A Pilot Randomized Control Trial of the Striving Towards EmPowerment and Medication Adherence (STEP-AD) Intervention for Black Women Living with HIV.

Dale, Sannisha K.; Wright, Ian A.; Madhu, Aarti; Reid, Rachelle; Shahid, Naysha N.; Wright, Mya; Sanders, Jasmyn; Phillips, Arnetta; Rodriguez, Allan; Safren, Steven A.

Black women living with HIV (BWLWH) face adversities associated with lower HIV medication adherence, viral non-suppression, and mental health symptoms (e.g., post-traumatic stress disorder) such as trauma/violence, racism, HIV-related discrimination/stigma, and gender-related stressors. We developed the first intervention based in cognitive behavioral therapy and culturally congruent coping for BWLWH to increase medication adherence and decrease PTSD symptoms by enhancing resilience, self-care, engagement in care, and coping for trauma, racism, HIV-related discrimination/stigma, and gender-related stressors. A pilot randomized control trial was conducted with BWLWH and histories of trauma who were at risk for their HIV viral load remaining or becoming detectable (i.e., below 80% medication adherence, detectable viral load in the past year, and/or missed HIV-related appointments). 119 BWLWH were assessed at baseline and 70 met inclusion criteria, completed one session of Life-Steps adherence counseling, and were randomized to either nine sessions of STEP-AD (Striving Towards EmPowerment and Medication Adherence) or ETAU (enhanced treatment as usual consisting of biweekly check-ins). Women completed a post intervention follow up assessment (3 months post baseline) and 3-month post intervention follow-up (6 months post baseline). Via STATA the difference-in-difference methodology with mixed models compared STEP-AD to ETAU on changes in outcomes over time. BWLWH in STEP-AD compared to E-TAU had significantly higher ART adherence (estimate = 9.36 p = 0.045) and lower likelihood of being clinically diagnosed with PTSD (OR =.07, estimate = − 2.66, p = 0.03) as well as borderline significance on higher CD4 count (estimate = 161.26, p = 0.05). Our findings suggest preliminary efficacy of STEP-AD in improving ART adherence, mental health, and immune function.

UNITED States; TREATMENT of post-traumatic stress disorder; EDUCATION of African Americans; WOMEN'S education; AMERICAN women; PATIENT compliance; POST-traumatic stress disorder; HEALTH self-care; PSYCHOLOGICAL resilience; WOUNDS & injuries; LIFE; SELF-efficacy; MENTAL health; RESEARCH funding; HIV-positive persons; EDUCATIONAL outcomes; PILOT projects; CULTURE; STATISTICAL sampling; TREATMENT effectiveness; HIV infections; RANDOMIZED controlled trials; PSYCHOLOGICAL adaptation; PATIENT care; RACISM; PRE-tests & post-tests; ODDS ratio; PSYCHOLOGICAL stress; DRUGS; COGNITIVE therapy; ANTI-HIV agents; COUNSELING; DATA analysis software; PATIENT participation; SOCIAL stigma; EVALUATION

AIDS & Behavior, 2024, Vol 28, Issue 10, p3483

1090-7165

Academic Journal

10.1007/s10461-024-04408-w