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Clinical Trial
. 2023 Nov;27(11):3695-3712.
doi: 10.1007/s10461-023-04086-0. Epub 2023 May 25.

Effects of Behavioral Intervention Components for African American/Black and Latino Persons Living with HIV with Non-suppressed Viral Load Levels: Results of an Optimization Trial

Charles M Cleland  1   2 , Marya Gwadz  3   4   5 , Linda M Collins  2   6 , Leo Wilton  7   8 , Noelle R Leonard  2   9 , Amanda S Ritchie  10   11 , Belkis Y Martinez  12 , Elizabeth Silverman  10 , Dawa Sherpa  10 , Caroline Dorsen  13
Affiliations
Clinical Trial

Effects of Behavioral Intervention Components for African American/Black and Latino Persons Living with HIV with Non-suppressed Viral Load Levels: Results of an Optimization Trial

Charles M Cleland et al. AIDS Behav. 2023 Nov.

Abstract

There is an urgent need for efficient behavioral interventions to increase rates of HIV viral suppression for populations with serious barriers to engagement along the HIV care continuum. We carried out an optimization trial to test the effects of five behavioral intervention components designed to address barriers to HIV care continuum engagement for African American/Black and Latino persons living with HIV (PLWH) with non-suppressed HIV viral load levels: motivational interviewing sessions (MI), focused support groups (SG), peer mentorship (PM), pre-adherence skill building (SB), and navigation with two levels, short (NS) and long (NL). The primary outcome was HIV viral suppression (VS) and absolute viral load (VL) and health-related quality of life were secondary outcomes. Participants were 512 African American/Black and Latino PLWH poorly engaged in HIV care and with detectable HIV viral load levels in New York City, recruited mainly through peer referral. Overall, VS increased to 37%, or 45% in a sensitivity analysis. MI and SG seemed to have antagonistic effects on VS (z = - 1.90; p = 0.057); the probability of VS was highest when either MI or SG was assigned, but not both. MI (Mean Difference = 0.030; 95% CI 0.007-0.053; t(440) = 2.60; p = 0.010) and SB (Mean Difference = 0.030; 95% CI 0.007-0.053; t(439) = 2.54; p = 0.012) improved health-related quality of life. This is the first optimization trial in the field of HIV treatment. The study yields a number of insights into approaches to improve HIV viral suppression in PLWH with serious barriers to engagement along the HIV care continuum, including chronic poverty, and underscores challenges inherent in doing so.

Keywords: Fractional factorial design; HIV care continuum; HIV viral suppression; Multiphase optimization strategy (MOST); Optimization trial; Racial/ethnic inequities.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow of participants from screening for eligibility to follow-up assessments
Fig. 2
Fig. 2
HIV viral suppression SG*MI interaction
Fig. 3
Fig. 3
Log10 HIV viral load NL*SG interaction
Fig. 4
Fig. 4
Log10 HIV viral load PM*SB interaction
See this image and copyright information in PMC

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