title: Computerized counseling reduces HIV-1 viral load and sexual transmission risk: findings from a randomized controlled trial.
abstract: OBJECTIVE
  Evaluate a computerized intervention supporting antiretroviral therapy (ART) adherence and HIV transmission prevention.
  
  
  METHODS
  Longitudinal randomized controlled trial.
  
  
  METHODS
  An academic HIV clinic and a community-based organization in Seattle.
  
  
  METHODS
  In a total of 240 HIV-positive adults on ART, 209 completed 9-month follow-up (87% retention).
  
  
  METHODS
  Randomization to computerized counseling or assessment only, 4 sessions over 9 months.
  
  
  METHODS
  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.
authors.affiliation: *New York University College of Nursing, New York, NY; †School of Nursing, Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA; ‡Research Triangle Institute, San Francisco, CA; Departments of §Global Health; ‖Medicine, University of Washington, Seattle, WA; ¶Pangaea Global AIDS Foundation, Oakland, CA; #University of California, San Francisco, CA; **Harborview Medical Center, HIV-Specialty Clinic Affiliated With UW, Seattle, WA; and ††Department of Psychology, University of Washington, Seattle, WA.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Kurth
authors.forename: Freya
authors.initials: F
authors.lastname: Spielberg
authors.forename: Charles M
authors.initials: CM
authors.lastname: Cleland
authors.forename: Barrot
authors.initials: B
authors.lastname: Lambdin
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Frick
authors.forename: Anneleen O
authors.initials: AO
authors.lastname: Severynen
authors.forename: Marc
authors.initials: M
authors.lastname: Clausen
authors.forename: Robert G
authors.initials: RG
authors.lastname: Norman
authors.forename: David
authors.initials: D
authors.lastname: Lockhart
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
authors.forename: King K
authors.initials: KK
authors.lastname: Holmes
mesh_terms: D000328:Adult; D003201:Computers; D003376:Counseling / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission* / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D012308:Risk Management / Q000379:methods; D012984:Software; D017216:Telemedicine / Q000379:methods*; D019562:Viral Load