Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Jul;29(7):2287-2298.
doi: 10.1007/s10461-025-04692-0. Epub 2025 Apr 5.

Increasing Sustained Viral Suppression Among Youth Living with HIV: A Randomized Controlled Trial of Stepped Care Intervention

Elizabeth Mayfield Arnold  1 , Mary Jane Rotheram-Borus  2 , Joan Christodoulou  3 , Matthew M Yalch  3 , Debra A Murphy  2 , Peter Norwood  2 , W Scott Comulada  2 , Dallas Swendeman  2 ; ATN CARES Team
Collaborators, Affiliations
Randomized Controlled Trial

Increasing Sustained Viral Suppression Among Youth Living with HIV: A Randomized Controlled Trial of Stepped Care Intervention

Elizabeth Mayfield Arnold et al. AIDS Behav. 2025 Jul.

Abstract

This study aimed to decrease viral load (VL) to increase viral suppression (VS) among youth living with HIV (YLH) ages 12-24. This study was a stepped care randomized controlled trial. Sixty-eight YLH with established infection, without VS, and with at least two follow-ups (N = 68) were randomized to a control condition (n = 25) or a stepped care intervention (n = 43), and repeatedly assessed for up to 24 months. Both conditions received referrals for health services and a daily automated text-messaging and monitoring intervention (AMMI). YLH in stepped care who were unsuppressed at 4-month assessments stepped up to peer support and later to coaching. Random effects regressions examined VL trajectories over time as well as trajectories of secondary outcomes. There was significant evidence suggesting a different longitudinal trajectory of VLs for the two conditions. The control condition had improved VLs at about 12 months and then started to return to higher VLs. The stepped-care condition improved over the same time period and remained relatively stable. We estimated that the average VL was lower in the stepped care condition at 24 months, but we cannot claim a statistically significant difference between conditions. Both intervention groups appeared to have positive intervention impacts suggesting some benefits of the AMMI intervention. The improvement in VL at 24 months for stepped care compared to the control condition are suggestive of a viable intervention strategy that warrants further study.

Keywords: Adherence; HIV; Treatment; Viral load; Viral suppression; Youth.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The first author has funding from Merck, Sharpe, and Dohme, but that project has no relationship to the current study. Dr. Murphy received consulting fees from the University of Texas Southwestern Medical Center for work related to this project. The other authors have declared that they have no competing or potential conflicts of interest. Ethical Approval: This study was approved by the University of California at Los Angeles Institutional Review Board. Consent to Participate: Written consent was obtained from all study participants.

Figures

Fig. 1
Fig. 1
Study flow consort diagram. It presents the flow of the study recruitment, enrollment, intervention, and follow-up visits
Fig. 2
Fig. 2
Plot of the viral load trajectories. The smaller, less-bold lines are the individual trajectories for all study participants. The larger, bold lines are the estimated mean trajectories from the Tobit model
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention, Testing HIV. and Youth. 2022. [cited 2022 November 18]; Available from: https://www.cdc.gov/healthy-youth/nyhaad/hiv-testing-and-youth.html
    1. Centers for Disease Control and Prevention. HIV Survelliance Report. 2021. 2023.
    1. Cohen MS, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011;365(6):493–505. - PMC - PubMed
    1. Lally MA, et al. HIV continuum of care for youth in the united States. J Acquir Immune Defic Syndr 2018;77(1):110–7. - PMC - PubMed
    1. Centers for Disease Control and Prevention. Vital Signs: HIV Among Youth in the US. 2012. [cited 2022 November 18]; Available from: https://archive.cdc.gov/#/details?url=https://www.cdc.gov/vitalsigns/hiv...

Publication types

Substances

LinkOut - more resources