AIDS and Behavior

, Volume 19, Issue 10, pp 1801–1817 | Cite as

Behavioral Intervention Improves Treatment Outcomes Among HIV-Infected Individuals Who Have Delayed, Declined, or Discontinued Antiretroviral Therapy: A Randomized Controlled Trial of a Novel Intervention

  • Marya GwadzEmail author
  • Charles M. Cleland
  • Elizabeth Applegate
  • Mindy Belkin
  • Monica Gandhi
  • Nadim Salomon
  • Angela Banfield
  • Noelle Leonard
  • Marion Riedel
  • Hannah Wolfe
  • Isaiah Pickens
  • Kelly Bolger
  • DeShannon Bowens
  • David Perlman
  • Donna Mildvan
  • The Heart to Heart Collaborative Research Team
Original Paper


Nationally up to 60 % of persons living with HIV are neither taking antiretroviral therapy (ART) nor well engaged in HIV care, mainly racial/ethnic minorities. This study examined a new culturally targeted multi-component intervention to address emotional, attitudinal, and social/structural barriers to ART initiation and HIV care. Participants (N = 95) were African American/Black and Latino adults with CD4 < 500 cells/mm3 not taking ART, randomized 1:1 to intervention or control arms, the latter receiving treatment as usual. Primary endpoints were adherence, evaluated via ART concentrations in hair samples, and HIV viral load suppression. The intervention was feasible and acceptable. Eight months post-baseline, intervention participants tended to be more likely to evidence “good” (that is, 7 days/week) adherence (60 vs. 26.7 %; p = 0.087; OR = 3.95), and had lower viral load levels than controls (t(22) = 2.29, p = 0.032; OR = 5.20), both large effect sizes. This highly promising intervention merits further study.


Antiretroviral therapy Intervention HIV/AIDS Disparities Motivational interviewing 



We wish to thank the men and women who participated in the study, the Peter Krueger Center for Immunological Disorders at Mount Sinai Beth Israel, Spencer Cox Center for Health at Mount Sinai St. Luke’s-Roosevelt Hospital Center, and Gay Men’s Health Crisis for making this study possible. Special thanks to Rob Shiau at the Peter Krueger Center and Zach Hennessey, MA at Spencer Cox for facilitating study implementation. This work would not have been possible without Lisa Sanfilippo, RN; Andrea Wagner, RN; Christopher Hilliard, MPH; Amy Braksmajer, Ph.D.; and Victoria Sharp, MD. The study was supported by the National Institutes of Mental Health (R34MH093352) and the Center for Drug Use and HIV Research (CDUHR; P30 DA011041). Dr. Monica Gandhi was supported by NIAID/NIH RO1AI098472 and we thank Drs. Yong Huang and Howard Horng, directors of the hair analysis laboratory at UCSF. We particularly wish to acknowledge our Program Officer at the National Institute of Mental Health (NIMH), Michael Stirratt, Ph.D., Program Chief at the NIMH Division of AIDS Research for scientific guidance throughout the study.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Marya Gwadz
    • 1
    Email author
  • Charles M. Cleland
    • 1
  • Elizabeth Applegate
    • 1
  • Mindy Belkin
    • 1
  • Monica Gandhi
    • 2
  • Nadim Salomon
    • 3
  • Angela Banfield
    • 1
  • Noelle Leonard
    • 1
  • Marion Riedel
    • 4
  • Hannah Wolfe
    • 5
  • Isaiah Pickens
    • 1
  • Kelly Bolger
    • 1
  • DeShannon Bowens
    • 1
  • David Perlman
    • 6
  • Donna Mildvan
    • 6
  • The Heart to Heart Collaborative Research Team
  1. 1.Center for Drug Use and HIV Research (CDUHR)New York University College of NursingNew YorkUSA
  2. 2.Division of HIV/AIDS, Department of MedicineUniversity of California San Francisco (UCSF)San FranciscoUSA
  3. 3.Department of Infectious Diseases, Peter Krueger Center for Immunological DisordersMount Sinai Beth IsraelNew YorkUSA
  4. 4.School of Social WorkColumbia UniversityNew YorkUSA
  5. 5.Mount Sinai St. Luke’s-Roosevelt Hospital CenterSpencer Cox Center for HealthNew YorkUSA
  6. 6.Department of Infectious DiseasesMount Sinai Beth IsraelNew YorkUSA

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