Substance Use-Related Intentional Nonadherence to Antiretroviral Therapy Among Young Adults Living with HIV

Antiretroviral therapy (ART) reduces HIV disease burden, increases life expectancy, and prevents HIV transmission. Previous research suggests that believing that it is harmful to take ART when using substances (i.e., interactive toxicity beliefs) leads to intentional ART nonadherence; however, these associations have not been investigated among younger adults living with HIV and have not been linked to clinical outcomes. We examined the associations among interactive toxicity beliefs, intentional nonadherence, and HIV clinical outcomes in young adults living with HIV. People living with HIV younger than the age of 36 years who tested positive for at least one substance use biomarker (N = 406) completed a 1-month pretrial run-in study that included computerized interviews, substance use biomarkers, HIV viral load, and unannounced pill counts for ART adherence. Analyses compared three HIV clinical outcome groups: (1) HIV viral unsuppressed, (2) HIV viral suppressed and ART nonadherent, and (3) HIV viral suppressed and ART adherent, on substance use, interactive toxicity beliefs, and substance use-related intentional ART nonadherence. Results showed that a majority of participants reported intentional nonadherence. Participants with unsuppressed HIV reported greater interactive toxicity beliefs and intentional nonadherence. We conclude that intentional nonadherence adds to the detrimental impacts of substance use on ART adherence and interactive toxicity beliefs that foster these behaviors may be amenable to interventions.

OPT-In For Life: A Mobile Technology-Based Intervention to Improve HIV Care Continuum for Young Adults Living With HIV

Young adults living with HIV (YALH) have lower rates of retention in care and HIV viral suppression. Multiple barriers exist to engage YALH in care. We developed and implemented a multifaceted, mobile application-based intervention, "OPT-In for Life," by targeting YALH to encourage retention in care and eventually viral suppression. The app integrated multiple user-friendly features for YALH to manage their HIV care, including a two-way secure messaging function, HIV-related laboratory results, and appointment or medication reminders. We recruited 92 YALH who were 18 to 34 years old and were newly diagnosed with HIV, had a history of falling out of care, or had a detectable HIV viral load into this intervention. Study participants used the app to manage their HIV care and to communicate and interact with their HIV care team. During the intervention period, the retention rate among our study participants increased from 41.3% at baseline to 78.6% at 6-month follow-up, maintained at 12-month follow-up (79.8%), and slightly decreased to 73.4% at 18-month follow-up but it was still significantly higher than the baseline retention rate (p < .0001). The viral suppression rate (HIV RNA <200 copies/ml) increased from 64.1% at baseline to about 85% at 6-month and at 12-month follow-up and reached 91.4% at 18-month (p = .0002) among participants who were retained in care. Our study demonstrated using a HIPAA-compliant mobile application as an effective intervention to engage YALH in care. This mobile technology-based intervention can be incorporated into routine clinical practice to improve HIV care continuum.