Development and Testing of an Adherence Intervention for HIV+ Women of Color

DESCRIPTION (provided by applicant): Oni Blackstock, MD, MHS, is a primary care internist with fellowship training in HIV medicine and health services research, conducting research to improve health outcomes among HIV+ African American and Latina women. HIV+ women of color comprise the overwhelming majority of HIV+ women in the United States and are at high risk for poor health outcomes. Racial and ethnic disparities in antiretroviral (ARV) adherence contribute to these poor health outcomes; HIV+ women of color, and in particular African American women, have lower ARV adherence rates than their white counterparts. Suboptimal ARV adherence is associated with increased risk of progression to AIDS and death. To begin to address these disparities, effective, evidence- based adherence interventions are needed. To this end, the group clinical visit model -- a group of patients seen simultaneously by a clinician for regularly scheduled visits over time -- represents a novel approach to potentially improving ARV adherence among HIV+ women of color. In particular, group visits can harness the peer-group dynamic to provide mutual support and motivation for positive behavior change. Clinical assessment, education, and self-management skills development, all in the group setting, are components that have been integral to successful group clinical visit models. Social media, an emerging tool in health-related interventions, may further enhance communication and social support outside of the clinical setting. Using an enhanced version of the Social Learning Theory as a framework, Dr. Blackstock's goal is to develop and pilot test an intervention for HIV+ women of color with suboptimal ARV adherence adapted from the group clinical visit model and incorporating social media. The aims for this proposal are: 1) in a predesign phase, to elicit inpu from HIV+ women of color on the content and format of an adherence intervention (Sisters-GPS); 2a) to develop Sisters-GPS by tailoring the group clinical visit model and integrating social media; 2b) to assess its feasibility and acceptability, and 3) to pilot test the efficacy of Sisters-GPS in improving ARV adherence in an RCT. The primary outcome for pilot testing will be ARV adherence; secondary outcomes will be HIV viral load and health care utilization. Mediation analysis will be performed to explore how variables such as HIV-related stigma and perceived social support may mediate the effect of Sisters-GPS. Dr. Blackstock will receive mentorship from a multidisciplinary team of experts in ARV adherence, qualitative and mixed methods research, intervention design, and social media in health interventions. Dr. Blackstock's training goals for this proposed career development award are to develop skills in: 1) advanced qualitative and mixed methods research; 2) development and testing of behavioral interventions; 3) use of social media in health-related interventions, and 4) statistical analysis f longitudinal and clustered data. The proposed studies will provide training, mentorship, and research experience that will provide the foundation for Dr. Blackstock's career as an independently funded clinical investigator dedicated to improving health outcomes for HIV+ women of color.