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People living with HIV and substance use disorders frequently discontinue treatment and experience viral rebound. Moments when people are at high risk for these lapses in HIV care may be predictable and ultimately preventable if care providers had access to the relevant information at the right time.


In this 2-stage, crossover clinical trial, we will provide smartphones running the A-CHESS application to 150 HIV-positive patients who have a past-year history of alcohol, opioid, or stimulant use disorder. In the first phase, participants will use the A-CHESS application to report data in real time describing their drug use, mood, social support, and other factors during a 6-month ecologic momentary assessment (EMA) study. These data will be used to develop and validate a predictive model of treatment non-adherence in this population. fter 6 months, all patients will cross over to the second study phase, during which the full, multi-component, tailored mHealth intervention will be delivered using the A-CHESS platform. Simultaneously, data captured by A-CHESS describing participants’ risk of treatment lapse will be communicated to patient’s providers and clinical support staff, allowing timely and focused support interventions. The effectiveness of the intervention for improving the rate of viral suppression will be assessed using a mixed effects logistic regression model. This project has the potential for high impact because it identifies the critical time-varying determinants of lapses in HIV care for substance using patients, and translates these diverse inputs into actionable, patient-specific alerts to clinical providers.

Partners / Participant Sites

Johns Hopkins Moore Clinic

Funding Period:
June 1, 2016 - May 31, 2021
Principal Investigators:
Ryan Westergaard, M.D., Ph.D.
Klaren Pe-Romashko, Study Coordinator