Healthy Choices intervention improves viral load, reduces alcohol use among youth with HIV
An intervention that included sessions with community health workers improved viral load and reduced alcohol use among youth with HIV, according to a study published in JAMA Network Open.
Four 30-minute sessions targeted medication adherence and alcohol use.
“While brief interventions may be more easily implemented in clinic settings, a more intensive intervention may be needed to sufficiently halt viral replication among youths at highest risk,” Sylvie Naar, PhD, distinguished endowed professor of behavioral sciences and social medicine at Florida State University College of Medicine, and colleagues wrote. “Some youths may benefit from motivational interviewing alone, and some may benefit more from motivational interviewing combined with cognitive-behavioral skills-building interventions.”
Naar and colleagues compared the efficacy of the Healthy Choices program, a 10-week intervention that uses motivational interviewing, when delivered in a home or community setting vs. in a clinic. The study included 183 young people with HIV from five U.S. adolescent HIV clinics.
Individuals living with HIV aged 16 to 24 years who were fluent in English, had a current HIV medication prescription, had a detectable viral load and had used alcohol in the previous 12 weeks were included for analysis. Individuals with active psychosis who were unable to complete the questionnaire were excluded. They identified viral load and changes in alcohol use, measured via the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), following 52 weeks of follow-up as the study’s primary outcomes.
Of the participants, 90 were randomly assigned to the home setting, whereas 93 were placed in the clinical setting. A total of 10 participants in the home group showed an undetectable viral load at 52 weeks, whereas 18 participants in the clinic group had an undetectable viral load at 52 weeks.
“Unexpectedly, the clinic setting outperformed home-based delivery for viral suppression,” the researchers wrote.
ASSIST scores also declined in the clinic group (P = .02; 95% CI, –0.81 to –0.07).
“Future studies could consider an adaptive design to test the effect of a single session, with additional sessions offered to nonresponders,” the researchers wrote. “Furthermore, because home- and community-based delivery did not result in increased session attendance, other modes of delivery, such as videoconferencing and mobile apps, should be considered to increase session attendance.”