A novel behavioral intervention targeted to racial minorities with HIV who were not taking antiretroviral therapy appeared to effectively address barriers to care among this population, according to recent findings.
Researchers recruited 95 HIV adult patients from hospital-based HIV clinics, community organizations, and peer recruitment. Eligible participants were infected with HIV for at least 6 months, black or Hispanic, and had a most recent CD4 count of at least 500 cells/mm3. Participants also were required to be either ART-naive or to have received ART infrequently within the past 6 months and not within the previous 30 days. All were ART eligible for at least 3 months.
Participants were randomly assigned to an intervention (n = 47) or control group (n = 48). Controls received standard care; the intervention group received care through the Heart to Heart (HTH) intervention. This intervention included one-on-one motivational interviewing, a support partner, patient navigation, and focused support groups. HTH was designed primarily to achieve ART initiation with high adherence.
The study’s primary goal was to assess the efficacy of the intervention, regarding: biomarkers of ART adherence via hair analysis, HIV load responses, ART initiation and adherence measured by self-report, and participation in primary care evaluated from the medical record. The researchers also analyzed differences in the acceptability, feasibility and efficacy of the intervention based on sex, race or ethnicity, sexual minority status and substance abuse.
At 3-month follow-up, participants rated the intervention activities as “very good” or “excellent.” Information received was deemed “helpful” or “very helpful” (100%), and staff were viewed as understanding the participants’ ethnic, racial or cultural group needs “most” or “all the time” (97.1%).
In addition, most aspects of the intervention were feasible, with 93.6% of participants engaging in intervention activities, including motivational interviewing (93.6%), navigation (85.1%) and support groups (59%).
At 8 months, patients in the intervention group were more likely to demonstrate biomarker-based good adherence (7 days/week) to ART (60% in the intervention group vs. 26.67% in the control group; OR = 3.59; 95% CI, 0.8-23.54) and had lower viral loads (t = 2.29; OR=5.2; 95% CI, 1.16-22.55) than controls.
The researchers said these findings suggest promise for culturally targeted interventions such as HTH.
“There is an urgent need for interventions to improve outcomes along the HIV continuum of care for the nation’s most vulnerable people living with AIDS,” the researchers wrote. “The present study sheds light on strategies to seek out and engage these populations, who are largely hidden and wary of health care settings.” – by Jen Byrne
The researchers report no relevant financial disclosures.