{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T09:52:52Z","timestamp":1785232372333,"version":"3.55.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30CA240139"],"award-info":[{"award-number":["P30CA240139"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Clinical Trials Registry","award":["NCT03999411"],"award-info":[{"award-number":["NCT03999411"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Low-income people living with HIV (PLWH) in the United States encounter several behavioral challenges. Multiple-behavior interventions targeting multiple risks are promising. Cigarette smoking remains high among PLWH (47%), and smokers have low adherence to antiretroviral therapy (ART). This study explores the feasibility of a smartphone app-based intervention combining mindfulness training (MT) for smoking cessation with video directly observed therapy (vDOT) for ART monitoring among minority and low-income PLWH.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a proof-of-concept feasibility three-arm randomized controlled trial among PLWH (n\u2005=\u200539; 53.8% males) to test three treatment groups (Gs): (G1) usual care (UC; brief advice to quit and ART adherence); (G2) MT app plus brief advice to ART adherence; and (G3) MT plus vDOT apps. The primary outcomes were intervention feasibility, acceptability, app usability, smoking cessation, and ART adherence improvement.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Enrollment rate was low (37%) due to low access to technology and language barriers. Retention rates were high (UC: 92.3%, G2: 84.6%, G3: 100.0%). The MT app usability was higher (G2: 72.8%, G3: 69.2%) than the vDOT app (G3: 23.1%). G2 participants were more satisfied with treatment than G3 (p\u2005&amp;lt;\u2005.04). Smoking abstinence rates in G2 and G3 were double that in UC (UC: 25.0%, G2: 45.5%, G3: 53.8%). ART adherence improved by 53.0% in G2 and G3 compared to 30.7% in UC.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The combined intervention was promising. However, the app-based intervention feasibility was low, and vDOT for ART monitoring was unacceptable. These results will inform the optimization and further testing of the multi-component intervention.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>Disparities in HIV persist among minority and low-income groups who face several behavioral challenges. The current proof-of-concept trial indicated that the multiple-behavior intervention targeting smoking cessation and adherence to ART in minority and low-income PLWH is promising. However, given the low access to technology and the language barrier in this group, the feasibility of the app-based intervention was low. Video-based strategy to monitor ART adherence was not acceptable due to privacy concerns. As healthcare becomes more reliant on technology-based tools, research is needed to address the digital divide among this group to prevent the exacerbation of existing healthcare access disparities.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntaf077","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T08:29:54Z","timestamp":1743668994000},"page":"1513-1523","source":"Crossref","is-referenced-by-count":2,"title":["A Proof-of-Concept Feasibility Trial Testing a Multi-Component App-Based Intervention for Improving Smoking Cessation and Adherence to Treatment in Low-Income HIV Patients"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1133-9723","authenticated-orcid":false,"given":"Taghrid","family":"Asfar","sequence":"first","affiliation":[{"name":"Department of Public Health Sciences, University of Miami Miller School of Medicine , Miami, FL ,","place":["USA"]},{"name":"Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine , Miami, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7536-9692","authenticated-orcid":false,"given":"David J","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of Miami Miller School of Medicine , Miami, FL ,","place":["USA"]},{"name":"Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine , Miami, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa","family":"Alcaide","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine , Miami, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4106-8891","authenticated-orcid":false,"given":"Deborah L","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine , Miami, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1869-0906","authenticated-orcid":false,"given":"Michael J","family":"Zvolensky","sequence":"additional","affiliation":[{"name":"Department of Behavioral Science, The University of Texas MD Anderson Cancer Center 3 HEALTH Institute, University of Houston , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1488-3997","authenticated-orcid":false,"given":"Olusanya J","family":"Oluwole","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of Miami Miller School of Medicine , Miami, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of Miami Miller School of Medicine , Miami, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judson","family":"Brewer","sequence":"additional","affiliation":[{"name":"Department of Behavioral and Social Sciences, Brown Mindfulness Center, Brown University School of Public Health , Providence, RI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Carrico","sequence":"additional","affiliation":[{"name":"Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work , Miami, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"issue":"3","key":"2025082200012832300_CIT0001","first-page":"1\/6","article-title":"Estimated HIV Incidence and Prevalence","volume":"28","author":"CDC","year":"2022; 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