Intervention to Increase Timely Initiation of HAART among Those who Delay/Decline
Funded by: National Institute of Mental Health
Project dates: July 2011 - October 2014
Principal Investigator: Gwadz, Marya

Of the 1.2 million Americans living with HIV infection, an estimated 60% are not retained in medical care, 63% are not taking antiretroviral therapy (ART), and only 30% have undetectable viral loads, the ultimate goal of HIV treatment.  Typically, vulnerable persons living with HIV/AIDS (PLHA) face multiple barriers to initiating ART, maintaining good adherence, and engaging regularly in HIV care. In contrast to the great many interventions to support adherence to ART, there is a dearth of approaches to foster ART initiation among PLHA who have delayed, declined, or discontinued ART, many of whom struggle with substance use problems, poverty, fear of ART, and stigma. To address this gap, this project developed and examined the efficacy of a new culturally targeted and individually tailored intervention, called Heart to Heart.  The pilot intervention was comprised of three intervention sessions, involvement of a support partner, patient navigation as needed over 3 months, and support groups with other PLHA who had declined medication co-led by a “successful” peer who was taking ART with high adherence and engaged in HIV care. It was evaluated in a small-scale randomized controlled trial (N=95) where the control arm received treatment as usual. The study found that eight months after their baseline interview, intervention participants tended to be more likely to evidence “good” (that is, 7 days/week) adherence, based on hair samples, and had lower viral load levels based on medical records than those who received treatment as usual. These findings support the promise of this this new intervention strategy to improve the uptake of ART and the reduction of HIV viral load in this vulnerable population.

Abstract on NIH RePORTER
Related Publications
Freeman R, Gwadz MV, Silverman E, Kutnick A, Leonard NR, Ritchie AS, Reed J, Martinez BY (2017).
Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/Black and Hispanic persons living with HIV in the United States: A qualitative exploration
International Journal for Equity in Health, 16, 54. doi: 10.1186/s12939-017-0549-3. PMCID: PMC5364619.

Gwadz M, de Guzman R, Freeman R, Kutnick A, Silverman E, Leonard NR, Ritchie AS, Munoz-Plaza C, Salomon N, Wolfe H, Hilliard C, Cleland C, Honig S (2016).
Exploring how substance use impedes engagement along the HIV care continuum: A qualitative exploration
Frontiers in Public Health, 4, 62. doi: 10.3389/fpubh.2016.00062. PMCID: PMC4824754.

Gwadz M, Cleland CM, Applegate E, Belkin M, Gandhi M, Salomon N, Banfield A, Leonard N, Riedel M, Wolfe H, Pickens I, Bolger K, Bowens D, Perlman D, Mildvan D (2015).
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
AIDS and Behavior, 19 (10), 1801-1807. doi: 10.1007/s10461-015-1054-6. PMCID: PMC4567451.

Gwadz MV, Applegate E, Cleland C, Leonard NR, Wolfe H, Salomon N, Belkin M, Riedel M, Banfield A, Colon P, Sanfilippo L, Wagner A, Mildvan D (2014).
HIV-infected individuals who delay, decline, or discontinue antiretroviral therapy: Comparing clinic- and peer-recruited cohorts
Frontiers in Public Health, 2, 81. doi: 10.3389/fpubh.2014.00081. PMCID: PMC4100062.