Virtual, peer-led program shows promise for improving HIV treatment adherence for teens and young adults

A virtual intervention led by peer coaches can help HIV-positive Black and Hispanic adolescents and young adults adhere to their medication, according to a proof-of-concept study published in the journal AIDS and Behavior. The findings lay the groundwork for a larger, ongoing study to improve HIV treatment adherence.

“The combination of technology and peer health coaches is highly promising for HIV behavioral science, and has the potential to improve clinical treatment and prevent transmission in this population,” said Ann-Margaret Navarra, PhD, CPNP-PC, FAAN, associate professor at NYU Rory Meyers College of Nursing and the study’s lead author.

Current treatments for HIV are very effective at reducing the levels of the virus in the blood, or viral load, and preventing transmission. However, antiretroviral therapy (ART) must be taken as prescribed in order to be effective.

People with HIV face numerous barriers that hinder their ability to consistently take ART, including lower access to care, discrimination, and stigma. Studies show that HIV-positive Black and Hispanic teens and young adults have lower rates of ART adherence, with nearly 40% reporting not consistently taking their medication, increasing their chances of poor outcomes and transmitting HIV to sexual partners.

To encourage ART adherence in this population, Navarra designed an intervention called ACCESS (Adherence Connection Counseling, Education, and Support) that embraces the use of trained peer health coaches and mobile technology. The peer health coaches lead weekly videoconferencing sessions with participants who are given study-provided smartphones. During each of the five sessions, the peer coaches use cognitive behavioral strategies, including motivational interviewing techniques, to enhance problem-solving, target knowledge and beliefs about ART treatment, and improve self-efficacy around medication adherence.

“Even before the COVID-19 pandemic, we saw the value in using videoconferencing to form partnerships with community and clinical partners, and connect with participants to bring information and support to them,” said Navarra.

Sixteen Black and Hispanic teens and young adults (ages 16–29 years) living with HIV completed the ACCESS intervention in the study published in AIDS and Behavior. After the five sessions, participants showed significant improvements in their knowledge of HIV treatment and their confidence in their ability to stick with their treatments as prescribed. Their ART adherence also improved, with participants reporting a 32% increase in doses taken. Notably, they experienced a 47.5% reduction in HIV viral load based on blood tests.

“The virologic and adherence data are very promising. Our study shows that integrating peer health coaches as core members of the study team and mobilizing them using technology is a viable method for delivering an intervention to a population facing stigma and barriers to care,” said Navarra.

This small study demonstrated the feasibility and acceptability of the ACCESS intervention. The researchers are currently in the midst of a larger randomized controlled trial to test the intervention with 120 participants (also Black and Hispanic adolescents and young adults with HIV) and are recruiting study participants, including in a local LGBTQ+ magazine.  Using feedback from the smaller study, the researchers refined and expanded the ACCESS session content, adding three new sessions to the protocol for a total of eight weekly sessions.

“We look forward to completing our randomized controlled trial to see if the results are upheld in a larger study,” added Navarra.

In addition to Navarra, study authors include Jason Fletcher, Charles Cleland, and Gail D’Eramo Melkus of NYU Meyers, as well as Michael G. Rosenberg of Jacobi Medical Center, Maurade Gormley of the University of Connecticut School of Nursing, Suzanne Bakken of Columbia University School of Nursing, Robin Whittemore of Yale School of Nursing, and Marya Gwadz of NYU Silver School of Social Work. The study was funded by the National Institute of Nursing Research (K23NR015970). The ongoing randomized controlled trial is also funded by the National Institute of Nursing Research (R01NR019535).