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Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes

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Abstract

We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest–posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants’ first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.

Resumen

Diseñamos una intervención infográfica para ayudar a los médicos brindar información médica a personas viviendo con el VIH. En este estudio, evaluamos en qué medida nuestra intervención puede mejorar los resultados de salud (conteo de CD4, carga viral, y compromiso con el médico entre otros), medidos de una manera objetiva y subjetiva, cuando se incorpora en las visitas médicas de rutina en la República Dominicana. En este estudio de prueba previo y posterior, seguimos los participantes durante 9 meses a intervalos de 3 meses. Los médicos administraron la intervención durante las primeras 3 visitas de los participantes. Seleccionamos las medidas de resultado utilizando un marco conceptual y las evaluamos en los 4 puntos de tiempo. Evaluamos cambios a lo largo del tiempo usando regresiones lineales generales y pruebas de asociación de Wilcoxon Signed-Rank. Los participantes (N = 50) fueron mayormente mujeres (56%) y habían estado viviendo con el VIH durante una media de 6,3 años (DE = 6,1). Todos los resultados, aparte del conteo de CD4, demostraron mejoras estadísticamente significativas al final del estudio. Esto proporciona evidencia preliminar de que nuestra intervención puede mejorar los resultados de la salud, pero se justifican pruebas adicionales.

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Data Availability

All data and coding available upon request.

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Acknowledgements

The authors would like to cordially thank our participants as they made this study possible. We would also like to thank Ynaliza González, who worked with us as a research assistant throughout the study. Her strong committment to our study population and this research project was notable and a tremendous asset to our team.

Funding

The research reported in this publication and the first author were supported by the National Institute of Nursing Research of the National Institutes of Health under award number K99NR017829. The mentorship of RS was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number K24NR018621. The contributions of SB, TRC, and MG were supported by the Precision in Symptom Self-Management Center which is supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number P30NR016587. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Anschutz Medical Campus, University of Colorado College of Nursing, 13120 E. 19th Ave, Aurora, CO, 80045, USA

    Samantha Stonbraker

  2. Clínica de Familia La Romana, La Romana, Dominican Republic

    Samantha Stonbraker & Mina Halpern

  3. Columbia University School of Nursing, New York, NY, USA

    Jianfang Liu, Maureen George, Suzanne Bakken & Rebecca Schnall

  4. University of South Florida College of Public Health, Tampa, FL, USA

    Gabriella Sanabria

  5. Columbia University Irving Medical Center, New York, NY, USA

    Silvia Cunto-Amesty

  6. Columbia School of Social Work, New York, NY, USA

    Carmela Alcántara

  7. New York University School of Global Public Health, New York, NY, USA

    Ana F. Abraído-Lanza

  8. University of Wisconsin – Madison School of Social Work, Madison, WI, USA

    Tawandra Rowell-Cunsolo

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  1. Samantha Stonbraker
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All authors meet authorship requirements as set forth by the International Committee of Medical Journal Editors (ICMJE) and all have approved the final version for submission.

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Correspondence to Samantha Stonbraker.

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The authors declare they have no conflicting interests.

Ethical approval

This study was approved by the Columbia University Irving Medical Center Institutional Review Board (Protocol# AAAR9023) and by the Consejo Nacional de Bioética en Salud (CONABIOS), the ethical review board in the Dominican Republic (Protocol# 016-2018). The trial was registered on clinicaltrial.gov (#03616106).

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Stonbraker, S., Liu, J., Sanabria, G. et al. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav 25, 4061–4073 (2021). https://doi.org/10.1007/s10461-021-03331-8

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