Consistent treatment with anti-retroviral therapy (ART) suppresses viral load (VL), prolonging life and improving quality of life for HIV+ persons. Suppressing VL benefits communities by reducing transmission to others. Mere availability of ART and care, however, is insufficient;the benefits of ART depend upon HIV+ persons'continuous visits to the health care provider, regular monitoring and regular delivery of medications, - known as retention in HIV care. In spite of national efforts, up to a quarter of HIV+ persons, especially low- income minorities, are out of care. Innovative interventions are therefore urgently needed to maximize engagement and retention in HIV care, self-reported adherence, as well as HIV-1 RNA viral load suppression. In pursuit of these aims, the proposed study will assess outcomes of the following interventions in comparison to usual care: 1) contingency management (CM) only;2) peer navigation (PN) only;and 3) a combined approach that integrates both CM and PN (CA). The interventions will then be implemented and evaluated in a fully powered Randomized Control Trial (RCT) using 1) contingency management (CM) only;2) peer navigation (PN) only;and 3) a combined approach that integrates both CM and PN (CA). to examine the effect of the interventions (CM and PN) compared to one another, to their combination (CA) and to usual care. A total of 660 inadequately retained individuals (165/group) will be recruited from publically-funded clinics providing HIV Care in Los Angeles County (LAC). These 495 intervention and 165 controls will be assessed through interviews, VL tests and electronic record review for HIV care visits. The evaluation will address retention in HIV care, use of ART medications, and viral load suppression outcomes, as well as intermediate variables, such as barriers to care, substance use, mental health, social support, self-efficacy, knowledge, stigma, and other factors that may affect the effectiveness of the intervention. We will also assess the costs of the intervention and potential cost savings from long-term intervention outcomes (cost offset and cost-effectiveness). If shown to be effective and cost-effective, this study could have substantial, widespread impact on both individual and public health in Los Angeles and other major metropolitan areas.
Prior research strongly suggests that racial and ethnic disparities substantially and persistently affect retention in HIV care rates. In order to improve both individual and community HIV prevention and care outcomes, innovative interventions are urgently needed to target the underlying factors that contribute to these disparities in care. We therefore propose to evaluate the effectiveness of two distinct and promising cognitive behavioral strategy interventions: Peer Navigation (PN) and Contingency Management (CM), and their combination to optimize retention in HIV care among a vulnerable population of HIV+ individuals served by a safety net health care system that includes the second largest epicenter of HIV+ persons in the U.S.