Mobile Health Intervention to Reduce HIV Transmission: A Randomized Trial of Behaviorally Enhanced HIV Treatment as Prevention (B-TasP)

• Type of Material: Article
• Authors: Seth C. Kalichman, University of Connecticut; Chauncey Cherry, University of Connecticut; Moira O. Kalichman, University of Connecticut; Lisa A. Eaton, University of Connecticut; James Kohler, Emory University; Catherine Montero, Emory University; Raymond F Schinazi, Emory University
• Language: English
• Date: 2018-05-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000001637
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 78
• Issue: 1
• Start Page: 34
• End Page: 42
• Grant/Funding Information: This research was supported by grants from the National Institute on Drug Abuse (NIDA) R01-DA033067 (Kalichman); and National Institute of Allergy and Infectious Diseases P30-AI050409 (Schinazi).
• Keywords: HUMAN-IMMUNODEFICIENCY-VIRUS; CLINIC PATIENTS; Science & Technology; MEDICATION ADHERENCE; Infectious Diseases; HIV infectiousness; URINARY-TRACT-INFECTION; Life Sciences & Biomedicine; LEUKOCYTES; HIV prevention; Immunology; ANTIRETROVIRAL THERAPY; ANTIVIRAL TREATMENT; SEXUAL TRANSMISSION; treatment as prevention; RISK BEHAVIORS; SEMEN
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Objectives: We conducted a randomized clinical trial to test a mobile health behavioral intervention designed to enhance HIV treatment as prevention (B-TasP) by simultaneously increasing combination antiretroviral therapies (cART) adherence and improving the sexual health of people living with HIV. Methods: A cohort of sexually active men (n = 383) and women (n = 117) living with HIV were enrolled. Participants were baseline assessed and randomized to either (1) B-TasP adherence and sexual health intervention or (2) general health control intervention. Outcome measures included HIV RNA viral load, cART adherence monitored by unannounced pill counts, indicators of genital tract inflammation, and sexual behaviors assessed over 12 months. Results: Eighty-six percent of the cohort was retained for 12-month follow-up. The B-TasP intervention demonstrated significantly lower HIV RNA, OR = 0.56, P = 0.01, greater cART adherence, Wald χ 2 = 33.9, P = 0.01, and fewer indicators of genital tract inflammation, Wald χ 2 = 9.36, P = 0.05, over the follow-up period. Changes in sexual behavior varied, with the B-TasP intervention showing lower rates of substance use in sexual contexts, but higher rates of condomless sex with non-HIV positive partners occurred in the context of significantly greater beliefs that cART reduces HIV transmission. Conclusions: Theory-based mobile health behavioral interventions can simultaneously improve cART adherence and sexual health in people living with HIV. Programs aimed to eliminate HIV transmission by reducing HIV infectiousness should be bundled with behavioral interventions to maximize their impact and increase their chances of success.