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Addressing Syndemics and Self-care in Individuals with Uncontrolled HIV: An Open Trial of a Transdiagnostic Treatment

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Abstract

Interventions addressing syndemics and ART adherence are needed for individuals with uncontrolled HIV and psychosocial problems. Twenty-seven participants with detectable HIV plasma viral load (PVL) or recent STI participated in an open trial of transdiagnostic adherence counseling and cognitive behavioral therapy. Outcomes were collected at baseline, 4-, and 8-months. Log PVL improved from baseline to 4-month (γ = − 1.13, 95% CI − 1.72, − 0.55, p < 0.001) and 8-month (γ = − 0.93, 95% CI − 1.57, − 0.30, p = 0.006), with more participants suppressed at 4- (χ2(1) = 9.09, p = 0.001) and 8-month (χ2(1) = 5.14, p = 0.016). Self-reported adherence improved across major assessments (γ = 0.87, 95% CI 0.28, 1.46, p = .005); Wisepill adherence did not. Negative affect declined during treatment (γ = − 0.28, 95% CI − 0.40, − 0.16, p < 0.001), with improvement at 4- (γ = − 4.34, 95% CI − 6.99, − 1.69, p = 0.002) but not 8-month. Positive affect trended positively during treatment and from baseline to 4-month, with significant 8-month improvement (γ = 3.84, 95% CI 0.33, 7.44, p = 0.04). Depressive symptoms did not change. In a complicated sample of participants selected for uncontrolled HIV, the intervention yielded improved PVL and self-reported adherence. Efforts to end HIV should improve upon strategies such as these, addressing syndemics. Registration: clinicaltrial.gov: NCT02696681.

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Notes

  1. During data cleaning, we found that five participants completed some but not all of the PHQ-9 items (n = 5), with the maximum number of items missed being two. For these five cases, we imputed the missing values with the mean of the participants’ responses on the other completed items in order to retain their data.

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Funding

This study was funded by K24MH094214/9K24DA040489. It was also supported by P30MH116867 and 5P30AI073961. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health, the National Institute of Drug Abuse, The National Institute for Allergy and Infectious Disease, or the National Institutes of Health.

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Authors and Affiliations

  1. Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA

    S. A. Safren, J. S. Lee, N. A. Mendez, S. Bainter & G. Ironson

  2. Department of Public Health Sciences, University of Miami, Miami, FL, USA

    A. Harkness

  3. Department of Medicine, Brown University, Providence, RI, USA

    B. G. Rogers

  4. Department of Psychology, University of Maryland, College Park, MD, USA

    J. F. Magidson

  5. Department of Psychology, San Diego State University, San Diego, CA, USA

    A. J. Blashill

  6. Department of Medicine, University of Miami, Miami, FL, USA

    A. Rodriguez

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  1. S. A. Safren
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Correspondence to S. A. Safren.

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Dr. Safren receives royalties on books related to delivering cognitive behavioral therapy and motivational interviewing from Oxford University Press, Guilford Publications, and Springer/Humana Press.

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Safren, S.A., Harkness, A., Lee, J.S. et al. Addressing Syndemics and Self-care in Individuals with Uncontrolled HIV: An Open Trial of a Transdiagnostic Treatment. AIDS Behav 24, 3264–3278 (2020). https://doi.org/10.1007/s10461-020-02900-7

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