Comprehensive, tailored, technology-based intervention to improve virologic suppression among youth and young adults living with HIV

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Abstract/Project Summary: In the US, youth and young adults living with HIV (YLWH) have lower rates of antiretroviral therapy (ART) initiation, suboptimal ART adherence and retention in care, and higher rates of virologic failure, compared to older age groups. Additionally, there is an increased risk of substance dependence, psychiatric disorders, and mortality with increased risk of substance use at a younger age. Mental health (MH) and substance use (SU) impact every step of the HIV care continuum from diagnosis to viral suppression and exacerbate socioeconomic challenges of linkage and sustained access to healthcare. Given the strong evidence for the influence of MH and SU on poor HIV health outcomes, there is a clear need for increased access to and provision of these services. Despite the need to address these critical barriers to care in YLWH, there is a severe shortage of MH professionals nationwide and a lack of interventions tailored to this age group. In collaboration with the nonprofit AIDS Healthcare Foundation (the largest provider of HIV care) and a Youth Advisory Panel, the proposed study aims to address these barriers in a tailored manner using a differentiated care approach that is “youth-friendly.” Our goal is to test the effect of a tailored technology-based intervention in a randomized clinical trial (RCT) with an adaptive treatment strategy (ATS) among 200 YLWH (18–29 years old). The intervention includes: (1) brief weekly counseling sessions with a counselor to discuss MH, SU, HIV care engagement, and other barriers to care delivered via a video-chat platform, and (2) a mobile health application designed and developed using Human-Centered Design (HCD) with YLWH to address barriers to engagement in care. Individuals who are not virologically suppressed will be randomized to video- counseling+app or standard of care (SOC). Through this entirely remotely-conducted study, we will be able to: Aim 1: Test the efficacy of video-counseling+app vs SOC on virologic suppression in YLWH. We will compare HIV virologic suppression of those randomized to the intervention vs control arms at 16 weeks via an RCT. Aim 2: Assess the impact of video-counseling+app vs SOC on MH and SU in YLWH. We will evaluate the MH and SU differences between the intervention vs control arms at 16 weeks via an RCT. Aim 3: Explore an ATS to individualize the intervention by assigning the: (a) virologic “non-responders” in the intervention arm to intensified video-counseling+app for 16 more weeks, (b) virologic “responders” in the intervention arm to continue only app use for 16 more weeks. Therefore, in an era of severe shortages of MH providers when MH and SU challenges of YLWH are critical barriers to care, examining an innovative intervention developed using HCD with a differentiated care approach directed specifically to YLWH, grounded in a well-established theoretical model of care and formative research, and with community partnership is necessary for “getting to zero” and ending the HIV epidemic.