Abstract
Background: Among youth living with HIV (YLH) aged 12-24 years who have health care in the United States, only 30% to 40% are virally suppressed. YLH must achieve viral suppression in order to reduce the probability of infecting others as well as increasing the length and quality of their own life. Objective: This randomized controlled trial aimed to evaluate the efficacy of an Enhanced Standard Care condition (n=110) compared to an Enhanced Stepped Care intervention condition (n=110) to increase viral suppression among YLH aged 12-24 years with established infection (not acutely infected). Methods: YLH (N=220) who are not virally suppressed will be identified at homeless shelters, health clinics, and gay-identified community-based organizations in Los Angeles, CA, and New Orleans, LA. Informed consent will be obtained from all participants. YLH will be randomly assigned to one of two study conditions: Enhanced Standard Care, which includes standard clinical care plus an automated messaging and monitoring intervention (AMMI), or an Enhanced Stepped Care, which includes three levels of intervention (AMMI, Peer Support via social media plus AMMI, or Coaching plus Peer Support and AMMI). The primary outcome is viral suppression of HIV, and YLH will be assessed at 4-month intervals for 24 months. For the Enhanced Stepped Care intervention group, those who do not achieve viral suppression (via blood draw, viral load<200 copies/mL) at any 4-month assessment will “step up” to the next level of intervention. Secondary outcomes will be retention in care, antiretroviral therapy adherence, alcohol use, substance use, sexual behavior, and mental health symptoms. Results: Recruitment for this study began in June 2017 and is ongoing. We estimate data collection to be completed by the end of 2020. Conclusions: This is the first known application of an Enhanced Stepped Care intervention model for YLH. By providing the lowest level of intervention needed to achieve viral suppression, this model has the potential to be a cost-effective method of helping YLH achieve viral suppression and improve their quality of life.
| Original language | English |
|---|---|
| Article number | e10791 |
| Journal | JMIR Research Protocols |
| Volume | 8 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2019 |
Bibliographical note
Publisher Copyright:© Elizabeth Mayfield Arnold, Dallas Swendeman, Danielle Harris, Jasmine Fournier, Leslie Kozina, Susan Abdalian, Mary Jane Rotheram, Adolescent Medicine Trials Network CARES Team.
Funding
The Comprehensive Adolescent Research and Engagement Studies (CARES) is a program project grant funded by the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) at the National Institutes of Health (U19HD089886). The Eunice Kennedy National Institute of Child Health and Human Development (NICHD) is the primary funder of this network, with support of the National Institute of Mental Health (NIMH), National Institute of Drug Abuse (NIDA), and National Institute on Minority Health and Health Disparities (NIMHD).
| Funders | Funder number |
|---|---|
| National Institutes of Health (NIH) | U19HD089886 |
| Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse | |
| National Institute on Minority Health and Health Disparities (NIMHD) | |
| City of Hope Comprehensive Cancer Center |
Keywords
- Adolescent
- HIV seroposivity
- Sustained virologic responses
- Young adult
ASJC Scopus subject areas
- General Medicine
