BACKGROUND:Poor sleep is a well-established risk factor for heavy drinking, and evidence suggests that sleep could serve as a potential treatment target for reducing alcohol consumption. The relationship between poor sleep and problematic drinking appears to be stronger among females, but no studies to date have assessed sex differences in alcohol consumption following insomnia treatment. Here, we combine the samples from two clinical trials to investigate sex differences in the effects of a digital cognitive behavioral therapy for insomnia (Sleep Healthy Using the Internet; SHUTi) on sleep and alcohol outcomes. METHODS:184 heavy drinking individuals with insomnia (weekly binge episodes: 4/5 + drinks in one sitting for females/males; AUDIT score >7; ISI score >14) were randomly assigned to either the SHUTi program (n = 102) or an active control program (n = 82). Participants completed self-report assessments at baseline, immediately following the 9-week intervention period, and at 3 and 6-months post-intervention. RESULTS:Linear mixed effects models showed that SHUTi effects over time were stronger among females than males for improved sleep outcomes and reduced frequency of total and heavy drinking days (ps ≤ 0.038). Follow-up comparisons of within-group effect sizes revealed consistently larger reductions in alcohol consumption among SHUTi females (Cohen's d range = 0.92-2.23) than SHUTi males (Cohen's d range = 0.65-1.95). CONCLUSIONS:Findings suggest that SHUTi may be more efficacious in improving sleep and reducing drinking among females with insomnia compared to males. These results could have important implications for sex-specific prevention and treatment efforts for heavy drinking individuals with insomnia.

Digital cognitive behavioral therapy for insomnia (d-CBT-I) shows promise for improving sleep and reducing drinking among heavy drinkers with comorbid insomnia, a population characterized by a bidirectional relationship between alcohol use and sleep disturbance. This qualitative study examined experiences of a subgroup of heavy drinkers with insomnia who completed SHUTi, a well-validated d-CBT-I program, as part of two sequential randomized controlled trials (NCT04564807; NCT05630118). Semi-structured post-intervention interviews of SHUTi completers (n = 46) were analyzed using Braun and Clarke’s reflexive thematic analysis. Four themes emerged: overall impressions; advantages and disadvantages for sleep; advantages and disadvantages for alcohol use; and suggested program improvements. SHUTi was perceived as highly beneficial for sleep. Perceived alcohol benefits were modest and indirect, suggesting that the alcohol benefit is best understood as a clinically important hypothesis about alcohol use mediated by changes in insomnia severity as well as a rationale for future SHUTi adaptations to better support alcohol reduction. Trial Registration: ClinicalTrials.gov Identifiers: NCT04564807 (Registered 09-22-2020) and NCT05630118 (Registered 11-17-2022).

Poor sleep and problematic drinking share a bidirectional relationship. Recent studies have targeted sleep as a novel means of improving drinking outcomes, including a prior pilot trial by our group which showed that a digital insomnia intervention (Sleep Healthy Using the Internet [SHUTi]) significantly improved sleep and drinking outcomes to a greater degree than a patient education (PE) program. In the present study, we aimed to replicate and extend our prior findings by assessing diary-derived measures of sleep and alcohol use as well as mental health outcomes in a larger sample. One hundred thirteen heavy drinkers with insomnia were randomly assigned to either the SHUTi (n = 61) or a sleep PE program (n = 52). Participants completed assessments immediately following the intervention period (9 weeks) and again at 3- and 6-months postintervention. Linear mixed-effects models showed that those in the SHUTi condition reported significantly greater improvements in sleep and greater reductions in drinking frequency relative to the PE condition. Additionally, those in the SHUTi condition reported greater reductions in depression symptoms and sleep medication use relative to the PE condition. Limitations include relatively high attrition, reliance on self-report measures, and demographic homogeneity. These findings replicate and extend the pilot trial results and support the utility of incorporating sleep interventions into alcohol use disorder prevention and treatment efforts. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Violence against women is prevalent in South Africa. This qualitative study sought to describe female village residents' perspectives on intimate partner violence (IPV) in their communities. As part of a multi-year collaborative mixed-methods study on IPV and alcohol-related sexual risks, a culturally tailored vignette was developed to prompt verbal reflection from 31 female community residents aged 18 to 40 years in rural Limpopo. Participants discussed the controlling and abusive behaviour described within the vignette. Audiotapes were transcribed and underwent thematic analysis. Major themes included traditional male dominance, addressing violence against women, and victim's consequences. While most women opposed the husband's violent behaviour in the vignette, some viewed it as acceptable, believing that a wife should 'submit'. Notably, certain participants attributed blame to women for provoking their husbands' violent acts. Some suggested that the woman in the vignette had implicitly accepted such treatment from the outset, thus bearing responsibility for its continuation. Proposed solutions ranged from ending the relationship and seeking family advice, to acknowledging that the husband's violent tendencies require professional intervention beyond mere advice. In rural areas like Limpopo, traditional male-dominant behaviours often remain unchallenged. To reduce male-perpetrated IPV, interventions at the community, family, and professional levels are needed.

Background:Binge drinking, which is linked to various immediate and long-term negative outcomes, is highly prevalent among US college students. Behavioral interventions delivered via mobile phones have a strong potential to help decrease the hazardous effects of binge drinking by promoting safer drinking behaviors. Objective:This study aims to evaluate the preliminary efficacy of bhoos, a novel smartphone app designed to promote safer drinking behaviors among US college students. The app offers on-demand educational content about safer alcohol use, provides dynamic feedback as users log their alcohol consumption, and includes an interactive drink tracker that estimates blood alcohol content in real time. Methods:The bhoos app was tested in 2 independent pre-post studies each lasting 4 weeks, among US college students aged 18-35 years. The primary outcome in both trials was students' self-reported confidence in using protective behavioral strategies related to drinking, with self-reported frequency of alcohol consumption over the past month examined as a secondary outcome. Results:In study 1, bhoos was associated with increased confidence in using protective behavioral strategies. Students also endorsed the high usability of the app and reported acceptable levels of engagement. Study 2 replicated findings of increased confidence in using protective behavioral strategies, and demonstrated a reduction in the self-reported frequency of alcohol consumption. Conclusions:Bhoos is a personalized, accessible, and highly scalable digital intervention with a strong potential to effectively address alcohol-related behaviors on college campuses.

Older adults with insomnia face considerable challenges accessing treatment given limited availability to first-line therapy (Cognitive-Behavioral Therapy for Insomnia, CBT-I). This study evaluated the efficacy of Sleep Healthy Using the Internet for Older Adults Suffering with Insomnia and Sleeplessness (SHUTi OASIS), a tailored CBT-I internet intervention for older adults with insomnia, in a 3-arm randomized controlled trial (SHUTi OASIS alone, SHUTi OASIS + stepped support, online patient education [PE]). 311 participants (ages 55-95) were randomized to receive SHUTi OASIS (alone n = 105; with stepped support n = 102), with both conditions reporting significant improvements across post, 6-month, and 12-month follow-ups in insomnia severity compared to those receiving PE (n = 104). Clinically meaningful indices of insomnia response and remission were also higher among those receiving SHUTi OASIS. Those who received SHUTi OASIS also significantly outperformed those receiving PE on secondary outcomes, including sleep onset latency, wake after sleep onset, sleep efficiency, number of awakenings, sleep quality, and fatigue, across most timepoints. Results indicate that digital CBT-I provides important benefits for older adults, offering strong potential to expand access to insomnia treatment for this underserved population.

By consistently taking medication, people with HIV (PWH) can attain viral suppression, improving their health and reducing transmission risk. PositiveLinks (PL) is a clinic-deployed mobile platform designed to improve engagement in care for PWH by enabling them to track their medications, connect with peers, and communicate with providers. This project investigated the experience of PL users who had recent periods of viral non-suppression to understand how these high-risk episodes can be predicted and prevented. Fifteen participants completed mental health measures and in-depth interviews. Two members of the study team independently coded interview transcripts and resolved any discrepancies. The codebook was developed iteratively until thematic saturation and intercoder reliability were achieved. Participants revealed mental health and substance use concerns. Frequent stressors highlighted were relationship challenges, financial difficulties, and unstable living situations. Relationship challenges were a common barrier to care, along with competing priorities, transportation and finances. In contrast, positive relationships, motivation, positive interactions with clinic staff, and social programs facilitated regaining viral suppression. Participants highlighted the importance of strong patient-provider relationships and social support in overcoming barriers to care. We identified factors that impact medication adherence, which will inform efforts to mitigate and prevent viral non-suppression and thus improve health outcomes.

Youth with HIV (YWH) face challenges in achieving viral suppression, particularly in the Southern United States, and welcome novel interventions responsive to community needs. The Theory of Planned Behavior (TPB) describes factors that influence behavior change, and the Positive Youth Development (PYD) supports youth-focused program design. We applied TPB and PYD to explore factors supporting care engagement and challenges for YWH in South Texas. We conducted 14 semi-structured interviews with YWH and 7 focus groups with 26 stakeholders informed by TPB, PYD, and themes from a youth advisory board (YAB). The research team and YAB reviewed emerging themes, and feedback-aided iterative revision of interview guides and codebook. Thematic analysis compared code families by respondent type, TPB, and PYD. All study methods were reviewed by the UT Health San Antonio and University Health Institutional Review Boards. Emerging themes associated with care engagement included: varied reactions to HIV diagnosis from acceptance to fear/grief; financial, insurance, and mental health challenges; history of trauma; high self-efficacy; desire for independence; and desire for engagement with clinic staff from their age group. Stakeholders perceived YWH lifestyle, including partying and substance use, as care barriers. In contrast, YWH viewed "partying" as an unwelcome stereotype, and barriers to care included multiple jobs and family responsibilities. Two key themes captured in PYD but not in TPB were the importance of youth voice in program design and structural barriers to care (e.g., insurance, transportation). Based on these findings, we provide critical and relevant guidance for those seeking to design more effective youth-centered HIV care engagement interventions. By considering the perspectives of YWH in program design and incorporating the PYD framework, stakeholders can better align with YWHs' desire for representation and agency. Our findings provide important and relevant guidance for those seeking to design more effective HIV care engagement interventions for YWH.

In HIV care, a strong rapport between patient and provider is essential for strengthening trust, enhancing therapy adherence, and ultimately leading to improved health outcomes. As the adoption of digital interactions in HIV care via mobile health (mHealth) tools is emerging, maintaining rapport in these asynchronous text-based communications becomes a critical yet challenging task. In this paper, we analyze 1,740 messages from an mHealth platform, categorized by experienced clinicians as either ‘rapport-building’ or ‘information-only.’ We utilize linguistic analysis to uncover key attributes of rapport-building communication. This led to a set of machine learning (ML) models and Large Language Models (LLMs) capable of classifying these communication styles. Further, we propose the application of LLMs not only to identify but also to actively rewrite ‘information only’ messages into versions that enhance rapport building without compromising information integrity. Our research demonstrates potential advancements in HIV mHealth communication by integrating linguistic analysis with language models, leading to more effective patient-provider interactions.

Background:Evaluating implementation of digital health interventions (DHIs) in practice settings is complex, involving diverse users and multistep processes. Proactive planning can ensure desired implementation determinants and outcomes are captured for hybrid studies, but operational guidance for DHI studies is limited. Methods:We planned a cluster randomized, type II hybrid effectiveness-implementation trial testing PositiveLinks, a smartphone application for HIV care, compared to usual care (n = 6 sites per arm), among HIV outpatient sites in the DC Cohort Longitudinal HIV Study in Washington, DC. Our process included: 1) Defining components of the DHI and associated implementation strategy, 2) Selecting implementation science frameworks to accomplish evaluation aims, 3) Mapping framework dimensions, domains, and constructs to implementation strategy steps, 4) Modifying/creating instruments to collect data for implementation outcome measures and determinants and 5) Developing a compatible implementation science data collection and management plan. Results:Specification of components of the DHI and implementation strategy identified relevant platform usage data and necessary implementer actions, toward planning measurement of program reach and adoption. A priori mapping of implementation strategy steps to the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework identified how data would be collected for each step/corresponding outcome measure. The multi-site cohort study provided infrastructure for prospective, scaled implementation research, including site research assistants (RAs) coordinating implementation. Existing cohort tools (periodic site assessments, patient consent logs) were adapted for the evaluation to further capture representativeness and reach/adoption 'denominators.' New survey instruments allowed for framework-guided evaluation of provider adaptations/dose/fidelity to planned implementation across a large number of participants and multiple timepoints. Some aspects of real-world implementation were challenging to mirror within the planned hybrid trial (e.g. RAs selected as de facto site implementation leads) or were modified to preserve internal validity of effectiveness measurement (e.g. PositiveLinks 'community of practice'). Conclusions:Challenges and opportunities arose in planning the implementation evaluation for PositiveLinks within a hybrid trial in a cohort population. Prospective hybrid trial planning must balance generalizability of implementation processes to 'real world' conditions, with rigorous trial procedures to measure intervention effectiveness. Rapid, scalable tools require further study to enable evaluations within large, multi-site hybrid studies.

BACKGROUND:To reduce substance use and sexual HIV transmission risk among sexual minority men (SMM) requires the development of interventions tailored for those in relationships. In the past 5 years, there have been considerable advances in the development of motivational nterviewing (MI) with couples. The Couples Health Project (CHP) is the first multi-session risk reduction protocol built on this formative research. The purpose of this study is to evaluate the efficacy of CHP relative to a standard of care control - couples HIV testing and counseling (CHTC). METHODS:Eligibility includes couples where both partners are aged 18 or older, identify as cisgender male (assigned male sex at birth and identify as male gender), live in the US, and can communicate in English. Additionally, at least one partner has to be aged 18-34, HIV-negative, report recent drug use (excluding cannabis) and report condomless anal sex during the past 30 days. Couples are randomized post-baseline assessment to either CHP or CHTC. Follow-up assessments are completed at 3, 6, and 9-months post-randomization. DISCUSSION:Findings from this trial will inform the practice of MI with couples. If found efficacious, the CHP intervention would be the first multi-session MI with couples' risk reduction protocol designed for use by substance use treatment or HIV prevention service providers who wish to engage SMM and their relationship partners. PROTOCOL VERSION:1.0; April 1, 2024. TRIAL REGISTRATION:ClinicalTrials.gov Protocol Registration; NCT06307977; completed March 6, 2024; https://register. CLINICALTRIALS:gov/ .

Background: Cancer caregivers are more likely to report clinically significant symptoms of insomnia than patients with cancer and the general population, yet research has been limited regarding cognitive-behavioral therapy for insomnia (CBT-I) among this population. Methods: To better understand cancer caregivers' engagement with and benefit from CBT-I, cancer caregivers were enrolled in a nonrandomized pilot feasibility trial of an evidence-based Internet-delivered insomnia program. Thirteen caregivers completed mixed-methods assessments before receiving the insomnia program and after the nine-week intervention period. Results: Compared with the five caregivers who did not complete any intervention Cores, the eight caregivers who completed at least one of the intervention Cores tended to report more sleep impairment (insomnia symptom severity; minutes of sleep onset latency and wake after sleep onset), less physical and emotional strain from caregiving, and less maladaptive sleep beliefs at the baseline assessment. These caregivers who used the program also showed large improvements in their insomnia symptoms. Caregivers' qualitative feedback about their experience with the program identified potential areas that might be modified to improve caregivers' engagement with and benefit from Internet-delivered insomnia programs. Conclusions: Findings suggest that family cancer caregivers can use and benefit from a fully automated Internet-delivered CBT-I program, even without caregiving-specific tailoring. Further rigorous research is needed to better understand whether and how program modifications may allow more caregivers to initiate and engage with this program.

Background: Older adults with insomnia face considerable challenges accessing treatment given limited availability to first-line therapy (cognitive-behavioral therapy for insomnia, CBT-I) and risks related to second-line treatment (pharmacotherapy).Objectives: Evaluate the efficacy of Sleep Healthy Using the Internet for Older Adults Suffering with Insomnia and Sleeplessness (SHUTi OASIS), a tailored CBT-I program for older adults with insomnia delivered via the Internet. Design: Randomized controlled trial with three conditions (SHUTi OASIS, SHUTi OASIS + stepped support, online patient education [PE]).Setting: Remotely conducted trial in the United States.Participants: Older adults with chronic insomnia (age range 55 to 95).Methods: 311 participants were enrolled and completed assessments of self-reported questionnaires, including the Insomnia Severity Index, and 10 prospectively-collected online sleep diaries at baseline, post (after 9-week intervention period), 6-month post, and 12-month post.Results: Participants randomized to receive SHUTi OASIS (n=207; conditions collapsed given limited need of stepped support) were compared to those receiving PE (n=104). SHUTi OASIS significantly outperformed PE with overall group by time interactions for the primary outcome of insomnia severity (F3,779=30.61, p<.001), as well as for sleep onset latency (F3,774=6.15, p<.001) and wake after sleep onset (F3,778=11.13, p<.001), with participants receiving SHUTi OASIS showing greater improvements at post, 6-months post, and 12-months post. Clinically meaningful indices of insomnia response and remission were also higher among SHUTi OASIS participants compared to PE participants. Conclusion: Older adults can meaningfully benefit from online CBT-I, which holds significant promise to increase access to effective insomnia treatment among this underserved population.

Youth and emerging adults with HIV (YWH) are less likely to engage in care and achieve viral suppression, compared with other age groups. YWH also have a high degree of self-efficacy and willingness to adopt novel care modalities, including mobile health (mHealth) interventions. Interventions to increase care engagement could aid YWH in overcoming structural and social barriers and leveraging youth assets to improve their health outcomes. We used an assets-based framework, Positive Youth Development, and human-centered design principles to adapt an existing mHealth intervention, PositiveLinks (PL) to support care engagement for 18-29-year-olds with HIV. We conducted a formative evaluation including semi-structured interviews with 14 YWH and focus groups with 26 stakeholders (providers, nurses, case managers, clinic staff). Interviews covered barriers to care, provider communication, and concerns or suggestions about mHealth interventions. The research team compiled responses into families and used thematic analysis. In the second phase, design thinking processes informed adaptation of the existing PositiveLinks platform using data from three YWH’s real time use suggestions. Throughout the formative evaluation and adaptation, a Youth Advisory Board (YAB) provided input. YWH and stakeholders identified common elements of an mHealth intervention that would support care engagement including: the convenience of addressing needs through the App, virtual support groups to support interconnection, short videos or live chats with other YWH or providers, appointment and medication reminders, and medical information from a trustworthy source. Stakeholders also mentioned the need for youth empowerment. Concerns included worries about confidentiality, unintentional disclosures of status, urgent content in an unmoderated forum, and the impersonality of virtual platforms. Design suggestions from YWH included suggestions on appearance, new formatting for usability of the virtual support group, and prioritization of local content. Based on the feedback received, iterative changes were made to transform PL into Positive Links for Youth (PL4Y). Final votes on adaptations were made by the YAB. The overall appearance of the platform was changed, including logo, color, and font. The virtual support group was divided into three channels which support hashtags and content searches. The 'Resources' and 'Frequently Asked Questions' sections were condensed and revised to prioritize South Texas-specific content. Our assets-based framework supported YWH and stakeholder input in the transformation an mHealth intervention to meet the needs of 18-29 yos in South Texas. The human-centered design approach allowed YWH to suggest specific changes to the intervention’s design to support usability and acceptability. This adapted version, Positive Links for Youth (PL4Y), is now ready for pilot testing in the final phase of this implementation science project. n/a

PositiveLinks (PL) is a mHealth platform to support care engagement by people with HIV (PWH). Daily reminders prompt the user to report medication adherence, mood, and daily stress. Higher response rate to PL check-ins has been associated with better suppression of viral load over 6–18 months. We conducted a retrospective chart review for a three-year period collecting demographic information, average mood and stress scores, and all viral loads obtained in usual patient care. We performed multivariable logistic regression modeling to identify factors associated with loss of viral load suppression and a time-to-event survival analysis until first unsuppressed viral load stratified by PL usage. Of the 513 PWH included, 103 had at least one episode of viral non-suppression. Low users of PL were more likely to have an unsuppressed viral load with an adjusted Odds Ratio (aOR) of 5.8 (95

Background:Smoking remains the leading cause of preventable death, yet physicians inconsistently provide best-practices cessation advice to smokers. Point-of-care digital health tools can prompt and assist physicians to provide improved smoking cessation counseling. QuitAdvisorMD is a comprehensive web-based counseling and management digital health tool designed to guide smoking cessation counseling at the point-of-care. The tool enables clinicians to assess patient readiness to change and then deliver stage-appropriate interventions, while also incorporating Motivational Interviewing techniques. We present the research protocol to assess the efficacy of QuitAdvisorMD to change frequency and quality of smoking cessation counseling and its effect on patient quit rates.Methods:A practice-based, clustered, randomized controlled trial will be used to evaluate QuitAdvisorMD. Cluster design will be used where patients are clustered within primary care practices and practices will be randomized to either the intervention (QuitAdvisorMD) or control group. The primary outcome is frequency and quality of clinician initiated smoking cessation counseling. Secondary outcomes include, 1) changes in physician knowledge, skills and perceived self-efficacy in providing appropriate stage-based smoking cessation counseling and 2) patient quit attempts. Analyses will be conducted to determine pre- and post-test individual clinician outcomes and between intervention and control group practices for patient outcomes.Conclusion:Results from this study will provide important insights regarding the ability of an integrated, web-based counseling and management tool (QuitAdvisorMD) to impact both the quality and efficacy of smoking cessation counseling in primary care settings.

BackgroundHIV viral suppression and retention in care continue to be challenging goals for people with HIV in Washington, District of Columbia (DC). The PositiveLinks mobile app is associated with increased retention in care and viral load suppression in nonurban settings. The app includes features such as daily medication reminders, mood and stress check-ins, an anonymized community board for peer-to-peer social support, secure messaging to care teams, and resources for general and clinic-specific information, among other features. PositiveLinks has not been tailored or tested for this distinct urban population of people with HIV. ObjectiveThis study aimed to inform the tailoring of a mobile health app to the needs of people with HIV and their providers in Washington, DC. MethodsWe conducted a 3-part formative study to guide the tailoring of PositiveLinks for patients in the DC Cohort, a longitudinal cohort of >12,000 people with HIV receiving care in Washington, DC. The study included in-depth interviews with providers (n=28) at study clinics, focus groups with people with HIV enrolled in the DC Cohort (n=32), and a focus group with members of the DC Regional Planning Commission on Health and HIV (COHAH; n=35). Qualitative analysis used a constant comparison iterative approach; thematic saturation and intercoder agreement were achieved. Emerging themes were identified and grouped to inform an adaptation of PositiveLinks tailored for patients and providers. ResultsEmerging themes for patients, clinic providers, and COHAH providers included population needs and concerns, facilitators and barriers to engagement in care and viral suppression, technology use, anticipated benefits, questions and concerns, and suggestions. DC Cohort clinic and COHAH provider interviews generated an additional theme: clinic processes. For patients, the most commonly discussed potential benefits included improved health knowledge and literacy (mentioned n=10 times), self-monitoring (n=7 times), and connection to peers (n=6 times). For providers, the most common anticipated benefits were improved communication with the clinic team (n=21), connection to peers (n=14), and facilitation of self-monitoring (n=11). Following data review, site principal investigators selected core PositiveLinks features, including daily medication adherence, mood and stress check-ins, resources, frequently asked questions, and the community board. Principal investigators wanted English and Spanish versions depending on the site. Two additional app features (messaging and documents) were selected as optional for each clinic site. Overall, 3 features were not deployed as not all participating clinics supported them. ConclusionsPatient and provider perspectives of PositiveLinks had some overlap, but some themes were unique to each group. Beta testing of the tailored app was conducted (August 2022). This formative work prepared the team for a cluster randomized controlled trial of PositiveLinks’ efficacy. Randomization of clinics to PositiveLinks or usual care occurred in August 2022, and the randomized controlled trial launched in November 2022. International Registered Report Identifier (IRRID)RR2-10.2196/37748

Abstract Background People with HIV (PWH) and substance use (PWSU) have demonstrated inferior HIV care continuum outcomes, including lower retention in care (RIC), poorer ART adherence, and lower rates of viral suppression (VS) relative to peers without substance use within the literature. We compared 3-year outcomes among people with and without substance use who are enrolled in a smartphone intervention, PositiveLinks (PL), to determine the relative impact of PL for this subgroup of PWH. Methods We performed retrospective chart review of clinical encounter and laboratory data and ICD-diagnoses for 600 PWH enrolled in PL from 2017-2020. Substance use was categorized by diagnoses of illicit substance use and/or substance use-related visits conducted at the UVA Ryan White Clinic. Patients with no documented substance use, or documented tobacco or reported alcohol use with no criteria for a substance use disorder were considered non-substance using. We analyzed HIV clinical outcomes (VS, RIC by HRSA-1 measure) for PL members in each group at baseline (April 2017) and three years later (April 2020, t-test). Results Chart review for the 3-year period of interest for 600 PWH enrolled in PL revealed 117 PWH meeting criteria for substance use and 483 not meeting criteria. A mean of 13 Ryan White Clinic visits were conducted per person among 117 PWSU, compared to 8 visits each among 483 PWH without documented substance use (p< .01) over 3 years. Among PWSU, RIC increased from 56% to 79% (p< .01) while among PWH without substance use, RIC increased from 47% to 69% (p< .01). VS increased significantly among PWSU from 71% to 90% (p< .01), while among PWH without documented substance use, VS increased from 70% to 87%, (p< .01). Differences between groups for RIC and VS were not statistically significant at either time point. Conclusion A sample of 600 PWH using PL demonstrated comparable HIV clinical outcomes across 3 years regardless of substance use status. This sample selects for PWSU who stayed enrolled in PL at 3 years, and may not reflect outcomes expected for a broader population of variably engaged PWSU offered non-tailored mobile health interventions for HIV care. Further analysis is planned to determine whether covariates including demographic characteristics and PL usage patterns influence outcomes observed. Disclosures Sylvia Caldwell, MPH, DHSc, Warm Health Technology: Advisor/Consultant Ben Elliott, MSW, Warm Health Technology: Advisor/Consultant Ava Lena Waldman, M.H.S., CHES, CCRP, Warm Health Technology: Advisor/Consultant Rebecca Dillingham, MD MPH, Warm Health Technology: Advisor/Consultant