Inconsistent use of HIV medical care has been associated with potentially dire outcomes for both the individual HIV positive patient in care and the surrounding community due to increased burden of individual- and community-level viral load. While there have been recent intense efforts to enroll people living with HIV (PLWH) into care and to re-engage PLWH lost to care, less is known about factors influencing sustained maintenance in HIV-care once initiated or re-initiated, despite this group's particular vulnerability to additional complications (such as resistance due to intermittent adherence) and the window of opportunity for clinic- based intervention that they present. The proposed work aims to address this gap in the literature and unmet service-related needs through the development and evaluation of a theory based model of retention in care and a brief targeted intervention to support retention in care for those tenuously engaged. We adapt the well- established the Information-Motivation-Behavioral Skills (IMB) model to retention in HIV medical for use in two studies. This IMB model is used to identify the core psycho-social processes in terms of the types of information, motivation, and behavior skills needed to sustain regular use of HIV medical care over time by identifying potentially modifiable deficits in these psychological processes that can be used to inform retention- related intervention strategies. In Study 1 we will use a cross-sectional IMB-based measure of retention in care to test the model and identify the critical levels of information, motivation, and behavioral skills related to retention in care within an inner-city clinic sample. Specifically, our first aim is to test an Information- Motivation- Behavioral Skills Model of retention in HIV medical care in an inner-city clinic population. Study 2 will pilot an intensive single-session motivational-interviewing based intervention that uses an IMB- model based screener to identify individual model-based barriers to retention in care to tailor the patient- centered discussion targeting adherence to the next clinic visit specifically for patients who have gapped in HIV care over the last year and a half. This intervention will be evaluated against a time and attention control condition within the same cohort on objective indices of care utilization six months post intervention, as well as on immediate post-intervention changes in information, motivation, and behavioral skills. Thus, our second aim is to design, implement, and evaluate a proof-of-concept clinic-based intervention designed to address core IMB model determinants of retention in care, and promote retention in care in a tenuously engaged inner-city sample. The proposed project will contribute uniquely to this area of inquiry and have practical implications for viable intervention approaches for controlling individual- and community-level viral burden.

Public Health Relevance

The proposed project will test an Information Motivation Behavioral Skill model of retention in HIV medical care and evaluate a brief targeted intervention to promote retention in care via improvements in the core factors identified by this mode, which uniquely contributes to this area of research by providing a comprehensive model of retention that can be easily translated to effective intervention approaches. The pilot of the targeted theory-based intervention has implications for both extending our understanding of effective interventions for retention in care as well as for providing guidance for potential strategies to promote engagement delivered at the point of clinical care. Such efforts to enhance and sustain retention in care are necessary to achieve improved health and significant reductions in viral load critical to individual and public health.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZRG1-AARR-H (22))
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Stoff, David M
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University of Connecticut
Schools of Arts and Sciences
United States
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Smith, Laramie R; Amico, K Rivet; Fisher, Jeffrey D et al. (2018) 60 Minutes for health: examining the feasibility and acceptability of a low-resource behavioral intervention designed to promote retention in HIV care. AIDS Care 30:255-265
Smith, Laramie R; Strathdee, Steffanie A; Metzger, David et al. (2017) Evaluating network-level predictors of behavior change among injection networks enrolled in the HPTN 037 randomized controlled trial. Drug Alcohol Depend 175:164-170
Smith, Laramie R; Earnshaw, Valerie A; Copenhaver, Michael M et al. (2016) Substance use stigma: Reliability and validity of a theory-based scale for substance-using populations. Drug Alcohol Depend 162:34-43
Earnshaw, Valerie A; Smith, Laramie R; Cunningham, Chinazo O et al. (2015) Intersectionality of internalized HIV stigma and internalized substance use stigma: Implications for depressive symptoms. J Health Psychol 20:1083-9
Earnshaw, Valerie A; Smith, Laramie R; Shuper, Paul A et al. (2014) HIV stigma and unprotected sex among PLWH in KwaZulu-Natal, South Africa: a longitudinal exploration of mediating mechanisms. AIDS Care 26:1506-13
Earnshaw, Valerie; Smith, Laramie; Copenhaver, Michael (2013) Drug Addiction Stigma in the Context of Methadone Maintenance Therapy: An Investigation into Understudied Sources of Stigma. Int J Ment Health Addict 11:110-122
Smith, Laramie R; Amico, K Rivet; Shuper, Paul A et al. (2013) Information, motivation, and behavioral skills for early pre-ART engagement in HIV care among patients entering clinical care in KwaZulu-Natal, South Africa. AIDS Care 25:1485-90
Earnshaw, Valerie A; Smith, Laramie R; Chaudoir, Stephenie R et al. (2013) HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav 17:1785-95
Smith, Laramie R; Fisher, Jeffrey D; Cunningham, Chinazo O et al. (2012) Understanding the behavioral determinants of retention in HIV care: a qualitative evaluation of a situated information, motivation, behavioral skills model of care initiation and maintenance. AIDS Patient Care STDS 26:344-55
Earnshaw, Valerie A; Smith, Laramie R; Chaudoir, Stephenie R et al. (2012) Stereotypes about people living with HIV: implications for perceptions of HIV risk and testing frequency among at-risk populations. AIDS Educ Prev 24:574-81