Health coaching improves virologic control for people living with HIV: A randomized controlled trial

Background: Many individuals living with HIV, even those who face minimal financial and other access barriers, fail to achieve the regimen adherence needed for HAART to be most effective. Hoping to improve this situation, the leadership of Indiana's high-risk insurance program (ICHIA) developed Positive Choices, a novel program that employs non-medically trained health coaches to improve health outcomes by developing a strong facilitator-client relationship and focusing on adherence and clients' capacity to navigate the health care system.

Methods: Study participants were enrolled in Indiana's high-risk pool and had access to care at minimal out-of-pocket cost. 449 individuals living with HIV in Indianapolis were randomly allocated to treatment (Positive Choices, n=91) and control (standard non-clinical case management, n=358) groups, and followed for approximately one year to assess the impact on drug adherence, clinical outcomes, and health status.

Results: Subjects were primarily middle-aged (mean age=44.3, SD=9.5) and male (85%). Approximately 75% had received CD4 and viral load tests in the baseline period. Among those, the average CD4 count was 558.0 (SD=305.7) and nearly 50% had an undetectable viral load (<50 copies/mL). In the follow-up period, intervention subjects were more likely to be adherent to prescribed HIV medications (OR=1.83, p=.0459) by ‘medication possession ratio' measures and more likely to achieve undetectable viral load (<50 copies/mL, OR=2.01, p=.0106).

Conclusions: Our results suggest the use of formalized social support as an adjunct to traditional case management may be a promising strategy to effect positive behavioral change and virologic control among HIV-positive persons.