Abstract
Context
Exacerbated by life stressors, fatigue is the most common symptom for people living
with HIV.
Objective
To adapt, develop, and assess the feasibility of a Cognitive Behavioral Stress Management
Mobile Health (CBSM mHealth) application (app) for HIV-related fatigue.
Methods
This study had two phases: app development with key informants (N = 5) and a randomized controlled trial (N = 30). Patients randomized to the intervention group completed 10 weekly CBSM modules;
those in the control group received a generic healthy lifestyle app. Measures included
HIV-related fatigue, depression, anxiety, stressful life events, CD4 count, HIV viral
load, credibility and acceptability of the intervention, and barriers to treatment
participation.
Results
We were able to recruit participants for this study, and they were able to complete
the required measures. They found the intervention to be credible and acceptable and
reported few barriers to treatment participation. The direction of change in the primary
outcome, a decrease in fatigue, is in the expected direction and provides evidence
of the promise of the intervention, which still needs to be tested in an adequately
powered trial. For completers (randomized to the intervention group and completed
at least 80% of the modules), there were significant changes (95% CI; lower scores
indicate improvement) in fatigue intensity (from 64.2 to 59.7) and overall fatigue-related
functioning (from 6.6 to 4.2).
Conclusion
We have proof of concept as to the feasibility, acceptability, and initial signals
of efficacy for an mHealth intervention to help people with HIV-related fatigue better
cope with stress and reduce their fatigue.
Key Words
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References
- Predictors and treatment strategies of HIV-related fatigue in the combined antiretroviral therapy era.AIDS. 2010; 24: 1387-1405
- Racial and socioeconomic disparities in the symptom profile of persons living with HIV.AIDS Care. 2018; 30: 774-783
- Bidirectional relationships between fatigue and everyday experiences in persons living with HIV.Res Nurs Health. 2016; 39: 154-163
- Validity assessment of the PROMIS fatigue domain among people living with HIV.AIDS Res Ther. 2017; 14: 21
- Intensity, chronicity, circumstances, and consequences of HIV-related fatigue.Clin Nurs Res. 2014; 23: 514-528
- The impact of specific HIV treatment-related adverse events on adherence to antiretroviral therapy: a systematic review and meta-analysis.AIDS Care. 2013; 25: 400-414
- Early warning indicators for first-time virologic failure independent of adherence measures in a South African urban clinic.AIDS Patient Care STDS. 2013; 27: 657-668
- Trauma, stressful life events, and depression predict HIV-related fatigue.AIDS Care. 2008; 20: 1258-1265
- Mindfulness-based stress reduction for people living with HIV/AIDS: preliminary review of intervention trial methodologies and findings.Health Psychol Rev. 2015; 9: 224-243
- Stressful life events and adherence in HIV.AIDS Patient Care STDs. 2008; 22: 403-411
- The impact of stressful life events, symptom status, and adherence concerns on quality of life in people living with HIV.J Assoc Nurses AIDS Care. 2013; 24: 478-490
- A longitudinal investigation of the impact of life stress on HIV treatment adherence.J Behav Med. 2010; 33: 486-495
- Physiological and psychosocial factors that predict HIV-related fatigue.AIDS Behav. 2010; 14: 1415-1427
- Fatigue in HIV-infected people: a three-year observational study.J Pain Symptom Manage. 2015; 50: 69-79
- Fatigue in HIV and AIDS: an analysis of the evidence.J Assoc Nurses AIDS Care. 2013; 24: S5-S14
- Chronicity and remission of fatigue in patients with established HIV infection.AIDS Patient Care STDs. 2009; 23: 239-244
- Cognitive-behavioral stress management for individuals living with HIV: Facilitator guide.Oxford University Press, New York2007
- Cognitive-behavioral stress management workbook.Oxford University Press, New York2007
- Effects of psychological interventions on neuroendocrine hormone regulation and immune status in HIV-positive persons: a review of randomized controlled trials.Psychosom Med. 2008; 70: 575-584
- Meta-analysis of cognitive-behavioral interventions on HIV-positive persons’ mental health and immune functioning.Health Psychol. 2008; 27: 4-14
- Stress management interventions for HIV-positive adults: a meta-analysis of randomized controlled trials, 1989 to 2006.Health Psychol. 2008; 27: 129-139
- Cognitive-behavioral stress management interventions for persons living with HIV: a review and critique of the literature.Ann Behav Med. 2008; 35: 26-40
- Brief exposure to cognitive behavioral therapy reduces side-effect symptoms in patients on antiretroviral therapy.J Assoc Nurses AIDS Care. 2016; 27: 455-467
- Racial and ethnic differences in how people use mobile technology.
- Psychometric properties of the credibility/expectancy questionnaire.Jnl Behav Ther Exper Psychiatry. 2000; 31: 73-86
- Barriers to treatment participation scale: Evaluation and validation in the context of child outpatient treatment.Jnl Child Psychol Psychiat. 1997; 38: 1051-1062
- Psychometric properties of the HIV-related fatigue scale.J Assoc Nurses AIDS Care. 2002; 13: 66-75
- Measuring fatigue in people living with HIV/AIDS: psychometric characteristics of the HIV-Related Fatigue Scale.AIDS Care. 2008; 20: 829-837
- PROMIS® measures of Pain, fatigue, negative Affect, Physical function and social function demonstrate clinical validity across a range of chronic conditions.J Clin Epidemiol. 2016; 73: 89-102
- PROMIS fatigue item bank had clinical validity across Diverse chronic conditions.J Clin Epidemiol. 2016; 73: 128-134
- Validity assessment of the PROMIS fatigue domain among people living with HIV.AIDS Res Ther. 2017; 14: 21
- Manual for the State-Trait Anxiety Inventory.Consulting Psychologists Press, Palo Alto, CA1983
- Beck Depression Inventory II Manual.Psychological Corporation, San Antonio, TX1996
- Assessing the impact of life changes: development of the life experiences Survey.J Consult Clin Psychol. 1978; 46: 932-946
- Highly stressed: stressful and traumatic experiences among individuals with HIV/AIDS in the Deep South.AIDS Care. 2011; 23: 152-162
- The role and interpretation of pilot studies in clinical research.J Psychiatr Res. 2011; 45: 626-629
Article info
Publication history
Published online: September 17, 2019
Accepted:
September 11,
2019
Identification
Copyright
© 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
