title: Behavioral intervention improves treatment outcomes among HIV-infected individuals who have delayed, declined, or discontinued antiretroviral therapy: a randomized controlled trial of a novel intervention.
abstract: Nationally up to 60 % of persons living with HIV are neither taking antiretroviral therapy (ART) nor well engaged in HIV care, mainly racial/ethnic minorities. This study examined a new culturally targeted multi-component intervention to address emotional, attitudinal, and social/structural barriers to ART initiation and HIV care. Participants (N = 95) were African American/Black and Latino adults with CD4 < 500 cells/mm(3) not taking ART, randomized 1:1 to intervention or control arms, the latter receiving treatment as usual. Primary endpoints were adherence, evaluated via ART concentrations in hair samples, and HIV viral load suppression. The intervention was feasible and acceptable. Eight months post-baseline, intervention participants tended to be more likely to evidence "good" (that is, 7 days/week) adherence (60 vs. 26.7 %; p = 0.087; OR = 3.95), and had lower viral load levels than controls (t(22) = 2.29, p = 0.032; OR = 5.20), both large effect sizes. This highly promising intervention merits further study.
authors.affiliation: Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA. mg2890@nyu.edu.
authors.forename: Marya
authors.initials: M
authors.lastname: Gwadz
authors.affiliation: Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA. cmc13@nyu.edu.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Cleland
authors.affiliation: Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA. eaa6@nyu.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Applegate
authors.affiliation: Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA. mjf223@nyu.edu.
authors.forename: Mindy
authors.initials: M
authors.lastname: Belkin
authors.affiliation: Division of HIV/AIDS, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA. monica.gandhi@ucsf.edu.
authors.forename: Monica
authors.initials: M
authors.lastname: Gandhi
authors.affiliation: Department of Infectious Diseases, Peter Krueger Center for Immunological Disorders, Mount Sinai Beth Israel, New York, NY, USA. nsalomon@chpnet.org.
authors.forename: Nadim
authors.initials: N
authors.lastname: Salomon
authors.affiliation: Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA. adb12@nyu.edu.
authors.forename: Angela
authors.initials: A
authors.lastname: Banfield
authors.affiliation: Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA. nrl4@nyu.edu.
authors.forename: Noelle
authors.initials: N
authors.lastname: Leonard
authors.affiliation: School of Social Work, Columbia University, New York, NY, USA. mr108@columbia.edu.
authors.forename: Marion
authors.initials: M
authors.lastname: Riedel
authors.affiliation: Mount Sinai St. Luke's-Roosevelt Hospital Center, Spencer Cox Center for Health, New York, NY, USA. hannahlahozwolfe@gmail.com.
authors.forename: Hannah
authors.initials: H
authors.lastname: Wolfe
authors.affiliation: Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA. isaiah.pickens@gmail.com.
authors.forename: Isaiah
authors.initials: I
authors.lastname: Pickens
authors.affiliation: Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA. bolgerkelly9@gmail.com.
authors.forename: Kelly
authors.initials: K
authors.lastname: Bolger
authors.affiliation: Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA. dkbow@yahoo.com.
authors.forename: DeShannon
authors.initials: D
authors.lastname: Bowens
authors.affiliation: Department of Infectious Diseases, Mount Sinai Beth Israel, New York, NY, USA. perlman@chpnet.org.
authors.forename: David
authors.initials: D
authors.lastname: Perlman
authors.affiliation: Department of Infectious Diseases, Mount Sinai Beth Israel, New York, NY, USA. dmildvan@chpnet.org.
authors.forename: Donna
authors.initials: D
authors.lastname: Mildvan
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001521:Behavior Therapy; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology; D010349:Patient Compliance / Q000208:ethnology / Q000523:psychology; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: Antiretroviral therapy; Disparities; HIV/AIDS; Intervention; Motivational interviewing
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