Does intervention location matter for an HIV program?

The days of HIV being a quick death sentence are long past, but adolescents and young adults are still struggling to have optimal outcomes. A new report in JAMA Network Open looks at whether the Healthy Choices Intervention has better efficacy when delivered in HIV clinics or when provided remotely.¹

Investigators ran a randomized clinical trial from November 2014 to January 2018, which had 52 weeks of follow-up. The study participants were recruited from HIV clinics in Chicago, Illinois; Detroit, Michigan; Memphis, Tennessee; Los Angeles, California; and Philadelphia, Pennsylvania. They were adolescents aged 16 to 24 years who were living with HIV, fluent in English, currently had a prescription for HIV medication, used alcohol in the past 12 weeks, and had a detectable viral load. Each participant was randomized to undergo the Healthy Choices intervention either in the home or in a clinic setting. They were given 4 30-minute individual sessions that used motivational interviewing to improve medication adherence and drinking behavior.

The researchers recruited 183 adolescents and young adults who had HIV. Ninety were randomized to receive the intervention in the home setting and 93 were randomized to receive the intervention in the clinical setting. Following growth-curve analysis, the 2 groups showed declines in their viral load following intervention. In the home intervention group, 12 had an undetectable viral load at 16 weeks; 12 had an undetectable viral load at 28 weeks; and 10 had it at 52 weeks. Meanwhile in the clinic group, 16 had an undetectable viral load at 16 weeks; 20 were undetectable at 28 weeks; and 18 had an undetectable load at 52 weeks. The clinic group maintained the gains, but those counseled at home had a different and increasing trajectory during follow-up (unstandardized β = −0.07; 95% CI,−0.14 to −0.01; P = .02). A comparable pattern was seen with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) score in the clinic group (unstandardized β = −0.44; 95% CI,−0.81 to −0.07; P = .02)

The researchers concluded that the Health Choices intervention performed well and led to improvements in the viral load and alcohol use. However, the clinic setting improved the trajectory of the ASSIST scores and performed better than home-based delivery with viral suppression.

Reference

1. Naar S, Robles G, MacDonell K, et al. Comparative effectiveness of community-based vs clinic-based healthy choices motivational intervention to improve health behaviors among youth living with HIV. JAMA Netw Open. 2020;3(8):e2014650. doi:10.1001/jamanetworkopen.2020.14650