Intervention to Increase Timely Initiation of HAART Among Those Who Delay/Decline

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DESCRIPTION (provided by applicant): This study addresses racial/ethnic disparities in HIV/AIDS treatment. Many persons living with HIV/AIDS (PLHA) in the US (10-19%), predominantly people of color, delay taking Highly Active Antiretroviral Therapy (HAART) until late in their HIV disease or never initiate HAART when it is medically indicated. This population experiences higher morbidity and early mortality, higher health care costs, and is less likely to achieve virologic suppression (increasing the probability of HIV transmission to others) compared to those taking HAART. However, we do not have a behavioral intervention to increase the timely initiation and continued use of HAART in this group. This proposal seeks to develop a sustainable, flexible, and individualized video-based intervention to motivate and prepare individuals to initiate and continue HAART, targeted to the specific barriers experienced by the population. We refer to this population of PLHA medically eligible for HAART but who have delayed or declined HAART as "PLHA-DD." The proposed intervention is a complement to adherence interventions, from which PLHA-DD can benefit when they initiate HAART. The intervention will be tailored to address the multi-level barriers to HAART experienced by PLHA-DD, who are predominantly African-American and Latino. These barriers include individual- (e.g., fear, mistrust, low self efficacy, competing priorities), social- (e.g. negative peer health norms, stigma), and structural-level influences (e.g., access). Guided by the Theory of Triadic Influence, a multi-level social-cognitive theory, and the Anti-racist Stance, the intervention period will last 12 weeks and be made up of three individual sessions (3.5 hours total time) and patient navigation, a low-threshold, supportive, and adaptable approach for reducing health care system barriers, the intensity of which will depend on the participant's needs. Intervention sessions will consist of targeted video and individualized interactive components. To reduce social barriers, the intervention will include a "support partner." Psychosocial and medical aspects of HAART initiation will be closely integrated. The aims of this three-year project are to: (1) explore providers' and PLHA-DD's perspectives on barriers to initiation/continuation of HAART; and (2) develop components of an intervention and examine their acceptability, safety, feasibility, and gather preliminary evidence of efficacy with respect to HAART initiation/continuation. To accomplish these aims, we propose a three phase study: (1) Elicitation, to study the perspectives of providers (N=18) and PLHA-DD (N=16); (2) Development, to create intervention components; and (3) Evaluation, to test and revise intervention components (N=80 PLHA-DD; 50% African-American, 50% Latino/Hispanic recruited from two large HIV clinics). The proposed study is innovative in that it seeks to broaden the HAART adherence research paradigm to include HAART initiation. Although PLHA-DD are a modest proportion of the population, effective interventions to reduce morbidity, increase longevity, reduce health care costs, and increase viral load suppression among PLHA-DD have high public health significance.