Randomized Controlled Trial of Rise, A Community-Based Culturally Congruent Counseling Intervention to Support Antiretroviral Therapy Adherence Among Black/African American Adults Living with HIV

Laura M Bogart, Matt G Mutchler, Kathy Goggin, Madhumita Ghosh-Dastidar, David J Klein, Uzaib Saya, Sebastian Linnemayr, Sean J Lawrence, Keshav Tyagi, Damone Thomas, Mahlet Gizaw, Jeff Bailey, Glenn J Wagner, Laura M Bogart, Matt G Mutchler, Kathy Goggin, Madhumita Ghosh-Dastidar, David J Klein, Uzaib Saya, Sebastian Linnemayr, Sean J Lawrence, Keshav Tyagi, Damone Thomas, Mahlet Gizaw, Jeff Bailey, Glenn J Wagner

Abstract

Structural inequities have led to HIV disparities, including relatively low antiretroviral therapy adherence and viral suppression rates among Black Americans living with HIV. We conducted a randomized controlled trial of Rise, a community-based culturally congruent adherence intervention, from January 2018 to December 2021 with 166 (85 intervention, 81 control) Black adults living with HIV in Los Angeles County, California [M (SD) = 49.0 (12.2) years-old; 76% male]. The intervention included one-on-one counseling sessions using basic Motivational Interviewing style to problem solve about adherence, as well as referrals to address unmet needs for social determinants of health (e.g., housing services, food assistance). Assessments included electronically monitored adherence; HIV viral load; and baseline, 7-month follow-up, and 13-month follow-up surveys of sociodemographic characteristics, HIV stigma, medical mistrust, and HIV-serostatus disclosure. Repeated-measures intention-to-treat regressions indicated that Rise led to significantly (two-fold) higher adherence likelihood, lower HIV stigmatizing beliefs, and reduced HIV-related medical mistrust. Effects on HIV viral suppression, internalized stigma, and disclosure were non-significant. Moreover, Rise was cost-effective based on established standards: The estimated cost per person to reach optimal adherence was $335 per 10% increase in adherence. Interventions like Rise, that are culturally tailored to the needs of Black populations, may be optimal for Black Americans living with HIV (ClinicalTrials.gov #NCT03331978).

Keywords: Adherence; Antiretroviral therapy; Black/African American; HIV; Motivational Interviewing; Randomized controlled trial.

Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose; the authors have no conflicts of interest to declare that are relevant to the content of this article; all authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript; and the authors have no financial or proprietary interests in any material discussed in this article.

© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Figures

Fig. 1
Fig. 1
CONSORT diagram of participant flow through the Rise study
Fig. 2
Fig. 2
Percentages of participants with optimal adherence (75% of doses taken, per electronic monitoring) throughout the 13-month study period by treatment condition. The vertical line between 1 and 2 months represents the end of the baseline period, and the vertical line between 7 and 8 months represents the end of the intervention period. Percentages are weighted for presence of adherence data and restricted to the N = 164 included in the model estimating the effect of Rise on adherence

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