- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03432819
A Pilot Intervention to Improve Coping With Discrimination and Adherence Among HIV-Positive Latino MSM
March 27, 2023 updated by: RAND
R34-funded study to pilot test an intervention to improve coping with discrimination and adherence among Latino men who have sex with men (MSM) living with HIV.
The proposed research aims to modify and refine Siempre Seguiré, a culturally congruent cognitive behavior therapy group intervention for HIV-positive Latino men who have sex with men (LMSM), to include strategies for ART adherence and retention in HIV care; and to conduct a small randomized pilot of Siempre Seguiré to examine feasibility and acceptability, as well as to explore preliminary effects on coping responses to discrimination and antiretroviral treatment adherence among LMSM living with HIV.
Study Overview
Detailed Description
HIV-related disparities in diagnosis and disease outcomes persist among Latinos, and Latinos living with HIV show a lower percentage of viral suppression compared to the general HIV-positive population.
A growing body of work suggests that stigma and discrimination contribute to health disparities, especially among people living with HIV, who may experience discrimination due to multiple stigmatized identities related to HIV-serostatus, race/ethnicity, and sexual orientation.
Internalized stigma and discrimination may lead to health-related disparities by increasing detrimental physiological stress responses, resulting in maladaptive coping and poor health behaviors, including non-adherence to treatment.
Moreover, the chronic stress of discrimination may weaken immune function, leading to worse HIV outcomes, including increased HIV viral load.
The proposed research will integrate adherence skills-building strategies into a recently developed intervention, Siempre Seguiré, an 8-session group cognitive behavioral therapy (CBT) intervention for HIV-positive Latino men who have sex with men (LMSM) that aims to improve adaptive coping responses to discrimination.
The specific aims are: (1) To modify and refine Siempre Seguiré, a newly developed culturally congruent CBT group intervention for HIV-positive LMSM, to include strategies for antiretroviral treatment adherence and retention in HIV care; and (2) To conduct a small randomized pilot of Siempre Seguiré to examine feasibility and acceptability, as well as to explore preliminary effects on: (a) coping responses to discrimination; and (b) antiretroviral treatment adherence, viral load suppression, and HIV care retention, among LMSM living with HIV.
In Phase 1, HIV treatment adherence intervention experts and key stakeholders, including a community advisory board, will help to refine our pilot intervention as needed and update our manual to integrate information and skills building regarding HIV treatment adherence and retention in care.
In Phase 2, a small randomized controlled trial of 80 participants (40 intervention participants divided evenly over 4 intervention groups vs. 40 wait-list control participants) will be conducted.
Participants will complete surveys at baseline, and 4- and 6-months post-baseline to assess coping and HIV care processes and outcomes.
Adherence will be electronically monitored, and viral load will be collected from medical providers at baseline and at 6-month follow-up.
Intervention group sessions will take place once per week for 8 weeks.
Sessions will take place in a private room at Bienestar (a Latino-serving AIDS service organization in LAC) and will last approximately 90 minutes.
We hypothesize that the intervention will improve coping responses to discrimination and HIV treatment adherence.
Study Type
Interventional
Enrollment (Actual)
82
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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California
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Los Angeles, California, United States, 90022
- Bienestar Human Services, Inc.
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
Yes
Genders Eligible for Study
Male
Description
Inclusion Criteria:
- Age 18 years-old or older, HIV-positive, biologically male at birth and continue to identify as male, identify as Latino, report having sex with men in the past 12 months, and prescribed ART.
Exclusion Criteria:
- Being unwilling or unable to provide informed consent; having mental health problems that require immediate treatment (e.g., psychotic symptoms) or a diagnosed mental disorder that would limit ability to participate (e.g., dementia); and cognitive impairments that result in limited ability to provide informed consent.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Siempre Seguiré
We will conduct a small randomized controlled trial (RCT), testing study protocols and materials, the acceptability of randomization, and overall program feasibility.
The pilot will help to identify logistical considerations; assess whether the program is acceptable and understandable LMSM; and collect initial data on how successfully the program motivates change in coping and adherence.
It will allow us to estimate expected attrition and response rates, and to perform preliminary power analyses in preparation for a fully powered RCT.
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A culturally congruent CBT group intervention for HIV-positive LMSM, to include strategies for ART adherence and retention in HIV care.
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No Intervention: Control
Control participants will not be randomized to receive the intervention and will receive standard of care during the intervention period.
We will offer the program to any interested control participants shortly after the 6-month follow-up surveys are completed.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Continuous Adherence (MEMS)
Time Frame: 4-5 and 6-7 months post-baseline
|
Percentage of doses taken, of those prescribed, from electronic monitoring
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4-5 and 6-7 months post-baseline
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Continuous Adherence (Self-report)
Time Frame: 4 and 7 months post-baseline
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Percentage of doses taken, of those prescribed, self-report
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4 and 7 months post-baseline
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Functional Coping Strategies
Time Frame: 4 and 7 months post-baseline
|
Functional coping strategies as measured by 16 Brief COPE items on active coping, acceptance, social support, positive reframing, planning, humor, and religion, and three additional functional coping items based on prior qualitative research on coping in communities of color ("I tell myself that other people are ignorant"; "I avoid certain situations or people so that I am not discriminated against in the future"; and "I change the way that I dress or talk so that I am not discriminated against in the future").
Responses were 1 = I haven't been doing this at all, 2 = I've been doing this a little bit, 3 = I've been doing this a medium amount, and 4 = I've been doing this a lot in response to discrimination
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4 and 7 months post-baseline
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Positive Religious Coping Strategies
Time Frame: 4 and 7 months post-baseline
|
Positive religious coping strategies as measured by an R-COPE sub-scale to assess secure relationships with a divine force/spiritual connectedness.
Responses were 1 = I haven't been doing this at all, 2 = I've been doing this a little bit, 3 = I've been doing this a medium amount, and 4 = I've been doing this a lot in response to discrimination
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4 and 7 months post-baseline
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Dysfunctional Coping Strategies
Time Frame: 4 and 7 months post-baseline
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Dysfunctional/ineffective coping strategies dysfunctional/ineffective as measured by 12 Brief COPE items on denial, substance use, behavioral disengagement, venting, self-blame, and self-distraction.
Responses were 1 = I haven't been doing this at all, 2 = I've been doing this a little bit, 3 = I've been doing this a medium amount, and 4 = I've been doing this a lot in response to discrimination
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4 and 7 months post-baseline
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Negative Religious Coping Strategies
Time Frame: 4 and 7 months post-baseline
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Negative religious coping strategies as measured by an R-COPE sub-scale to assess underlying spiritual tensions/internal struggles.
Responses were 1 = I haven't been doing this at all, 2 = I've been doing this a little bit, 3 = I've been doing this a medium amount, and 4 = I've been doing this a lot in response to discrimination
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4 and 7 months post-baseline
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Medical Mistrust (General)
Time Frame: 4 and 7 months post-baseline
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General medical mistrust was measured with the Mistrust of Healthcare Scale.
Response options were 1 = Strongly Disagree to 5 = Strongly Agree.
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4 and 7 months post-baseline
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Medical Mistrust (HIV Conspiracy Beliefs)
Time Frame: 4 and 7 months post-baseline
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HIV-specific medical mistrust was measured with the HIV Conspiracy Beliefs Scale.
Response options were 1 = Strongly Disagree to 5 = Strongly Agree.
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4 and 7 months post-baseline
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Internalized Stigma (Sexual Orientation)
Time Frame: 4 and 7 months post-baseline
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Internalized sexual minority stigma was assessed with the Internalized-Homophobia Scale-Revised.
Response options were 1 = Strongly Disagree to 5 = Strongly Agree.
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4 and 7 months post-baseline
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Internalized Stigma (HIV)
Time Frame: 4 and 7 months post-baseline
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Internalized HIV stigma was assessed with the Internalized AIDS-Related Stigma Scale.
Response options were 1 = Strongly Disagree to 5 = Strongly Agree.
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4 and 7 months post-baseline
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
March 27, 2018
Primary Completion (Actual)
September 12, 2019
Study Completion (Actual)
September 16, 2019
Study Registration Dates
First Submitted
January 31, 2018
First Submitted That Met QC Criteria
February 7, 2018
First Posted (Actual)
February 14, 2018
Study Record Updates
Last Update Posted (Actual)
March 29, 2023
Last Update Submitted That Met QC Criteria
March 27, 2023
Last Verified
March 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- R34MH113413 (U.S. NIH Grant/Contract)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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