Social Network Intervention to Engage Community PLH to Engage in HIV Medical Care

Phase I of the planned research will be the conduct of in-depth interviews with 30 HIV+
persons not in medical care or not adherent to anti-retroviral therapy (ART) regimens,
including men and women representing diverse exposure risks (drug use, men who have sex with
men, and heterosexual transmission). Interviews will elicit information on ways in which
HIV-positive friends can support one another in HIV care entry, retention, and adherence;
types of support from PLH friends that would best support treatment engagement; and how peer
supports can lessen the negative effects of substance use on care engagement.

Phase 2 will recruit 48 out-of-care or ART nonadherent HIV+ individuals from community
settings in St. Petersburg, Russia. These individuals, who are referred to as "network
seeds," will invite their HIV+ friends, who will in turn invite their own HIV+ friends into
the study, creating a sample of 48 networks (expected n=288, 6 members/network x 48
networks). Following baseline assessment of care engagement, ART adherence, treatment
attitudes, psychosocial distress, substance use, and CD4+ and viral load, 24 networks (n=144
participants) will be randomized to an intervention condition and 24 networks (n=144) to the
comparison condition. All members of each intervention condition network will together attend
a 4-session intervention to strengthen attitudes, intentions, and skills for entering,
remaining, and adhering to HIV medical care. Because participants will attend sessions with
other individuals who are their own friends in day-to-day life, the intervention will build
and increase mutual social support within each network for HIV care and adherence. Peer
champions identified in each intervention network will attend 3 additional sessions in which
they are guided to reinforce and help to sustain friends' medical care engagement.
Intervention outcomes will be determined by baseline to 6- and 12-month followup change on
primary measures of participant attendance at HIV medical care visits, adherence to ART
regimens, and viral load as well as secondary measures of alcohol use, drug use, sexual risk
behavior, treatment attitudes, and psychosocial distress.

Inclusion Criteria:

- Age 18 or older;

- Self-report as being HIV-positive, with positive HIV status confirmed in
study-provided testing;

- Except for initial seeds, must be named by an already-enrolled participant as a PLH
friend; and

- Do not plan to move from the St. Petersburg, Russia, area for the next 18 months.

Exclusion Criteria:

- Age 17 or younger;

- Self-report as HIV-negative or HIV-positive serostatus is not confirmed by testing;

- Not be named as a PLH friend by an already-enrolled participant; and

- Intend to move from the St. Petersburg, Russia, area during the next 18 months.