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Mechanism of Change in Cognitive Behavioral Therapy for Body Image and Self-Care on ART Adherence Among Sexual Minority Men Living with HIV

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Abstract

Body image disturbance is a common problem reported among sexual minority men living with HIV, and is associated with poor antiretroviral therapy (ART) adherence. Recently, a novel integrated intervention (cognitive behavioral therapy for body image and self-care; CBT-BISC) was developed and pilot tested to simultaneously improve body image and ART adherence in this population. Although CBT-BISC has demonstrated preliminary efficacy in improving ART adherence, the mechanisms of change are unknown. Utilizing data from a two-armed randomized controlled trial (N = 44 sexual minority men living with HIV), comparing CBT-BISC to an enhanced treatment as usual (ETAU) condition, sequential process mediation via latent difference scores was assessed, with changes in body image disturbance entered as the mechanism between treatment condition and changes in ART adherence. Participants assigned to CBT-BISC reported statistically significant reductions in body image disturbance post-intervention, which subsequently predicted changes in ART adherence from post-intervention to long term follow-up (b = 20.01, SE = 9.11, t = 2.19, p = 0.028). One pathway in which CBT-BISC positively impacts ART adherence is through reductions in body image disturbance. Body image disturbance represents one, of likely several, mechanism that prospectively predicts ART adherence among sexual minority men living with HIV.

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Acknowledgements

Funding from this project came from K23MH096647. Author time for Dr. Safren was supported by K24DA040489 (formally K24MH094214). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

Funding

This study was funded by K23MH096647. Author time for Dr. Safren was supported by K24DA040489 (formally K24MH094214).

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Authors and Affiliations

  1. San Diego State University, San Diego, CA, USA

    Kalina M. Lamb, Kelsey A. Nogg & Aaron J. Blashill

  2. University of Miami, Coral Gables, FL, USA

    Steven A. Safren

  3. San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA

    Aaron J. Blashill

Authors
  1. Kalina M. Lamb
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  2. Kelsey A. Nogg
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  4. Aaron J. Blashill
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Correspondence to Kalina M. Lamb.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and 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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Lamb, K.M., Nogg, K.A., Safren, S.A. et al. Mechanism of Change in Cognitive Behavioral Therapy for Body Image and Self-Care on ART Adherence Among Sexual Minority Men Living with HIV. AIDS Behav 22, 2711–2717 (2018). https://doi.org/10.1007/s10461-018-2143-0

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  • DOI: https://doi.org/10.1007/s10461-018-2143-0

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