Date of Award

January 2025

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Trace Kershaw

Abstract

Despite the availability of antiretroviral therapy (ART), only 66% of people with HIV in the U.S. achieve viral suppression, often due to suboptimal ART adherence. Barriers such as limited access to care and forgetfulness impact adherence, which must be ≥95% to prevent viral rebound. Combining community health worker (CHW) support with mobile health (mHealth) technologies may help address these barriers and improve outcomes. This pilot study evaluated the feasibility, acceptability, and preliminary efficacy of the remotely delivered Community Health Worker and mHealth to Improve Viral Suppression (CHAMPS) intervention, which combines the WiseApp, CHW support, and the CleverCap smart pill bottle. This mixed methods study enrolled 40 participants with HIV, randomized to either control (n=20) or CHAMPS (n=20) over three months. The intervention group engaged in up to 12 sessions with CHWs and used the WiseApp and CleverCap to support adherence. Remote baseline and follow-up visits were conducted via Zoom and included surveys on adherence, self-efficacy, and usability. Semistructured interviews explored user experience. Thematic analysis was guided by the Mobile Health Technology Acceptance Model. CHAMPS was feasible and acceptable, with high usability ratings (Health-ITUES: mean 4.35, SD 0.58; PSSUQ: mean 2.04, SD 1.03). Nonsignificant improvements were observed in adherence (P=.29) and self-efficacy (P=.07). The adjusted odds ratio for achieving undetectable viral load in the intervention group was 3.01 (95% CI –1.59 to 4.12). Overall retention was 75%, with higher retention in the control group. Participants appreciated the convenience of remote procedures and highlighted the intervention’s potential to address logistical barriers. CHAMPS demonstrates promise as a scalable strategy to support ART adherence in underserved populations. Trial Registration: ClinicalTrials.gov NCT05938413; https://clinicaltrials.gov/study/NCT05938413

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/16/2026

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