REMAIN

Background

Despite the widespread availability of effective antiretroviral therapy (ART) in the United States, there remains significant numbers of people living with HIV (PLWH) who fail to achieve and or maintain viral suppression (VS). Recent CDC data (2020) indicates persistent disparities with the lowest levels of VS among Black individuals (60.4%), people who inject drugs (55.3%), youth ages 13-24 (63.5%) and people residing in rural areas (63.6%). This study will examine the overlapping epidemics, known as syndemics, underlying these outcomes including substance use, mental health, and structural and social barriers to HIV care including racial discrimination, stigma, and rural isolation.

Given persistent health inequities related to HIV, research on challenges to ART adherence and sustained VS among key populations must go beyond individual level factors and address the multi-faceted, multilevel barriers that have thwarted progress in ending the HIV epidemic, to date. Digital cohorts, or eCohorts, utilize the flexibility and capacity of the internet to complement traditional approaches to epidemiological research, helping address some of the limitations and challenges associated with conventional cohort studies. Standard cohort studies, especially those with large sample sizes, tend to be time-consuming, costly, and prone to attrition, whereas digital cohorts have the potential to reach, retain, and engage participants through simple and low burden communication methods. Furthermore, self-reported information can be collected more frequently, allowing for timely tailored observation. Data collection can be administered using non-stigmatizing approaches, thus avoiding negative encounters with the health system. For our e-cohort we will use an app (cell phone-based program) empirically proven to engage and retain cohorts remotely.