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Effectiveness of a Viral Load Suppression Intervention for Highly Vulnerable People Living with HIV

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Abstract

We examine the effect of the Undetectables Intervention (UI) on viral loads among socially vulnerable HIV-positive clients. The UI utilized a toolkit that included financial incentives, graphic novels, and community-based case management services. A pre-post repeated measures analysis (n = 502) through 4 years examined longitudinal effects of the intervention. Logistic models regressed social determinants on viral loads. Finally, in-depth qualitative interviews (n = 30) examined how UI shaped adherence. The proportion of virally suppressed time-points increased 15% (from 67 to 82% pre to post-enrollment, p < 0.0001). The proportion of the sample virally suppressed at all time-points increased by 23% (from 39 to 62% pre to post-enrollment, p < 0.0001). African Americans and the homeless were the most likely to be unsuppressed at baseline, but, along with substance users, benefitted the most from UI. The intervention shaped adherence through two pathways, by: (1) establishing worth around adherence, and (2) increasing motivation to become suppressed, and maintain adherence.

Resumen

Examinamos el efecto de la Intervención los Indetectables (II) sobre cargas virales entre clientes de VIH que son socialmente vulnerables. La II utilizo un conjunto de servicios y recursos que incluía incentivos financieros, novelas gráficas, y servicios de manejo de casos basados en la comunidad. Un análisis repetitivo pre y post- (n = 502) sobre cuatro años examino longitudinalmente los efectos de la intervención. Modelos logísticos incluyeron determinantes sociales sobre cargas virales. Finalmente, entrevistas cualitativas a profundidad examinaron como la II afecto adherencia a la medicación. La proporción de puntos en tiempo de cargas virales suprimidas aumento 15% (de 67% preinscripción a 82% postinscripción, p < 0.0001). La proporción de la muestra de cargas virales suprimidas a todos puntos en tiempo aumento por 23% (de 39% preinscripción a 62% postinscripción, p < 0.0001). Afroamericanos y gente sin hogar fueron más probable de no tener cargas virales suprimidas en la línea de base, pero, junto con individuos que usan substancias, fueron los que beneficiaron más de la II. La intervención dio forma a la adherencia a través de dos rutas, por: (1) estableciendo valor a la adherencia, y (2) aumentando motivación para suprimir la carga viral y mantenerse adherente.

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Acknowledgements

We thank the Robin Hood Foundation for funding this study. We thank Housing Works for supporting the intervention and this study. We also thank Farnaz Malik, Michelle Davidson, and Paige Andrews for providing support for the study.

Funding

This study was funded by a Robin Hood Foundation Grant.

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Authors and Affiliations

  1. School of Social Policy and Practice, University of Pennsylvania, D17 Caster Building, 3401 Locust Walk, Philadelphia, PA, 19104, USA

    Toorjo Ghose & Sambuddha Choudhuri

  2. Housing Works, New York, NY, USA

    Virginia Shubert & Vaty Poitevien

  3. School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Robert Gross

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  1. Toorjo Ghose
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  2. Virginia Shubert
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  3. Vaty Poitevien
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  4. Sambuddha Choudhuri
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Correspondence to Toorjo Ghose.

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Conflict of interest

Toorjo Ghose declares that he has no conflict of interest. Virginia Shubert declares that she has no conflict of interest. Vaty Poitevien declares that she has no conflict of interest. Sambuddha Choudhuri declares that he has no conflict of interest. Robert Gross declares that he has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ghose, T., Shubert, V., Poitevien, V. et al. Effectiveness of a Viral Load Suppression Intervention for Highly Vulnerable People Living with HIV. AIDS Behav 23, 2443–2452 (2019). https://doi.org/10.1007/s10461-019-02509-5

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