The Skills TO Manage Pain (STOMP) Randomized Trial: Results of antiretroviral therapy adherence, HIV primary care retention, and virologic suppression outcomes

Abstract

Background: People with HIV (PWH) commonly endorse chronic pain contributing to poor HIV outcomes. The current study is a secondary analysis of a multi-site randomized control trial that improved pain with a behavioral pain treatment, Skills to Manage Pain (STOMP), among PWH and chronic pain. We examined whether participants randomized to STOMP, as compared to enhanced usual care (EUC), evidenced improved HIV outcomes at 12-month follow-up visit.

Setting: Participants (N=278) were recruited from Center for AIDS Research Network of Integrated Clinical Systems clinics in Alabama and North Carolina. Eligible participants were randomized to receive either STOMP, combined 1-on-1 skill-building sessions delivered by staff interventionists with group sessions co-led by peer interventionists, or EUC.

Methods: We compared 12-month outcomes of adherence to anti-retroviral therapy (ART), retention in HIV care, virologic suppression. We employed logistic regressions using generalized estimating equations to account for correlations within groups and were adjusted for baseline values.

Results: At baseline, most participants were virologically suppressed (STOMP: 95.2%; EUC: 93.6%) and adherent to ART (≥90% medication taken past month; STOMP: 93.6%, EUC: 89.0%). There were no significant differences between EUC and STOMP for adherence to ART, retention in HIV care, or virologic suppression at 12-month follow-up (all p's > .16).

Conclusions: Participants receiving STOMP had no differences in 12-month HIV outcomes, despite improvements in chronic pain severity at 3-months. High baseline adherence may have created a ceiling effect on changes.

Keywords: Chronic pain; HIV; adherence; behavioral treatment; virologic suppression.