) adults (age ≥18 years), (2) Latino birth or ancestry, (3) speaks Spanish (mono- or multilingual), and (4) on antiretrovirals. Linear and generalized mixed linear effects models were used to analyze primary outcomes, which included ART adherence, sexual transmission risk behaviors, and HIV-1 viral loads. Exit interviews were offered to purposively selected intervention participants to explore cultural acceptability of the tool among participants, and focus groups explored the acceptability and system efficiency issues among clinic providers, using the TAM framework. RESULTS: A total of 494 Spanish-speaking HIV clinic attendees were enrolled and randomly assigned to the intervention (arm A: n=253) or risk assessment-only control (arm B, n=241) group and followed up at 3-month intervals for one year. Gender distribution was 296 (68.4%) male, 110 (25.4%) female, and 10 (2.3%) transgender. By study end, 433 of 494 (87.7%) participants were retained. Although intervention participants had reduced viral loads, increased ART adherence and decreased sexual transmission risk behaviors over time, these findings were not statistically significant. We also conducted 61 qualitative exit interviews with participants and two focus groups with a total of 16 providers. CONCLUSIONS: A computer-based counseling tool grounded in the TAM theoretical model and delivered in Spanish was acceptable and feasible to implement in a high-volume HIV clinic setting. It was able to provide evidence-based, linguistically appropriate ART adherence support without requiring additional staff time, bilingual status, or translation services. We found that language preferences and cultural acceptability of a computer-based counseling tool exist on a continuum in our urban Spanish-speaking population. Theoretical frameworks of technology's usefulness for behavioral modification need further exploration in other languages and cultures. TRIAL REGISTRATION: ClinicalTrials.gov NCT01013935; https://clinicaltrials.gov/ct2/show/NCT01013935 (Archived by WebCite at http://www.webcitation.org/6ikaD3MT7).

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Published In

J Med Internet Res

DOI

EISSN

1438-8871

Publication Date

July 13, 2016

Volume

18

Issue

7

Start / End Page

e195

Location

Canada

Related Subject Headings

  • Young Adult
  • Therapy, Computer-Assisted
  • Telemedicine
  • Risk-Taking
  • Risk Reduction Behavior
  • Medical Informatics
  • Male
  • Longitudinal Studies
  • Linguistics
  • Internet
 

Citation

APA
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ICMJE
MLA
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Kurth, A. E., Chhun, N., Cleland, C. M., Crespo-Fierro, M., Parés-Avila, J. A., Lizcano, J. A., … Sharp, V. L. (2016). Linguistic and Cultural Adaptation of a Computer-Based Counseling Program (CARE+ Spanish) to Support HIV Treatment Adherence and Risk Reduction for People Living With HIV/AIDS: A Randomized Controlled Trial. J Med Internet Res, 18(7), e195. https://doi.org/10.2196/jmir.5830
Kurth, Ann E., Nok Chhun, Charles M. Cleland, Michele Crespo-Fierro, José A. Parés-Avila, John A. Lizcano, Robert G. Norman, Michele G. Shedlin, Barbara E. Johnston, and Victoria L. Sharp. “Linguistic and Cultural Adaptation of a Computer-Based Counseling Program (CARE+ Spanish) to Support HIV Treatment Adherence and Risk Reduction for People Living With HIV/AIDS: A Randomized Controlled Trial.J Med Internet Res 18, no. 7 (July 13, 2016): e195. https://doi.org/10.2196/jmir.5830.
Kurth AE, Chhun N, Cleland CM, Crespo-Fierro M, Parés-Avila JA, Lizcano JA, Norman RG, Shedlin MG, Johnston BE, Sharp VL. Linguistic and Cultural Adaptation of a Computer-Based Counseling Program (CARE+ Spanish) to Support HIV Treatment Adherence and Risk Reduction for People Living With HIV/AIDS: A Randomized Controlled Trial. J Med Internet Res. 2016 Jul 13;18(7):e195.

Published In

J Med Internet Res

DOI

EISSN

1438-8871

Publication Date

July 13, 2016

Volume

18

Issue

7

Start / End Page

e195

Location

Canada

Related Subject Headings

  • Young Adult
  • Therapy, Computer-Assisted
  • Telemedicine
  • Risk-Taking
  • Risk Reduction Behavior
  • Medical Informatics
  • Male
  • Longitudinal Studies
  • Linguistics
  • Internet