Adherence Connection for Counseling, Education, and Support (ACCESS) - II

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The highest rates of new human immunodeficiency virus infection (HIV+) are among Black and Hispanic adolescents and young adults (AYA). Suboptimal antiretroviral treatment (ART) adherence (<90%) is described among 39% of this cohort, and only half are virologically suppressed (HIV viral load <200 copies/ml), leading to high risk for sexual transmission. Adherence behavior is complex, shaped by a multi-level socioecological (SE) context. Yet there is a paucity of t heory based ART adherence interventions for this cohort. There is also a need to gain understanding of the symptom clusters associated with viral load outcomes or adherence phenotypes. Dr. Dunn Navarra, a K awardee nurse scientist, established proof of concept for a peer-led, technology-enabled (WebEx) cognitive behavioral ART adherence intervention, Adherence Connection for Counseling, Education, and Support (ACCESS) (K23-NR015970). Trained HIV+ peer health coaches delivered a five-session, ART adherence intervention, using videoconferences for hard-to- reach Black and Hispanic HIV+AYA with unsuppressed HIV viral load. ART doses taken increased by 32% (95th CI=11.2 to 53.3) with a 0.28 log10 (47.5%) reduction in HIV viral load at 12 months. Qualitative findings highlighted SE influences on ART adherence lending to refined/new ACCESS content on pervasive HIV stigma, substance use/psychological distress, and the importance of engagement with the HIV health system. The PI seeks the opportunity to expand this promising program of HIV biobehavioral research and enhance her career transition from new to independent investigator status. In the proposed ART adherence intervention, ACCESS II, we aim to: 1) evaluate the effect of ACCESS-II on the primary outcomes of self-reported ART adherence and HIV viral load and secondary outcomes of self-efficacy, HIV knowledge, HIV stigma, psychological distress, social support, and substance use; and 2) identify which SE factors (self-efficacy, HIV knowledge, HIV stigma, psychological distress, social support, and substance use) are associated with ART adherence and HIV viral load outcomes. Our methods include using a longitudinal (12 and 24-weeks), two- group, randomized control trial with Black and Hispanic HIV+AYA, ages 18-29 years (N=120). Participants in the intervention condition will use videoconferencing to connect synchronously with trained HIV+ peer health coaches who will deliver eight weekly, 60-minute cognitive behavioral motivational sessions for improved ART adherence. Participants in the control will connect asynchronously to a web-based HIV ART adherence education condition. We will use linear and generalized linear mixed models to examine the efficacy of ACCESS II on primary and secondary outcomes. Adherence phenotypes will be identified using visual graphical analysis (VGA) to examine and classify individual trajectories of 3-day self-reported ART adherence. In summary, ACCESS II is an innovative approach to engage Black and Hispanic HIV+AYA in a much needed adherence intervention, justified with prior research findings (K23) and current gaps in the evidence-base.