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Propelled by the transformative power of modern information and communication technologies, digitalization of data, and the increasing affordability of high-performance computing, Big Data science has brought forth revolutionary advancement in many areas of business, industry, health, and medicine. The HIV research and care service community is no exception to the benefits from the availability and utilization of Big Data analytics. Electronic health record (EHR) data (e.g., administrative and billing data, electronic medical records, or other digital records of information pertinent to individual or population health) are an essential source of health and disease outcome data because of the large amount of real-world, comprehensive, and often longitudinal data, which provide a good opportunity for leveraging advanced Big Data analytics in addressing challenges in HIV prevention, treatment, and care. This review focuses on studies that apply Big Data analytics to EHR data with aims to synthesize the HIV-related issues that EHR data studies can tackle, identify challenges in the utilization of EHR data in HIV research and practice, and discuss future needs and directions that can realize the promising potential role of Big Data in ending the HIV epidemic.

Opioid use disorder is a growing public health concern in the United States, causing economic burden and hindered by stigma. New forms of data, including location data, may improve the effectiveness of interventions for preventing and treating opioid use disorder and/or misuse, increase access to treatment and address racial and ethnic disparities. This qualitative study aimed to identify factors that contribute to users' experience with a publicly available location-tracking mobile app - and investigate their privacy and ethical concerns. The study was conducted through two 15-minute interviews within a 48-h time frame. Participants were recruited from a pool of past research participants, Facebook ads, and referrals, and had to meet certain inclusion criteria related to opioid use disorder and/or misuse. The study had a final sample of 30 participants, 15 male and 15 female. The study suggests that a simple onboarding process and convenient experience can enhance participant adherence to the study app and other similar location-based research apps. However, the study also found that participants had concerns about privacy and transparency about locational privacy when sharing their location data. To improve the app, researchers suggest incorporating user behavior earlier in the app development stage. The study also highlights the importance of addressing ethical and privacy concerns such as limiting the types of collected data, incorporating data encryption and retention strategies, giving access to research staff only, and not sharing the data with third-party companies or law enforcement agencies to increase user satisfaction.

Objectives: This study sought to explore the potential role of peer-led online communities to increase use of medications for opioid use disorder., Methods: From January through March 2020, participants with opioid use disorder and their family members/friends were recruited from paid Facebook ads; public health key stakeholders were recruited from referrals from the study team and opioid experts. Thirty participants from California were interviewed; 23 persons reporting opioid misuse, 3 family members/friends of persons misusing opioids, and 4 public health key stakeholders. We conducted semi-structured interviews asking about preferences, barriers and facilitators of treatment options for opioid use disorder, and perspectives around the use of digital/online communities. The categories of participants interviewed were each asked slightly different questions depending upon their role., Results: Results suggest that participants who misuse opioids (1) may prefer to engage in online communities rather than in-person meetings to discuss their opioid use, (2) generally prefer to receive opioid-related information from other patients with opioid use disorder and/or those in recovery rather than from health providers or other individuals, and (3) thought that an online community could be beneficial for helping address their opioid use., Conclusion: Results suggest an openness and interest in a peer-led online community to discuss opioid use and treatment among people who misuse opioids., Competing Interests: Conflict of Interest: The authors report no conflicts of interest

Background: Factors related to risky drinking (e.g., motives, protective behavioral strategies [PBS]) may vary between youth who engage in polysubstance use compared to those who consume alcohol only. We examined differences in factors among youth who consume alcohol only compared to alcohol with other substances (i.e., polysubstance use), and correlates associated with risky drinking between the groups., Methods: Participants ( N =  955; ages 16-24; 54.5% female) who reported recent risky drinking completed measures of alcohol/substance use, alcohol-related consequences, drinking motives, alcohol PBS, mental health symptoms, and emotion dysregulation. Participants were in the polysubstance group if they reported using at least one other substance (e.g., cannabis, stimulants) in addition to alcohol in the past three months. Chi-square and t -tests examined differences between the two groups and multiple regression analyses examined correlates of risky drinking., Results: Most participants (70.4%, n  = 672) reported polysubstance use; these individuals engaged in riskier patterns of drinking, experienced more alcohol-related consequences, used fewer PBS, had stronger drinking motives (enhancement, social, coping), endorsed more mental health symptoms, and reported more emotion dysregulation. Regression models showed that emotion dysregulation significantly associated with risky drinking in the alcohol-only group; conformity and coping motives, alcohol PBS, and anxiety symptoms significantly associated with risky drinking in the polysubstance group., Conclusions: Among risky drinking youth, results indicated youth engaging in polysubstance use have greater comorbidities and individual-level factors associated with risky drinking than youth who consume alcohol only. These findings may inform the tailoring of interventions for individuals who engage in risky drinking and polysubstance use.

Introduction: Vaccine hesitancy is still rampant in the United States, including health care personnel. Vaccination of frontline essential workers (e.g. health care workers) is very important, especially during a pandemic. We tested the efficacy of a 4-week online, peer-led intervention (Harnessing Online Peer Education) to promote requests for COVID-19 vaccine information among essential workers., Methods: Participants ( N  = 120) and peer leaders ( N  = 12) were recruited through online advertisements from July 23 to August 20, 2021. Eligibility criteria included: 18 years or older, U.S. resident, English speaker, part of phase 1a or 1 b of COVID-19 vaccine rollout (e.g. frontline essential workers), hadn't received a COVID-19 vaccine but able to receive one. This was a parallel assignment randomised trial. STATA was used to create a randomisation using a random number generator so that all possible assignments of participants and peer leaders to groups were equally likely. Participants were randomly assigned to intervention or control arms that consisted of two private, hidden Facebook groups, each with 30 participants. Peer leaders were randomly assigned to an intervention group, each with six peer leaders. Participants in the intervention arm were randomly assigned to three peer leaders. Participants were blinded after assignment. Peer leaders were tasked with reaching out to their assigned participants at least three times each week. Participants completed a baseline and a post intervention survey. The study is registered on ClinicalTrials.org under identifier NCT04376515 and is no longer recruiting. This work was supported by the NIAID under grant 5R01AI132030-05., Results: A total of 101 participants analysed (50 intervention and 51 control). Six people in the intervention group and 0 people in the control group requested vaccine information. Ten people in the intervention group and six people in the control group provided proof of vaccination. The odds of requesting vaccine information in the intervention group was 13 times that in the control group (95% confidence interval: (1.5, 1772), p -value = 0.015). Thirty-seven participants in the intervention group and 31 in the control group were engaged at some point during the study., Conclusions: Results suggest peer-led online community groups may help to disseminate health information, aid public health efforts, and combat vaccine hesitancy. Key MessagesThe odds of requesting vaccine information was 13 times in the intervention group.Peer-led online communities may help to disseminate information and aid public health efforts to combat vaccine hesitancy.

Background: Deaths due to opioid overdose continue to rise in the United States. Despite availability of effective treatment for opioid use disorder, uptake is low among those who misuse opioids. Methods: This paper explores the role of misconception, stigma, and misinformation in influencing decisions to initiate medications for opioid use disorder among patients and providers. Conclusion: Misinformation about opioids has been prevalent among future healthcare providers and first responders as well as pharmaceutical companies, which may have implications for treatment. Among individuals with opioid use disorder, treatment uptake and adherence have been negatively affected by misconceptions about treatment efficacy and side effects, as well as stigma. We discuss the role of social media, education, and the community, in mitigating misinformation and addressing misconceptions about opioids and treatment options.

Morbidity and mortality attributable to opioid use and misuse among adolescents and young adults are evident. Although recent trend data suggest a decrease in both opioid misuse and opioid use disorder among adolescents and young adults in the last few years, overdose cases continue to rise. The opioid epidemic among this population is complex and has a different profile compared to adults, with family facilitating exposure to opioids more often than other sources. Additionally, despite recommendations by experts to initiate medications for opioid use disorder, few initiate treatment. The recent COVID-19 pandemic has impacted many facets of daily life and its effects on the opioid crisis are largely unknown. Stay-at-home mandates resulting in online schooling and limited social interaction has had deleterious consequences for adolescents, especially their mental health. This viewpoint attempts to explore the effects of the pandemic on the opioid crisis in this vulnerable population.

Background: New data sources and analysis methods are urgently needed to improve opioid surveillance and prevent potential overdose. Social media data is one potential data source that might be used and integrated to address this issue. Objective: This study explored opioid-related topics discussed across geographical regions of varying population sizes to determine whether social media data might inform opioid surveillance. Methods: Between March 17th to July 17th, 2020, we collected tweets ( N  = 19,721) mentioning opioid-related keywords across seven cities within the United States. Results: Results found that opioid-related keywords were distributed as follows: New York (29%), Los Angeles (23%), Chicago (18%), Atlanta (18%), San Francisco (8%), Iowa (3%), and Orange County, CA (1%). We also found regional differences in the types of opioids and topics mentioned. Conclusions: Findings suggest the feasibility of using opioid-related social media data to inform surveillance efforts, as well as potential regional and time-varying differences in topics discussed.

The COVID-19 pandemic and its related policies, such as social distancing orders, are affecting the ability for people with substance use disorders (SUD) to seek prevention and treatment. In this commentary, we introduce conversational agents, a type of social technology. We discuss the role of conversational agents in the prevention and treatment of SUD in social distancing contexts and the potential benefits and limitations of designing and implementing such technology in the prevention and care for patients with SUD.

Background: Interdisciplinary approaches are needed to address complex societal problems, such as the opioid crisis. We sought to explore the feasibility and potential issues encountered in planning and implementing a 24-hour hackathon competition to bring together teams from law enforcement, public health, and data science to develop solutions to the opioid epidemic., Methods: We enlisted an advisory board and planning committee, including key stakeholders (e.g., high-level representatives from government agencies) to plan the event. Teams completed an online registration form with questions about team composition. Each team captain completed a survey at the event describing prior experiences with their team, knowledge and interest around the opioid epidemic, and hackathon expectations., Results: Twenty-nine teams (108 individuals) registered. 76% had a technical/engineering background. Participants were from industry (55%), academia (30%), public health/medicine (9%), and government/public policy (6%). Nineteen teams attended the event. Team captains were primarily 18-29 years of age, had moderate experience and interest in the opioid crisis, and had never attended an opioid-related event., Conclusions: It is feasible to implement a 24-hour opioid-focused hackathon and recruit teams/participants from a broad range of disciplines. We discuss the solutions developed, barriers encountered, and insights gained throughout the planning and implementation process., Competing Interests: The authors report no conflicts of interest.

Aims: Assess whether the Harnessing Online Peer Education (HOPE) social media-based support group can engage patients on opioids at risk for misuse/overdose to discuss risk reduction strategies. Methods: Fifty-one patients on chronic opioid therapy and risk factors for aberrant medication-taking behaviors were randomized to a HOPE intervention or control (Facebook) group. Results: Compared to control group participants, intervention participants had almost 10 times higher posting engagement ( n  = 411 posts versus 45; 73% versus 52% of participants). Participants discussed coping, pain, medication and non-medication treatments, and other opioid and addiction-related topics. Discussion: Results suggest that a HOPE online community might serve as an effective behavioral intervention tool among chronic pain patients on opioid therapy.

Social media technologies are newly emerging tools that can be used to address the growing prescription drug epidemic. In this study, we sought to determine the feasibility and acceptability of using social media to reduce complications of opioid use among patients experiencing chronic pain. Specifically, we evaluated the utility of the Harnessing Online Peer Education (HOPE) social media intervention to reduce the risk of addiction and overdose among non-cancer pain patients receiving chronic opioid therapy. University of California, Los Angeles (UCLA) patients receiving chronic opioid therapy and UCLA staff were invited to participate in interviews regarding the HOPE intervention. Questions focused on resources used to manage pain, the limitations and benefits of these approaches, and the likelihood of using an online community to reduce complications of opioid therapy. Using an open-coding process, three topics were identified for the patients: 1) online social support is important for improving outcomes, 2) offline social support is helpful for some patients but has limitations, and 3) a tailored, online peer support intervention is needed. Interviews with staff confirmed these results. The HOPE social media intervention and other online communities appear to be an acceptable technology for patients on chronic opioid therapy., Competing Interests: Declaration of Interest The authors report no conflicts of interest.

HIV remains concentrated among men who have sex with men (MSM) in Peru, and homophobia and AIDS-related stigmas have kept the epidemic difficult to address. Gay self-identity has been associated with increased HIV testing, though this relationship has not been examined extensively. Social media use has been rapidly increasing in Peru, yet little is known about MSM social media users in Peru. This study sought to investigate the demographic, behavioral, and stigma-related factors associated with HIV testing among social media-using Peruvian MSM. Five hundred and fifty-six MSM from Lima and surrounding areas were recruited from social networking websites to complete a survey on their sexual risk behaviors. We examined the demographic and social correlates of HIV testing behavior among this sample. Younger age and non-gay identity were significantly associated with lower likelihood of getting tested in univariate analysis. After controlling for key behaviors and AIDS-related stigma, younger age remained significantly associated with decreased testing. Participants who engaged in discussions online about HIV testing were more likely to get tested, while AIDS-related stigma presented a significant barrier to testing. Stigma severity also varied significantly by sexual identity. Youth appear to be significantly less likely than older individuals to test for HIV. Among Peruvian MSM, AIDS-related stigma remains a strong predictor of willingness to get tested. Social media-based intervention work targeting Peruvian youth should encourage discussion around HIV testing, and must also address AIDS-related stigma.

High levels of HIV stigma are one of the main difficulties in engaging African-American and Latino men who have sex with men (MSM) in HIV testing. The availability of home HIV test and the possibility of self-testing in private may improve uptake and counteract stigma. This paper sought to determine the correlates of requesting home HIV test kits among a sample of MSM social media users. The odds of participants requesting a test kit were significantly associated with using social networks to seek sexual partners (aOR: 2.47, 95% CI: 1.07-6.06) and thinking it is easier to use social networks for seeking sexual partners (1.87, 1.2-3.12), uncertain HIV status (4.29, 1.37-14.4), and having sex under the influence of alcohol (2.46, 1.06-5.77). Participants who had not been tested for more than 6 months were more likely to request a test kit than those who were tested in the past 6 months (2.53, 1.02-6.37). Participants who frequently talked to others about having sex with men online were less likely to request a test kit (0.73, 0.56-0.92). By reaching people over social media and offering them access to test kits, we were able to reach at-risk individuals who were uncertain about their HIV status and had not been regularly tested. The findings of the study will help to inform future HIV testing interventions., Competing Interests: statement: The authors declare there is no conflict of interest.

Peru is experiencing a concentrated HIV epidemic among men who have sex with men (MSM). Substance use (alcohol and drug use) has been found to be associated with HIV-related sexual risk behaviors. A recent surge in the number of social media users in Peru has enabled these technologies to be potential tools for reaching HIV at-risk individuals. This study sought to assess the relationship between substance use and sexual risk behaviors among Peruvian MSM who use social media. A total of 556 Peruvian MSM Facebook users (ages 18-59) were recruited to complete a 92-item survey on demographics, sexual risk behaviors, and substance use. We performed a logistic regression of various sexual risk behaviors (e.g., unprotected sex, casual sex) on substance abuse, including alcohol, adjusting for potential covariates. Drinking more than five alcoholic drinks a day in the past three months was associated with an increased odds of having unprotected sex (vaginal and anal) (aOR: 1.52; 95% CL: 1.01, 2.28), casual sex (1.75; 1.17, 2.62), and sex with unknown persons (1.82; 1.23, 2.71). Drug use was not significantly associated with sexual risk behaviors. Among Peruvian MSM social media users, findings suggest that alcohol use was associated with increased HIV-related sexual risk behaviors.

The recent increase in social media use allows these technologies to rapidly reach communities with higher HIV prevalence, such as African-American and Latino men who have sex with men (MSM). However, no studies have looked at HIV/AIDS stigma among social media users from African-American and Latino MSM communities, or the association between stigma and social media use among these groups. This study sought to assess the level of HIV/AIDS stigma among a sample of social media-using African-American and Latino MSM from Los Angeles. A total of 112 (primarily African-American and Latino, n = 98, 88%) MSM Facebook users completed a survey on demographics, online social network use, and HIV/AIDS stigma. A composite stigma score was created by taking the cumulative score from a 15-item stigma questionnaire. Cumulative logistic models were used to assess the association between HIV/AIDS stigma and online social network use. In general, participants reported a low level of HIV/AIDS stigma (mean = 22.2/75, SD = 5.74). HIV/AIDS stigma composite score was significantly associated with increased time spent on online social networks each day (Adjusted odds ratios (AOR): 1.07, 95% CI: 1.00, 1.15). Among this diverse sample of MSM online social network users, findings suggest that HIV/AIDS stigma is associated with usage of social media. We discuss the implications of this work for future HIV prevention., Competing Interests: DECLARATION OF CONFLICTING INTERESTS The authors report no conflicts of interest

This short report evaluates the feasibility of using electronic vending machines for dispensing oral, fluid, rapid HIV self-testing kits in Los Angeles County. Feasibility criteria that needed to be addressed were defined as: (1) ability to find a manufacturer who would allow dispensing of HIV testing kits and could fit them to the dimensions of a vending machine, (2) ability to identify and address potential initial obstacles, trade-offs in choosing a machine location, and (3) ability to gain community approval for implementing this approach in a community setting. To address these issues, we contracted a vending machine company who could supply a customized, Internet-enabled machine that could dispense HIV kits and partnered with a local health center available to host the machine onsite and provide counseling to participants, if needed. Vending machines appear to be feasible technologies that can be used to distribute HIV testing kits.

High stimulant-using and at-risk HIV populations, such as African American and Latino men who have sex with men (MSM), are increasingly using social networking technologies. However, no known research has explored associations between stimulant use, sexual risk behaviors, and social networking among these populations. Participants were recruited using the Facebook Connect software application, which narrowed the sample to 118 (primarily African American and Latino MSM) active Facebook users. Participants completed demographic, Internet and social media use, and drug use survey items. Participants reported high rates of cocaine and methamphetamine use (both more than 15% within the past 12 months). More than 70% of participants reported using social networking technologies to meet people, and more than 30% used them to find sexual partners. A multivariate logistic regression showed that (1) participants using social networks to find sexual partners were more likely to have used methamphetamines within the past 12 months and (2) those who were more comfortable talking online compared to face-to-face had over 4 times the odds of methamphetamine use and over 6 times the odds of cocaine use within the past 12 months. Minority MSM who used social networks to meet men and find sexual partners had high risk for stimulant use. Understanding drug use among minority social networking users will provide insights to incorporate these technologies into drug prevention interventions.

Novel methods, such as Internet-based interventions, are needed to combat the spread of HIV. While past initiatives have used the Internet to promote HIV prevention, the growing popularity, decreasing digital divide, and multi-functionality of social networking sites, such as Facebook, make this an ideal time to develop innovative ways to use online social networking sites to scale HIV prevention interventions among high-risk groups. The UCLA Harnessing Online Peer Education study is a longitudinal experimental study to evaluate the feasibility, acceptability, and preliminary effectiveness of using social media for peer-led HIV prevention, specifically among African American and Latino Men who have Sex with Men (MSM). No curriculum currently exists to train peer leaders in delivering culturally aware HIV prevention messages using social media. Training was created that adapted the Community Popular Opinion Leader (C-POL) model, for use on social networking sites. Peer leaders are recruited who represent the target population and have experience with both social media and community outreach. The curriculum contains the following elements: discussion and role playing exercises to integrate basic knowledge of HIV/AIDS, awareness of sociocultural HIV/AIDS issues in the age of technology, and communication methods for training peer leaders in effective, interactive social media-based HIV prevention. Ethical issues related to Facebook and health interventions are integrated throughout the sessions. Training outcomes have been developed for long-term assessment of retention and efficacy. This is the first C-POL curriculum that has been adapted for use on social networking websites. Although this curriculum has been used to target African-American and Latino MSM, it has been created to allow generalization to other high-risk groups.

We explore whether HIV stigma is associated with seeking to conceal testing interest. We examine 86,899 outpatient visits in a 1993-1997 national survey and compare HIV testing to four non-stigmatized tests: spirometry, allergy testing, mammography, and colonoscopy. We explore whether people testing for HIV, compared to people receiving control services, listed reasons for visit (RFV) less related to the test performed, listed their interest in testing more frequently as a non-primary RFV, and received more services unrelated to testing. A total of 48.7% of people tested for HIV listed a reason unrelated to testing as their primary RFV (spirometry: 8.9%; allergy testing: 29.3%), and 69.9% of people asking to test requested HIV testing as a secondary RFV (spirometry: 52%; allergy testing: 0%). People who tested for HIV received more services (M=1.83 additional services) than non-testers (M=0.95) on an index of seven services. We did not find this association for spirometry, allergy testing, colonoscopy, or mammography. We interpret these results to indicate that stigma may have behavioral correlates and that people may attempt to avoid HIV stigma by seeking a psychological cover for HIV testing. To our knowledge, this is the first study to attempt to use observational data on health service usage for assessing stigma and people's attempts to deal with HIV testing stigma.