Effectiveness of an evidence-based intervention to improve treatment adherence, service utilization and viral load among HIV-seropositive adult alcohol users

Background: The level of antiretroviral treatment (ART) adherence needed to sustain viral suppression may be challenging for substance users and people with neurocognitive impairment. We evaluated whether a manual-guided, group intervention with cognitive remediation strategies improved ART adherence, service utilization and viral load (VL) among HIV-positive adults who abuse alcohol.

Methods: Participants (n=243) from Miami, FL were randomized to the Holistic Health Recovery Program (HHRP-A) with cognitive remediation strategies or a comparison condition that provided only didactic general health information. Both conditions attended eight group sessions and provided self-report data on ART adherence, service utilization, and viral load (VL), and on two process variables—social support and stress—at baseline (T1), post-intervention (T2), 3-months (T3), and 6-months (T4).  Repeated measures ANOVA and non-parametric alternatives were used to compare groups over time.

Results: Participants were ≥18 and ≤60 (=45.7 years old), 74% male, and 78% black. There were no significant differences in demographic or study measures by treatment group assignment at baseline.  A significant difference (RR=1.55; p=.049) was observed between treatment groups in the proportions of participants reporting >95% adherence at T4 (HPC=80.6% versus HHRP-A=90.3%). Also at T4, HHRP-A participants were more likely (74.6%; RR=1.49; p=.033) to report an undetectable VL than in HPC (56.7%). Regarding process variables, HHRP-A showed better social support over time than HPC; this result approached significance [F=2.37, p<.06]. Support was significantly correlated with adherence at T4 (r=.28, p<.05).

Conclusions: Implementing risk reduction interventions that incorporate cognitive remediation strategies could improve health outcomes for HIV-seropositive substance users.