Comparing the Effectiveness of Two Alcohol+Adherence Interventions for HIV+ Youth
| Status: | Not yet recruiting |
|---|---|
| Conditions: | HIV / AIDS |
| Therapuetic Areas: | Immunology / Infectious Diseases |
| Healthy: | No |
| Age Range: | 16 - 24 |
| Updated: | 4/2/2016 |
| Start Date: | July 2014 |
| End Date: | November 2017 |
| Contact: | Sylvie Naar-King, PhD |
| Email: | snaarkin@med.wayne.edu |
| Phone: | 3137454875 |
Alcohol use among persons with HIV exacerbates health problems and accelerates HIV disease
progression. Antiretroviral therapy (ART) is the single most important treatment for people
living with HIV. However, ART adherence is suboptimal among adolescents and young adults
living with HIV, the age group with the fastest growing rates of HIV infection, and great
risk of engaging in risky behaviors such as alcohol use. The proposed study will compare the
effectiveness of home-based versus clinic-based "Healthy Choices", a brief, 4- session
intervention using Motivational Enhancement Therapy (MET) to address alcohol use, medication
adherence, and health outcomes in youth living with HIV (YLH) using a repeated measures
design. Unlike previous trials, Healthy Choices will be tested in a "real world" clinical
setting and be delivered by community health workers (CHW: already members of the HIV care
team). The study population will consist of YLH, ages 16-24, who are current patients at 5
ATN sites. Site staff will recruit potential participants. Youth will be randomized to
receive Healthy Choices, either clinic-based or home-based delivered by the same CHW in both
conditions. Outcomes are measured at baseline, 4-, 7-, and 13-months. Data collection for
biological measures will be through medical record extraction, and self-reported measures
will occur using a brief Web-based CASI (computer-administered self-interviewing) survey on
an iPad. All intervention sessions will be audio-recorded for MITI fidelity coding, and
investigators will support local supervisors during the active intervention phase. We will
conduct qualitative interviews with CHWs, supervisors and organization leaders at the end of
the trial to obtain information about barriers and facilitators of implementation. Thus, the
proposed trial will allow us to use a Type 1 Effectiveness-implementation hybrid design to
pilot a sustainable model of MI implementation in real-world youth care settings towards the
goals of 1) examining the effectiveness, cost-effectiveness, and scalability of an
efficacious behavioral intervention when delivered by CHWs in real-world adolescent HIV care
settings; 2) gathering information about who responds under what contexts; and 3) increasing
our understanding of the barriers and facilitators for future implementation. The primary
hypothesis is that YLH receiving home-based MET will have greater improvements in alcohol
use and viral load than YLH receiving clinic-based MET.
progression. Antiretroviral therapy (ART) is the single most important treatment for people
living with HIV. However, ART adherence is suboptimal among adolescents and young adults
living with HIV, the age group with the fastest growing rates of HIV infection, and great
risk of engaging in risky behaviors such as alcohol use. The proposed study will compare the
effectiveness of home-based versus clinic-based "Healthy Choices", a brief, 4- session
intervention using Motivational Enhancement Therapy (MET) to address alcohol use, medication
adherence, and health outcomes in youth living with HIV (YLH) using a repeated measures
design. Unlike previous trials, Healthy Choices will be tested in a "real world" clinical
setting and be delivered by community health workers (CHW: already members of the HIV care
team). The study population will consist of YLH, ages 16-24, who are current patients at 5
ATN sites. Site staff will recruit potential participants. Youth will be randomized to
receive Healthy Choices, either clinic-based or home-based delivered by the same CHW in both
conditions. Outcomes are measured at baseline, 4-, 7-, and 13-months. Data collection for
biological measures will be through medical record extraction, and self-reported measures
will occur using a brief Web-based CASI (computer-administered self-interviewing) survey on
an iPad. All intervention sessions will be audio-recorded for MITI fidelity coding, and
investigators will support local supervisors during the active intervention phase. We will
conduct qualitative interviews with CHWs, supervisors and organization leaders at the end of
the trial to obtain information about barriers and facilitators of implementation. Thus, the
proposed trial will allow us to use a Type 1 Effectiveness-implementation hybrid design to
pilot a sustainable model of MI implementation in real-world youth care settings towards the
goals of 1) examining the effectiveness, cost-effectiveness, and scalability of an
efficacious behavioral intervention when delivered by CHWs in real-world adolescent HIV care
settings; 2) gathering information about who responds under what contexts; and 3) increasing
our understanding of the barriers and facilitators for future implementation. The primary
hypothesis is that YLH receiving home-based MET will have greater improvements in alcohol
use and viral load than YLH receiving clinic-based MET.
Inclusion Criteria:
- HIV-infected
- Ability to speak and understand English
- Prescribed antiretroviral therapy
- Detectable viral load in the last month
Exclusion Criteria:
- Not fluent in English
- History of sever learning disability, mental retardation, major psychiatric disorders
(e.g., schizophrenia, bipolar disorder, major depression with psychotic features,
etc).
- Participation in another adherence intervention trial
- On ART due to pregnancy
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