Developing a U.S. National Cohort to Improve Virologic Suppression among Stimulant-using Men Living with HIV.

A resurgent stimulant epidemic among men living with HIV could compromise the U.S. Ending the HIV Epidemic (EHE) goals by interfering with HIV care engagement, adherence, and virologic suppression among men living with HIV. Prominent multi-level factors interfere with HIV virologic suppression for men living with HIV, particularly among those who use stimulants. We will digitally recruit at least 1,000 men living with HIV to identify multi-level determinants of HIV care engagement, adherence, and virologic suppression, and will recruit men living with HIV with and without stimulant use. Guided by the social ecological model, we will investigate network factors (i.e. number of friends living with HIV), geospatial determinants (stimulant use prevalence, EHE region), and other factors that affect virologic suppression (Aim 1). After recruitment milestones are met, we will perform a nested randomized clinical trial to test a multi-component intervention to improve virologic suppression, adherence, and stimulant use among men living with HIV who use stimulants (n=300). The intervention, known as reSTART, will combine an evidence-based positive affect intervention delivered through a smartphone app and use of urine point-of-care testing to perform adherence self-monitoring, with motivational messages to improve or maintain adherence delivered via the reSTART app (Aim 2). In Aim 3 of the proposal, we will assess the impact of reSTART on incremental cost per person on virologic suppression and stimulant use intensity as measured by hair stimulant levels. By this high-impact study’s end, we will have identified multi-level determinants of the treatment continuum among digitally recruited men living with HIV, including among those who use stimulants; and the impact of a multi-component reSTART mHealth intervention using novel point-of-care adherence self-monitoring on HIV virologic suppression, stimulant use, and cost.