Texting to Improve Adherence in HIV+ with Bipolar Disorder

David Moore, University of California, San Diego
Social and Behavioral Sciences
Targeted Theme: HIV-Related Disparities in Highly Impacted, Under-researched Populations
Innovative, Developmental, Exploratory Award (IDEA)

The overall goal of the present study is to improve the mental and physical health of persons with both HIV infection and bipolar disorder (HIV+/BD+). We will accomplish this goal by testing a text messaging intervention that automatically sends medication reminders to participants. Specific Aims: Aim 1: To develop a text messaging intervention designed to improve adherence to mood and HIV medications among HIV+/BD+ persons; Aim 2: To determine whether an intervention that includes education about medications plus daily text messaging (TEXT) is better than education about medications alone (CTRL) for improving medication adherence among HIV+/BD+ persons; Aim 3: To determine whether a daily self-rating of mood gathered via text messaging is related to medication adherence among HIV+/BD+ persons in the TEXT intervention. Background: HIV+ persons are more likely to have bipolar disorder (BD) than those without HIV infection (Beyer et al., 2007). Similarly, persons with BD are more likely to be HIV+ than those without BD (Otto-Salaj et al., 2001). Rates of BD in the general population are approximately 2%, whereas approximately 8% of our HIV+ cohort in San Diego has BD. Despite this high overlap, persons with BD are often excluded from research studies of HIV infection and vice versa. HIV+/BD+ persons are of public health importance because the characteristics of BD (e.g., mood instability, increased risk taking, elevated rates of substance abuse/dependence) may increase the likelihood of poor medication adherence and possibly increase engagement in HIV transmission risk behaviors. Our pilot work shows that 45% of HIV+/BD+ persons were nonadherent to ART and 67% were nonadherent to their primary psychotropic medication. Our data also suggests that depressed HIV+/BD+ persons may have poorer adherence. Methods: A randomized controlled trial will assign 25 HIV+/BD+ persons to a psychoeducational seminar on medication adherence (CTRL) and 25 HIV+/BD+ individuals will be assigned to psychoeducation + personalized daily text messaging medication adherence reminders (TEXT). Medication adherence will be tracked over 30-days for one mood medication and one HIV medication using special (MEMS) pill caps that record the date and time that the medication bottle is opened. Participants assigned to the TEXT intervention will also receive daily text messages asking them to rate their current mood. For both groups, other things that may relate to worse adherence will be examined, such as beliefs about medications, baseline depression and mania symptoms, substance abuse/dependence, social support, and overall medication burden. Strengths of TEXT are that it is 1) personalized; texts are specific to the person, medication and timing, 2) interactive; opportunity for participant to acknowledge receipt of reminders, unlike an alarm clock, 3) flexible; reminders can be altered to fit with changes in the participants medication taking routine, and 4) scalable; the intervention could be easily expanded over a longer course of time or modified to increase participant interaction. Potential Study Impact: If the intervention is successful, there may be improved physical and mental health, decreased likelihood of HIV transmission, and enhanced quality of life for HIV+/BD+ individuals. As such, the study may alter public health policy and pave the way for future studies into improving the way that HIV+/BD+ and other underserved HIV+ persons are treated.