A behavioral intervention for African-American gay and bisexual men living with HIV to address stigma-related barriers to antiretroviral therapy adherence

Stigma negatively affects adherence to HIV antiretroviral therapy, increasing the risk of virological failure and chronic inflammation, with subsequent impacts on morbidity, mortality, and transmission to HIV-negative partners. Stigma-related barriers to adherence are well documented among individuals living with HIV, including African-American gay and bisexual men living with HIV. Yet, effective interventions targeting stigma-related barriers remain scarce. Reminder-based approaches can improve adherence to antiretroviral therapy, but their effect on viral suppression remains unclear. These approaches primarily address sporadic non-adherence (e.g., missed doses from forgetfulness), with limited impact on viral suppression. Sustained non-adherence (i.e., prolonged dose gaps), on the other hand, is associated with virological failure, chronic inflammation (e.g., elevated Interleukin-6 levels), morbidity, and mortality. Because stigma-related barriers drive sustained non-adherence, interventions to address them are urgently needed. The candidate seeks training and research experience to design and pilot-test a technology-enhanced intervention that targets both sporadic and sustained non-adherence. While the intervention will initially be evaluated with African-American gay and bisexual men living with HIV, the candidate’s long-term goal is to expand the intervention so it can benefit other groups facing barriers to medication adherence across a range of chronic conditions. Training goals: Goal 1. Develop skills in behavioral intervention research; Goal 2. Gain skills in qualitative research methods; Goal 3. Acquire proficiency in the assessment and interpretation of biomarkers of antiretroviral therapy adherence and chronic inflammation. These goals, coupled with the candidate’s expertise in quantitative methods, stigma models, and clinical psychology, will support the following research aims: Aim 1. Identify stigma-related barriers to antiretroviral therapy adherence and strategies to counter these barriers through in-depth interviews with ~30 African-American gay and bisexual men living with HIV; Aim 2. Design a technology-enhanced intervention to address stigma-related barriers to antiretroviral therapy adherence; Aim 3. Evaluate the feasibility, acceptability, and effect size estimates of the intervention (Aim 2) through a pilot randomized control trial with 60 African-American gay and bisexual men living with HIV. The intervention will involve the adaptation and combination of 1) ARemind, a reminder-based strategy to decrease sporadic non-adherence, with 2) the Effective Skills to Empower Effective Men intervention, an approach that seeks to address stigma-related drivers of adherence. The intervention pilot test will involve participants’ randomization to either ARemind or the combined intervention. In addition to measures of feasibility and acceptability, the study will assess adherence to antiretroviral therapy based on self-report, Medication Event Monitoring System devices, and hair antiretroviral levels, viral suppression, and chronic inflammation. The pilot randomized control trial findings will inform an R01 to be submitted by the end of Year 5 of this award. This award will set the candidate on a clear path to research independence.