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Act Healthy: A Randomized Clinical Trial Evaluating a Behavioral Activation Intervention to Address Substance Use and Medication Adherence Among Low-Income, Black/African American Individuals Living with HIV/AIDS

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Abstract

There is a need for parsimonious behavioral interventions to support HIV and substance use treatment outcomes for low-income, Black/African American individuals living with HIV. This randomized clinical trial (N = 61) evaluated Act Healthy (AH), an integrated behavioral intervention to reduce substance use and improve medication adherence, compared to supportive counseling (SC) plus Life-Steps medication adherence counseling on substance use, craving, adherence-related outcomes, and depression over one year. Participants in AH had significantly steeper decreases in cravings compared to SC, but no significant differences in substance use. Across both groups, there was a significant increase in probability of being on antiretroviral therapy (ART) (86% on ART at 12 months vs. 56% at baseline), and a significant decrease in medication nonadherence. Findings provide preliminary support for an intervention to reduce cravings and strategies to improve ART use in a hard-to-reach, vulnerable population at high risk for poor treatment outcomes and ongoing HIV transmission.

Trial Registration

ClinicalTrials.gov trial registration number: identifier: NCT01351454. Retrospectively registered on May 10, 2011.

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Data Availability

Access to final study dataset was available to study authors. Other investigators can access the final de-identified dataset via written request to the last author. Treatment materials will also be made available upon request to the last author.

Code availability

Statistical code will be made available upon request from the second author.

Notes

  1. Analyses were also run using relative risk ratios instead of odds ratios and results did not differ.

  2. Of the participants at baseline who were not on ART, at the 12-month follow-up approximately 69% reportedly taking ART. Thus, the effect is not due to subsequent missing data for those not on ART at baseline.

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Funding

We would like to acknowledge that this study was funded by R01DA022974 (PI: Daughters). Dr. Safren is supported by 1P30MH116867. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA

    Jessica F. Magidson, Jennifer M. Belus, C. J. Seitz-Brown & Hannah Tralka

  2. Department of Psychology, University of Miami, Miami, FL, USA

    Steven A. Safren

  3. Department of Psychology and Neuroscience, UNC Chapel-Hill, Chapel Hill, NC, USA

    Stacey B. Daughters

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  1. Jessica F. Magidson
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  2. Jennifer M. Belus
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  3. C. J. Seitz-Brown
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  4. Hannah Tralka
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  5. Steven A. Safren
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  6. Stacey B. Daughters
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Contributions

SBD conceptualized the study, acquired study funding, oversaw study execution, and provided a critical review of the manuscript. JFM helped oversee study execution and wrote the first draft of the manuscript. JMB conducted analyses and wrote methods and results. CJSB was involved in data collection and contributed to writing method and discussion. SAS and HT provided a critical review of the manuscript. All authors made substantial intellectual contributions that warrant study authorship.

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Correspondence to Jessica F. Magidson.

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The study was approved by the University of Maryland College Park Institutional Review Board.

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Magidson, J.F., Belus, J.M., Seitz-Brown, C.J. et al. Act Healthy: A Randomized Clinical Trial Evaluating a Behavioral Activation Intervention to Address Substance Use and Medication Adherence Among Low-Income, Black/African American Individuals Living with HIV/AIDS. AIDS Behav 26, 102–115 (2022). https://doi.org/10.1007/s10461-021-03354-1

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