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We propose a randomized controlled trial of a disclosure intervention in which 300 PLH are randomized to either an: 1) experimental condition, a disclosure intervention (n = 150 parents) or 2) attention control condition, a nutrition intervention (n = 150). The intervention's impact will be assessed over two years (recruitment, 3, 6, 12, 18, & 24 months). The 3-session, culturally tailored disclosure intervention will be delivered by local nurses and address planning for developmentally appropriate disclosure (how and when to disclose), responding to children's reactions, building a supportive family environment, and custody planning. The attention control condition will be relevant to PLH, also delivered by nurses and address nutrition. Therefore, the Specific Aims are to: 1) Primary Aim: Assess the efficacy of the intervention to increase the frequency and timing of parental disclosure. We hypothesize that PLH randomized to the disclosure intervention will be significantly more likely to disclose their own HIV status to their children (parental disclosure) and disclose sooner than PLH randomized to the control condition. 2) Primary Aim: Assess the longitudinal impact of disclosure on parent (medical, psychological, social), child (psychological, behavioral, social) and family outcomes. We hypothesize that parent (health status, depression, anxiety, social support), child (depression, anxiety, HIV-transmission risk behaviors, social support) and family outcomes (family relationships, custody planning) will be significantly better for families in the intervention than families randomized to the control condition. 3) Secondary Aim: Assess the efficacy of the intervention to increase pediatric disclosure. We hypothesize that PLH randomized to the disclosure intervention will be significantly more likely to disclose to a child that s/he is HIV-positive (pediatric disclosure) than PLH randomized to the control condition. The proposed study addresses a neglected and profoundly understudied area that is of high importance to millions of families affected by HIV. If successful, the proposed study will provide evidence for a sustainable model and efficacious disclosure intervention in low-income settings.

This project has two aims: 1

1. To describe collective and individual belief systems of low-income township men who have sex with men (MSM) related to their sexuality, sexual health, choice of sexual partners, use of drugs and alcohol, use of condoms, utilization of health services, HIV voluntary counseling and testing (VCT) and disclosure of HIV status, in order to describe prevailing cultural norms around these subjects’ behaviors
2. To assess the prevalence of HIV risk factors and HIV infection among MSM from Soweto township.

This study is the first of its kind in South Africa. Through in-depth interviews, focus group discussions, and structured observations of MSM social venues, we have been able to describe the gender identities and sexualities that are prevalent in township MSM communities. We will estimate the prevalence of risk behaviors and HIV infection in Soweto using respondent-driven sampling methodology. This will be the first HIV prevalence data for an MSM community in South Africa.

The study brings together researchers from the University of California, San Francisco and St. John’s National Academy of Health Sciences in Bangalore, India. The overall goal of this study is to evaluate the impact of a promising Antiretroviral Therapy (ART) adherence-enhancing intervention grounded in Social Cognitive Theory (SCT) that addresses the needs of people living with HIV (PLHIV). This intervention targets not only medication adherence, but also other culturally-relevant topics designed to enhance physical and mental health among PLHIV, including yoga/meditation, nutrition, legal services, and assistance accessing local resources. We are testing this promising intervention in a Randomized Controlled Trial (RCT) among 500 sub-optimally adherent patients, comparing it to a time-matched active control condition, consisting of the non-adherence specific components of the intervention. Specifically, we propose:

1. To evaluate the impact of the Chetana intervention on antiretroviral medication adherence and treatment outcome, as measured by self-report, viral load, Wisepill wireless monitoring, and medical chart review. We hypothesize that participants in the intervention arm will show a significant reduction in missed pills as well as a reduced number of treatment interruptions and improved viral suppression, compared to participants in the time-matched active control group.
2. To evaluate the impact of the Chetana intervention on reported adherence barriers. We hypothesize that participants in the intervention arm will report a significant reduction in number of adherence barriers, compared to participants in the time-matched active control group.
3. To examine wireless adherence monitoring as a predictor of treatment outcome. We hypothesize that this ongoing, objective real-time measure of adherence will better predict subsequent viral load than our self-reported Optimal Adherence measure that combines past month adherence and treatment interruptions.

In the era of HIV treatment as prevention (TasP), efforts are needed to identify evidence-based combination prevention approaches that achieve greater decreases HIV viral load among populations that are more likely to engage in HIV transmission risk behavior. Because methamphetamine-using men who have sex with men (MSM) are at greater risk for acquiring and transmitting medication-resistant strains of HIV, interventions targeting stimulant use in this population of high-risk men could boost the effectiveness of TasP. At present, only conditional cash transfer approaches such as contingency management (CM) have demonstrated short-term efficacy in reducing stimulant use among substance-using MSM who are not actively seeking formal treatment. The proposed RCT will examine the efficacy of a positive affect intervention that is designed to optimize the effectiveness of CM to achieve long-term reductions in stimulant use and HIV viral load in this population. Our team will examine the efficacy of this integrative intervention in a randomized controlled trial (RCT) with 230 HIV-positive, methamphetamine-using MSM. After enrolling in CM, participants will be randomized to receive either: 1) the positive affect intervention; or 2) an attention-matched control condition. Follow-up data will be collected at 2, 3, 6, and 12 months post-randomization. This RCT will provide an opportunity to examine the efficacy of an integrative intervention designed to promote long-term reductions in HIV viral load as the primary outcome. Secondary outcomes that will be examined include: increases positive affect, reductions in stimulant use, improvements in T-helper (CD4+) count, and decreases HIV transmission risk behavior. Identifying an efficacious intervention approach to decrease HIV viral load among methamphetamine-using MSM would substantially support the goals of the National HIV/AIDS Strategy to reduce HIV incidence and mitigate HIV-related health disparities