Active engagement in HIV care is critical to optimize treatment outcomes among individuals living with HIV. This is especially true for men who have sex with men (MSM), a group disproportionately affected by HIV and continuing to experience high incidence rates. Social support, particularly in the context of primary romantic relationships, has consistently been documented as a predictor of health behaviors, including adherence to care for HIV and other conditions. As such, couples-based interventions have the potential to create a lasting effect on engagement in HIV care, uptake and adherence to pre-exposure prophylaxis (PrEP) for HIV prevention, and other health behaviors among MSM in primary relationships with other men. Building on years of formative work documenting couple-level effects on engagement in care among HIV serodiscordant and seroconcordant positive male couples, we have developed and piloted a couple-level intervention grounded in Social Control Theory aimed at improving engagement in care and virologic outcomes. We now propose to evaluate this intervention in a randomized controlled trial comparing virologic outcomes of couples randomized to the couple-level intervention or to an individual intervention. If the couple-level intervention proves efficacious, it will provide a potentially cost-effective and sustainable approach to optimizing treatment outcomes and reducing risk of new HIV transmissions among this population. This may, by extension, be subsequently adapted for other couples, other settings (including PrEP), and other health conditions that demand active patient engagement such as diabetes, cancer, and heart disease.

Public Health Relevance

Active engagement in HIV care is critical to optimize treatment outcomes among individuals living with HIV. We propose to evaluate a couple-level intervention in a randomized controlled trial comparing health outcomes of couples randomized to the couple intervention or to an individual intervention. If effective, this approach may be adapted for other couples, other settings, and other health conditions that demand active patient engagement such as diabetes, cancer, and heart disease.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR010187-14
Application #
9937858
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Henry, Rebecca
Project Start
2006-08-15
Project End
2021-05-31
Budget Start
2020-06-01
Budget End
2021-05-31
Support Year
14
Fiscal Year
2020
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94118
Gamarel, Kristi E; Neilands, Torsten B; Conroy, Amy A et al. (2017) A longitudinal study of persistent smoking among HIV-positive gay and bisexual men in primary relationships. Addict Behav 66:118-124
Conroy, Amy A; Gamarel, Kristi E; Neilands, Torsten B et al. (2016) Relationship Dynamics and Partner Beliefs About Viral Suppression: A Longitudinal Study of Male Couples Living with HIV/AIDS (The Duo Project). AIDS Behav 20:1572-83
Conroy, Amy A; Gamarel, Kristi E; Neilands, Torsten B et al. (2016) Partner Reports of HIV Viral Suppression Predict Sexual Behavior in Serodiscordant Male Couples. J Acquir Immune Defic Syndr 73:e31-3
Gamarel, Kristi E; Comfort, Megan; Wood, Troy et al. (2016) A qualitative analysis of male couples' coping with HIV: Disentangling the ""we"". J Health Psychol 21:2125-37
Gamarel, K E; Neilands, T B; Dilworth, S E et al. (2015) Smoking, internalized heterosexism, and HIV disease management among male couples. AIDS Care 27:649-54
Gamarel, Kristi E; Woolf-King, Sarah E; Carrico, Adam W et al. (2015) Stimulant use patterns and HIV transmission risk among HIV-serodiscordant male couples. J Acquir Immune Defic Syndr 68:147-51
Kamen, Charles; Mustian, Karen; Johnson, Mallory O et al. (2015) Same-sex couples matter in cancer care. J Oncol Pract 11:e212-5
Woolf-King, Sarah E; Neilands, Torsten B; Dilworth, Samantha E et al. (2014) Alcohol use and HIV disease management: the impact of individual and partner-level alcohol use among HIV-positive men who have sex with men. AIDS Care 26:702-8
Gamarel, Kristi E; Neilands, Torsten B; Golub, Sarit A et al. (2014) An omitted level: an examination of relational orientations and viral suppression among HIV serodiscordant male couples. J Acquir Immune Defic Syndr 66:193-6
Starks, Tyrel J; Gamarel, Kristi E; Johnson, Mallory O (2014) Relationship characteristics and HIV transmission risk in same-sex male couples in HIV serodiscordant relationships. Arch Sex Behav 43:139-47

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