Adherence to antiretroviral medications is necessary to achieve sufficient HIV suppression and non- adherence can lead to the development of treatment resistant genetic variants of HIV. Research has demonstrated that people living with HIV/AIDS who have low-levels of health literacy experience greater treatment non-adherence than their higher-literacy counterparts. Interventions are urgently needed to improve treatment adherence in people with poor literacy skills. This application proposes to test a theory- based behavioral intervention for improving HIV treatment adherence in people living with HIV/AIDS who have low-literacy skills. Grounded in the Information ? Motivation ? Behavioral Skills (IMB) model of health behavior change, the experimental intervention has been tailored for people with low-levels of health literacy and has been pilot tested in preliminary intervention development research. The intervention is delivered in three one-on-one counseling sessions and one maintenance-focused booster session. The intervention will be conducted in a community care setting in Atlanta. Men (n = 225) and women (n = 225) will be recruited from a AIDS services and infectious disease clinics throughout the Atlanta metropolitan area. Following screening, informed consent and baseline assessments participants will be randomly assigned to receive one of three conditions: (a) Theory-based literacy tailored treatment adherence intervention;(b) standard of care non-tailored time-matched adherence counseling intervention;(c) non- contaminating time-matched attention control intervention. Participants will be followed for 12-months observation. Assessments will include measures of information, motivation, and behavioral skills pertaining to HIV treatment adherence, self-report and objective medication adherence, and viral load. The study will test the hypothesis that a theory-based HIV treatment adherence intervention that is tailored for people with low-literacy will improve HIV treatment adherence and health relative to the standard and attention control conditions. The study will also examine the influence of IMB theoretical constructs on intervention outcomes. The intervention under investigation will be among the first to address treatment adherence among people with poor literacy skills. If shown effective, the intervention model will be ready for immediate dissemination to clinical and community adherence enhancement services for people living with HIV-AIDS. Consistent adherence to antiretroviral therapy is necessary for treatment success. People with poor health literacy skills experience considerable difficulty adhering to their medications. Effective strategies for improving adherence in patients with poor health literacy must be tailored to achieve optimal adherence and therefore viral suppression. This proposal requests support to conduct a randomized clinical trial of a theory-based HIV treatment adherence intervention tailored for people with low-literacy skills.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Study Section
Special Emphasis Panel (ZRG1-AARR-H (08))
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Stirratt, Michael J
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University of Connecticut
Schools of Arts and Sciences
United States
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Pellowski, Jennifer A; Kalichman, Seth C; White, Denise et al. (2014) Real-time medication adherence monitoring intervention: test of concept in people living with HIV infection. J Assoc Nurses AIDS Care 25:646-51
Pellowski, Jennifer A; Kalichman, Seth C; Grebler, Tamar (2014) Optimal Treatment Adherence Counseling Outcomes for People Living with HIV and Limited Health Literacy. Behav Med :1-9
Overstreet, Nicole M; Earnshaw, Valerie A; Kalichman, Seth C et al. (2013) Internalized stigma and HIV status disclosure among HIV-positive black men who have sex with men. AIDS Care 25:466-71
Kalichman, Seth C; Cherry, Chauncey; Kalichman, Moira O et al. (2013) Randomized clinical trial of HIV treatment adherence counseling interventions for people living with HIV and limited health literacy. J Acquir Immune Defic Syndr 63:42-50
Kalichman, Seth; Pellowski, Jennifer; Chen, Yiyun (2013) Requesting help to understand medical information among people living with HIV and poor health literacy. AIDS Patient Care STDS 27:326-32
Kalichman, Seth C; Cherry, Charsey; White, Denise et al. (2012) Falling through the cracks: unmet health service needs among people living with HIV in Atlanta, Georgia. J Assoc Nurses AIDS Care 23:244-54
Kalichman, Seth C; Pellowski, Jennifer; Kalichman, Moira O et al. (2011) Food insufficiency and medication adherence among people living with HIV/AIDS in urban and peri-urban settings. Prev Sci 12:324-32
Kalichman, Seth C; Pellowski, Jennifer; Turner, Christina (2011) Prevalence of sexually transmitted co-infections in people living with HIV/AIDS: systematic review with implications for using HIV treatments for prevention. Sex Transm Infect 87:183-90
Kalichman, Seth C; Cherry, Chauncey; White, Denise et al. (2011) Sexual HIV transmission and antiretroviral therapy: a prospective cohort study of behavioral risk factors among men and women living with HIV/AIDS. Ann Behav Med 42:111-9
Kalichman, Seth C; Kalichman, Moira O; Cherry, Chauncey et al. (2011) Brief behavioral self-regulation counseling for HIV treatment adherence delivered by cell phone: an initial test of concept trial. AIDS Patient Care STDS 25:303-10

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