Development and pilot testing of a virtual counselor delivered intervention for substance use among people with HIV. (Preprint)

Abstract

Substance use disorders are prevalent and undertreated among people with HIV (PWH). Computer-delivered interventions (CDI) show promise in increasing reach, delivering evidence-based care, and offering anonymity. Incorporating virtual counselors may increase CDI acceptability and engagement, and therefore improve health outcomes.

To develop and pilot a virtual counselor delivered brief intervention for PWH who use drugs called C-Raven that is theory grounded and uses evidence-based practices for behavior change.

Intervention mapping was used to develop CDI including review of the behavior change literature in SUD and HIV, and human computer interaction literature on use of virtual counselors. We describe the application of the information, motivation and behavior skills model and the systematic approach used to culturally adapt the content. The intervention manual underwent expert review for inclusion of evidence-based techniques, relevance, and utility. With a user interaction designer/developer, we created and tested various virtual counselors, CDI background and virtual counselor script. Finally, a mixed methods approach using in-depth interviews and quantitative assessment were used to assess usability, acceptability, and relevance of the intervention content and the virtual counselor.

PWH found CDI easy to use, useful, relevant and motivating. The most consistent suggestion was to provide more information about the negative impacts of drug use and the interaction of drugs with HIV. Participants also reported that they learned information about drug use and its health effects that they had not heard before. The C-Raven Satisfaction Scale showed that the program was well-received and all participants rated their satisfaction at either a 4 (n=2) or a 5 (n=8) on a 5-point Likert scale. The CDI was delivered by a “Raven,” virtual counselor, programmed to interact in motivational interviewing style. The Raven was perceived to be nonjudgmental, understanding, and emotionally responsive. All participants endorsed the statement: “I would like to use the C-Raven program again.” Although one preferred a human provider, participants noted that they could be more truthful with a virtual counselor.

CDIs show promise in extending access to care and improving health outcomes but their development necessarily requires integration from multiple disciplines including behavioral medicine and computer science. We developed a CDI that is led by a virtual counselor who interacts in motivational interviewing style and that 1) uses evidence based behavioral change methods 2) is culturally adapted to PWH who use drugs 3) has an engaging and interactive user interface and 4) presents personalized content based on participants’ ongoing responses. To advance continued development of this and other CDIs, we recommend expanded testing, standardized measures to evaluate user experience, comparison and/or connection with clinician delivered SUD care, and if effective, assess integration into HIV clinical care.