Computerized counseling reduces HIV-1 Viral load and sexual transmission risk: Findings from a randomized controlled trial

Ann E. Kurth, Freya Spielberg, Charles M. Cleland, Barrot Lambdin, David R. Bangsberg, Pamela A. Frick, Anneleen O. Severynen, Marc Clausen, Robert G. Norman, David Lockhart, Jane M. Simoni, King K. Holmes

Research output: Contribution to journalArticle

Abstract

Objective: Evaluate a computerized intervention supporting antiretroviral therapy (ART) adherence and HIV transmission prevention. Design: Longitudinal randomized controlled trial. Settings: An academic HIV clinic and a community-based organization in Seattle. Subjects: In a total of 240 HIV-positive adults on ART, 209 completed 9-month follow-up (87% retention). Intervention: Randomization to computerized counseling or assessment only, 4 sessions over 9 months. Main Outcome Measures: HIV-1 viral suppression, and selfreported ART adherence and transmission risks, compared using generalized estimating equations. Results: Overall, intervention participants had reduced viral load: mean 0.17 log10 decline, versus 0.13 increase in controls, P = 0.053, and significant difference in ART adherence baseline to 9 months (P = 0.046). Their sexual transmission risk behaviors decreased (odds ratio = 0.55, P = 0.020), a reduction not seen among controls (odds ratio = 1.1, P = 0.664), and a significant difference in change (P = 0.040). Intervention effect was driven by those most in need; among those with detectable virus at baseline (<30 copies/mL, n = 89), intervention effect was mean 0.60 log10 viral load decline versus 0.15 increase in controls, P = 0.034. ART adherence at the final follow-up was 13 points higher among intervention participants versus controls, P = 0.038. Conclusions: Computerized counseling is promising for integrated ART adherence and safer sex, especially for individuals with problems in these areas. This is the first intervention to report improved ART adherence, viral suppression, and reduced secondary sexual transmission risk behavior.

Original languageEnglish (US)
Pages (from-to)611-620
Number of pages10
JournalJournal of Acquired Immune Deficiency Syndromes
Volume65
Issue number5
DOIs
StatePublished - Apr 15 2014

Fingerprint

Viral Load
HIV-1
Counseling
Randomized Controlled Trials
HIV
Risk-Taking
Therapeutics
Odds Ratio
Safe Sex
Random Allocation
Outcome Assessment (Health Care)
Organizations
Viruses

Keywords

  • Antiretroviral therapy adherence
  • Computerized counseling
  • HIV
  • Prevention with positives
  • Viral load

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Computerized counseling reduces HIV-1 Viral load and sexual transmission risk : Findings from a randomized controlled trial. / Kurth, Ann E.; Spielberg, Freya; Cleland, Charles M.; Lambdin, Barrot; Bangsberg, David R.; Frick, Pamela A.; Severynen, Anneleen O.; Clausen, Marc; Norman, Robert G.; Lockhart, David; Simoni, Jane M.; Holmes, King K.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 65, No. 5, 15.04.2014, p. 611-620.

Research output: Contribution to journalArticle

Kurth, AE, Spielberg, F, Cleland, CM, Lambdin, B, Bangsberg, DR, Frick, PA, Severynen, AO, Clausen, M, Norman, RG, Lockhart, D, Simoni, JM & Holmes, KK 2014, 'Computerized counseling reduces HIV-1 Viral load and sexual transmission risk: Findings from a randomized controlled trial', Journal of Acquired Immune Deficiency Syndromes, vol. 65, no. 5, pp. 611-620. https://doi.org/10.1097/QAI.0000000000000100
Kurth, Ann E. ; Spielberg, Freya ; Cleland, Charles M. ; Lambdin, Barrot ; Bangsberg, David R. ; Frick, Pamela A. ; Severynen, Anneleen O. ; Clausen, Marc ; Norman, Robert G. ; Lockhart, David ; Simoni, Jane M. ; Holmes, King K. / Computerized counseling reduces HIV-1 Viral load and sexual transmission risk : Findings from a randomized controlled trial. In: Journal of Acquired Immune Deficiency Syndromes. 2014 ; Vol. 65, No. 5. pp. 611-620.
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AU - Lambdin, Barrot

AU - Bangsberg, David R.

AU - Frick, Pamela A.

AU - Severynen, Anneleen O.

AU - Clausen, Marc

AU - Norman, Robert G.

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AU - Simoni, Jane M.

AU - Holmes, King K.

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N2 - Objective: Evaluate a computerized intervention supporting antiretroviral therapy (ART) adherence and HIV transmission prevention. Design: Longitudinal randomized controlled trial. Settings: An academic HIV clinic and a community-based organization in Seattle. Subjects: In a total of 240 HIV-positive adults on ART, 209 completed 9-month follow-up (87% retention). Intervention: Randomization to computerized counseling or assessment only, 4 sessions over 9 months. Main Outcome Measures: HIV-1 viral suppression, and selfreported ART adherence and transmission risks, compared using generalized estimating equations. Results: Overall, intervention participants had reduced viral load: mean 0.17 log10 decline, versus 0.13 increase in controls, P = 0.053, and significant difference in ART adherence baseline to 9 months (P = 0.046). Their sexual transmission risk behaviors decreased (odds ratio = 0.55, P = 0.020), a reduction not seen among controls (odds ratio = 1.1, P = 0.664), and a significant difference in change (P = 0.040). Intervention effect was driven by those most in need; among those with detectable virus at baseline (<30 copies/mL, n = 89), intervention effect was mean 0.60 log10 viral load decline versus 0.15 increase in controls, P = 0.034. ART adherence at the final follow-up was 13 points higher among intervention participants versus controls, P = 0.038. Conclusions: Computerized counseling is promising for integrated ART adherence and safer sex, especially for individuals with problems in these areas. This is the first intervention to report improved ART adherence, viral suppression, and reduced secondary sexual transmission risk behavior.

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