Randomized Controlled Trial of Rise, A Community-Based Culturally Congruent Counseling Intervention to Support Antiretroviral Therapy Adherence Among Black/African American Adults Living with HIV.

Structural inequities have led to HIV disparities, including relatively low antiretroviral therapy adherence and viral suppression rates among Black Americans living with HIV. We conducted a randomized controlled trial of Rise, a community-based culturally congruent adherence intervention, from January 2018 to December 2021 with 166 (85 intervention, 81 control) Black adults living with HIV in Los Angeles County, California [M (SD) = 49.0 (12.2) years-old; 76% male]. The intervention included one-on-one counseling sessions using basic Motivational Interviewing style to problem solve about adherence, as well as referrals to address unmet needs for social determinants of health (e.g., housing services, food assistance). Assessments included electronically monitored adherence; HIV viral load; and baseline, 7-month follow-up, and 13-month follow-up surveys of sociodemographic characteristics, HIV stigma, medical mistrust, and HIV-serostatus disclosure. Repeated-measures intention-to-treat regressions indicated that Rise led to significantly (two-fold) higher adherence likelihood, lower HIV stigmatizing beliefs, and reduced HIV-related medical mistrust. Effects on HIV viral suppression, internalized stigma, and disclosure were non-significant. Moreover, Rise was cost-effective based on established standards: The estimated cost per person to reach optimal adherence was $335 per 10% increase in adherence. Interventions like Rise, that are culturally tailored to the needs of Black populations, may be optimal for Black Americans living with HIV (ClinicalTrials.gov #NCT03331978).

RESUMEN: Las desigualdades estructurales han dado lugar a disparidades relacionadas con el VIH, incluyendo la relativamente baja adherencia a la terapia antirretroviral (TAR) y las tasas de supresión viral entre los afroamericanos que viven con el VIH. Conducimos una prueba controlada aleatoria de Rise, una intervención de adherencia culturalmente congruente basada en la comunidad, desde Enero de 2018 hasta Diciembre de 2021 con 166 (85 intervención, 81 controlada) adultos afroamericanos que viven con el VIH en el condado de Los Ángeles, California [M (SD) = 49.0 (12,2) años; 76% de hombres]. La intervención incluyó sesiones de asesoramiento individualizadas, usando el estilo básico Motivacional para las entrevistas, para resolver los problemas de adherencia como también referencias para confrontar sus necesidades insatisfechas de los determinantes sociales de la salud (por ejemplo, servicios de vivienda y asistencia de alimentos). Las evaluaciones incluyeron la adherencia monitoreada electrónicamente; la carga viral del VIH; y encuestas de referencia, seguimiento a los 7 meses y seguimiento a los 13 meses sobre características sociodemográficas, el estigma del VIH, la desconfianza médica y divulgación del estado serológico respecto al VIH. Los efectos sobre la supresión viral del VIH, el estigma interiorizado y la revelación de información no fueron significativos. Además, Rise fue rentable según los estándares establecidos: El costo estimado por persona para alcanzar la adherencia óptima fue de 335 dólares por cada 10% de aumento en la adherencia. Las intervenciones como Rise, que se adaptan culturalmente a las necesidades de las poblaciones afroamericana, podrían ser óptimas para los estadounidenses afroamericanos que viven con el VIH.

COVID-19 Related Medical Mistrust, Health Impacts, and Potential Vaccine Hesitancy Among Black Americans Living With HIV.

BACKGROUND: Medical mistrust, a result of systemic racism, is prevalent among Black Americans and may play a role in COVID-19 inequities. In a convenience sample of HIV-positive Black Americans, we examined associations of COVID-19-related medical mistrust with COVID-19 vaccine and COVID-19 treatment hesitancy and negative impacts of COVID-19 on antiretroviral therapy (ART) adherence. METHODS: Participants were 101 HIV-positive Black Americans (age: M = 50.3 years; SD = 11.5; 86% cisgender men; 77% sexual minority) enrolled in a randomized controlled trial of a community-based ART adherence intervention in Los Angeles County, CA. From May to July 2020, participants completed telephone interviews on negative COVID-19 impacts, general COVID-19 mistrust (eg, about the government withholding information), COVID-19 vaccine and treatment hesitancy, and trust in COVID-19 information sources. Adherence was monitored electronically with the Medication Event Monitoring System. RESULTS: Nearly all participants (97%) endorsed at least one general COVID-19 mistrust belief, and more than half endorsed at least one COVID-19 vaccine or treatment hesitancy belief. Social service and health care providers were the most trusted sources. Greater COVID-19 mistrust was related to greater vaccine and treatment hesitancy [b (SE) = 0.85 (0.14), P < 0.0001 and b (SE) = 0.88 (0.14), P < 0.0001, respectively]. Participants experiencing more negative COVID-19 impacts showed lower ART adherence, assessed among a subset of 49 participants [b (SE) = -5.19 (2.08), P = 0.02]. DISCUSSION: To prevent widening health inequities, health care providers should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, to encourage COVID-19 vaccine and treatment uptake.

Age matters: differences in correlates of self-reported HIV antiretroviral treatment adherence between older and younger Black men who have sex with men living with HIV.

Black men who have sex with men (BMSM) show lower levels of adherence to antiretroviral therapy (ART) for HIV medications than other racial/ethnic groups in the U.S. Yet, little is known about age differences in factors that predict ART adherence among BMSM. We combined data from two surveys of HIV-positive BMSM, resulting in 209 participants (130 aged 18-50 years; 79 aged 50 years or older). Multivariate linear regressions examined associations between baseline characteristics and adherence to HIV medications as well as interactions of baseline characteristics with age. The associations between trust in healthcare and doctor satisfaction ratings with higher adherence were stronger for older vs younger men (p < .05); the association between problem drinking and lower adherence was stronger among younger men (p < .05). Future research should examine how interventions may address these age-specific factors to improve ART adherence among BMSM living with HIV.

Alcohol brand references in U.S. popular music, 2009-2011.

This study aimed to assess the prevalence and context of alcohol brand references in popular music. Billboard Magazine year-end charts from 2009 to 2011 were used to identify the most popular songs in four genres: Urban, Pop, Country, and Rock. Of the 720 songs, 23% included an alcohol mention, and 6.4% included an alcohol brand mention. Songs classified as Urban had the highest percentage of alcohol mentions and alcohol brand mentions. The context associated with alcohol brand mentions was almost uniformly positive or neutral. Public health efforts may be necessary to reduce youth exposure to these positive messages about alcohol use.