The Miriam Hospital is a private, not-for-profit hospital at 164 Summit Avenue in Providence, in the U.S. state of Rhode Island. It is a major teaching affiliate of the Warren Alpert Medical School of Brown University.
Background:The HIV epidemic in the United States disproportionately impacts gay, bisexual, and other men who have sex with men (MSM). Despite the effectiveness of HIV preexposure prophylaxis (PrEP) in preventing HIV acquisition, uptake among MSM remains suboptimal. Motivational interviewing (MI) has demonstrated efficacy at increasing PrEP uptake among MSM but is resource-intensive, limiting scalability. The use of artificial intelligence, particularly large language models with conversational agents (ie, "chatbots") such as ChatGPT, may offer a scalable approach to delivering MI-based counseling for PrEP and HIV prevention. Objective:This internal usability testing aimed to evaluate the development of an artificial intelligence-based chatbot, including its ability to provide MI-aligned education about PrEP and HIV prevention and potential to support PrEP uptake. Methods:The Chatbot for HIV Prevention and Action (CHIA) was built on a GPT-4o base model embedded with a validated knowledge database on HIV and PrEP in English and Spanish. The CHIA was fine-tuned through training on a large MI dataset and prompt engineering. The use of the AutoGen multiagent framework enabled the CHIA to integrate 2 agents, the PrEP Counselor Agent and the Assistant Agent, which specialized in providing MI-based counseling and handling function calls (eg, assessment of HIV risk), respectively. During internal testing from March 10-April 28, 2025, we systematically evaluated the CHIA's performance in English and Spanish using a set of 5-point Likert scales to measure accuracy, conciseness, up-to-dateness, trustworthiness, and alignment with aspects of the MI spirit (eg, collaboration, autonomy support) and MI-consistent behaviors (eg, affirmation, open-ended questions). Descriptive statistics and mixed linear regression were used to analyze the data. Results:A total of 296 responses, including 145 English responses and 151 Spanish responses, were collected during the internal testing period. Overall, the CHIA demonstrated strong performance across both languages, receiving the highest combined scores in the general response quality metrics including up-to-dateness (mean 4.6, SD 0.8), trustworthiness (mean 4.5, SD 0.9), accuracy (mean 4.4, SD 0.9), and conciseness (mean 4.2, SD 1.1). The CHIA generally received higher combined scores for metrics that assessed alignment with the MI spirit (ie, empathy, evocation, autonomy support, and collaboration) and lower combined scores for MI-consistent behaviors (ie, affirmation, open-ended questions, and reflections). Spanish responses had significantly lower mean scores than English responses across nearly all MI-based metrics. Conclusions:Our internal usability testing highlights the potential of the CHIA as a viable tool for delivering MI-aligned counseling in English and Spanish to promote HIV prevention and support PrEP uptake, though its Spanish language performance requires further improvement.
Objectives Emergency departments (ED) are increasingly implementing community health worker (CHW) and peer recovery specialist (PRS) programs to engage patients with substance use disorders and link them to harm reduction and addiction treatment services. This scoping review aims to provide a broad overview of current research on ED-based CHW and PRS programs in North America. Methods We conducted a comprehensive database search on PubMed, Embase, MEDLINE/OVID, and World of Science through December 31, 2022. Articles were screened for inclusion by 2 reviewers with conflicts resolved by a third reviewer. Data extraction from full-text articles was completed by 3 reviewers and checked for accuracy by a separate reviewer. Results We screened 12,187 abstracts, reviewed 398 full-text articles, and selected 64 papers about 35 distinct programs for inclusion. Study design included a mix of retrospective and prospective analyses, including a few randomized control trials. Core program components include services navigation (97.1%), motivational interviewing and/or a brief intervention (65.7%), harm reduction services (42.9%), and case management (28.6%). Most programs evaluating addiction treatment engagement noted comparative increase in treatment engagement after program implementation, which includes initiation of medication for opioid use disorder and outpatient treatment engagement. Programs evaluating ED utilization noted a reduction in ED visits after program implementation. Comparative outcome research about overdose, hospitalizations, mortality, and cost were limited. Conclusion ED-based CHW and PRS programs varied in design and services provided. Most studies measuring engagement reported favorable effects, although with limited effect size and heterogenous study quality, design, and metrics that limit generalizability. Future research should evaluate program effectiveness and identify key elements of successful ED-based programs to inform implementation.
Amid the increase in fatal overdoses in Rhode Island (RI) over the past decade, understanding substance use and harm reduction practices is critical for informing prevention strategies. This work aimed to evaluate trends in substance use behaviors, overdose experiences, and harm reduction practices among people who use non-prescribed substances in RI. In a convenience sample of 673 participants from the 2021-2024 Harm Reduction Surveillance System (HRSS), the most reported substances used in the past 30 days were: alcohol (73%), crack cocaine (72%), cannabis (69%), cocaine (42%), and fentanyl/heroin (39%). We observed a decrease in harm reduction practices in 2024, including always using fentanyl test strips and always using substances in the presence of others after an increase from 2021 to 2023. Notably, 86% of respondents reported having a disability. These findings emphasize the ongoing need for comprehensive harm reduction programs to engage high-risk individuals, tailored to those with disabilities.
As definitions of obesity evolve beyond a sole focus on weight, evidence-based obesity treatments may also benefit from a broadening in focus. This review discusses benefits of setting goals with patients that expand beyond weight or anthropometric change, and reviews recent data on expected outcomes in four such domains where patients may often desire change: obesity-related diseases, health-related quality of life (HrQoL), body image, and weight bias internalization (WBI). Lifestyle modification, obesity management medications, and metabolic and bariatric surgery can yield meaningful gains in obesity-related diseases, physical HrQoL, and body image. However, there is variability in response, and the expected magnitude of gains can differ by treatment approach and magnitude of weight loss. Less is known about WBI. Many patients are likely to see benefits beyond weight loss during treatment. Clarifying patients’ goals in these areas and aligning treatments accordingly can promote patient-centered care.
