Treatment Advocacy Intervention for HIV-Positive African Americans

Compared to other races/ethnicities, African Americans with HIV have lower levels of
engagement in care, are less likely to be on antiretroviral treatment (ART), and are more
likely to delay care and ART initiation; those on ART are less likely to be adherent at high
enough levels for the treatment to be effective. We propose to test an innovative,
culturally relevant treatment advocacy (TA) intervention for African Americans with HIV that
targets social, cultural, and structural issues contributing to poor HIV treatment
behaviors. TA, which has been sustained in many community organizations throughout the HIV
epidemic, has never been systematically evaluated. TA facilitates patient navigation through
the medical system and provides tailored HIV treatment education and client-centered
counseling to improve adherence and engagement in care. TA targets structural issues in
healthcare and patients' lives by advocating to providers to improve patient-provider
relationships, recommending changes in treatment and/or providers (if needed), and referring
patients to mental health and social services. TA is particularly appropriate for African
Americans with HIV, who may be mistrustful of providers: it can be conducted outside of the
medical system in a safe, neutral community setting by individuals not associated with
patients' healthcare. We developed a culturally relevant TA program that additionally
discusses factors such as racism that undermine healthcare in Black communities, by
acknowledging and directly addressing patients' medical mistrust and stigma as coping
strategies that arise in response to oppression. The specific aims are to (1) conduct a
randomized controlled trial to examine the effects of a culturally relevant TA program on
adherence among African Americans with HIV; (2) identify culturally relevant mediators that
explain the effects of treatment advocacy on antiretroviral treatment adherence among
African Americans with HIV (e.g., improved behavioral adherence skills, coping with
stress/discrimination, mental health, and patient satisfaction; lower levels of HIV
misconceptions, internalized HIV stigma/homophobia, medical mistrust, and substance use);
and (3) explore culturally relevant moderators of the effects of treatment advocacy on
antiretroviral treatment adherence among African Americans with HIV (e.g., access to care,
discrimination, incarceration, poverty, social support, spirituality, and trauma). A sample
of 200 African Americans with HIV will be randomly assigned to a TA intervention or
wait-list control group. Participants will complete surveys at screening, and at 3- and
6-months post-baseline, to assess pre-, intra-, and post-intervention effects on adherence.

Inclusion Criteria:

- 18 years of age or older;

- self-identify as African American or Black

- client of APLA

- they are on ART and missed at least 1 dose in the past month

- they have a currently detectable or unknown HIV viral load (or have not had a viral
load test within the last six months).

Exclusion Criteria:

- received treatment advocacy in last 6 months