Supporting Treatment Adherence Readiness Through Training (START) (START)

Inclusion Criteria:

1. The patient's provider views the patient as medically appropriate to begin (ART naïve) or restart ART (has been off ART for at least 2 months), and either

   • plans to start the patient on ART
   • would like to start the patient on ART but the provider or patient is uncertain about the patient's readiness to adhere well.

   Patients who are currently on ART are also eligible if they meet the following criteria, which are specific only to this type of patient:

   i) the patient has 2 or more HIV viral load tests in the past year > 1000 copies/ml ii) the patient has had no HIV viral load tests that were undetectable in the past year iii) the patient has a genotype in the past year that does not show resistance as a reason for virologic failure (detectable viral load) iv) primary care provider views the patient as a good candidate for the study, with the understanding that the patient will interrupt ART if assigned to the intervention.

   Criteria i to iii are intended to define a subgroup of nonadherent patients who are taking very little of their ART medications, as evidenced by the combination of consistently high viral load and no drug resistance. If the patient was taking at least a moderate level of drug and still had consistently high viral load, than they would have evidence of drug resistance. Providers are generally comfortable with this type of patient stopping their medication in order to facilitate the pre-treatment, adherence readiness assessment and training phase of the intervention prior to restarting the patient on treatment.

2. The patient's health status is stable. There is no current acute OI or medical condition that calls for immediate ART, as determined by the patient's provider.
3. Most recent HIV viral load is detectable.
4. If CD4 < 200, the patient is on or will be prescribed prophylactic medication
5. Patient is 18 or older.
6. Patient is able and willing to give informed consent.
7. English speaking.

Exclusion Criteria:

1. Patient just tested HIV+ and their provider suspects the patient may be acutely or recently infected (within past 6 months).