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Randomized Controlled Trial
. 2014 Apr 15;65(5):611-20.
doi: 10.1097/QAI.0000000000000100.

Computerized counseling reduces HIV-1 viral load and sexual transmission risk: findings from a randomized controlled trial

Ann E Kurth  1 , Freya Spielberg, Charles M Cleland, Barrot Lambdin, David R Bangsberg, Pamela A Frick, Anneleen O Severynen, Marc Clausen, Robert G Norman, David Lockhart, Jane M Simoni, King K Holmes
Affiliations
Randomized Controlled Trial

Computerized counseling reduces HIV-1 viral load and sexual transmission risk: findings from a randomized controlled trial

Ann E Kurth et al. J Acquir Immune Defic Syndr. .

Abstract

Objective: Evaluate a computerized intervention supporting antiretroviral therapy (ART) adherence and HIV transmission prevention.

Design: Longitudinal randomized controlled trial.

Settings: An academic HIV clinic and a community-based organization in Seattle.

Subjects: In a total of 240 HIV-positive adults on ART, 209 completed 9-month follow-up (87% retention).

Intervention: Randomization to computerized counseling or assessment only, 4 sessions over 9 months.

Main outcome measures: HIV-1 viral suppression, and self-reported ART adherence and transmission risks, compared using generalized estimating equations.

Results: Overall, intervention participants had reduced viral load: mean 0.17 log10 decline, versus 0.13 increase in controls, P = 0.053, and significant difference in ART adherence baseline to 9 months (P = 0.046). Their sexual transmission risk behaviors decreased (odds ratio = 0.55, P = 0.020), a reduction not seen among controls (odds ratio = 1.1, P = 0.664), and a significant difference in change (P = 0.040). Intervention effect was driven by those most in need; among those with detectable virus at baseline (>30 copies/mL, n = 89), intervention effect was mean 0.60 log10 viral load decline versus 0.15 increase in controls, P = 0.034. ART adherence at the final follow-up was 13 points higher among intervention participants versus controls, P = 0.038.

Conclusions: Computerized counseling is promising for integrated ART adherence and safer sex, especially for individuals with problems in these areas. This is the first intervention to report improved ART adherence, viral suppression, and reduced secondary sexual transmission risk behavior.

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Figures

Figure 1
Figure 1
CARE+ Computerized Counseling Intervention Content By Session
Figure 2
Figure 2
CARE+ Computerized Counseling Intervention Trial, Four Sessions Over 9 Months HIV denotes human immunodeficiency virus-1.
Figure 3
Figure 3. Adjusted Means* by Time and Treatment Condition
* NOTE: For these independent 95% confidence intervals, non-overlap indicates p < .05, but overlap does not reliably indicate that p > .05 (Cumming, 2009). See Fig. 4 for contrasts. Detectable BL: had detectable HIV1 viral load at first baseline (BL) session Full sample: All participants regardless of viral load status at baseline
Figure 4
Figure 4
Comparison of Viral Load, ART Adherence, and Unprotected Sex for Each Follow-up Point and Changes within each Treatment Condition.
See this image and copyright information in PMC

References

    1. Barroso PF, Schechter M, Gupta P, Bressan C, Bomfim A, Harrison LH. Adherence to antiretroviral therapy and persistence of HIV RNA in semen. J Acquir Immune Defic Syndr. 2003 Apr 1;32(4):435–440. - PubMed
    1. Donnell D, Baeten JM, Kiarie J, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet. 2010 Jun 12;375(9731):2092–2098. - PMC - PubMed
    1. Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. The New England journal of medicine. 2000 Mar 30;342(13):921–929. - PubMed
    1. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. The New England journal of medicine. 2011 Aug 11;365(6):493–505. - PMC - PubMed
    1. Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. Department of Health and Human Services; 2013. Panel on Antiretroviral Guidelines for Adults and Adolescents. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf.

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