Increasing Sustained Viral Suppression Among Youth Living with HIV: A Randomized Controlled Trial of Stepped Care Intervention

Abstract

This study aimed to decrease viral load (VL) to increase viral suppression (VS) among youth living with HIV (YLH) ages 12–24. This study was a stepped care randomized controlled trial. Sixty-eight YLH with established infection, without VS, and with at least two follow-ups (N = 68) were randomized to a control condition (n = 25) or a stepped care intervention (n = 43), and repeatedly assessed for up to 24 months. Both conditions received referrals for health services and a daily automated text-messaging and monitoring intervention (AMMI). YLH in stepped care who were unsuppressed at 4-month assessments stepped up to peer support and later to coaching. Random effects regressions examined VL trajectories over time as well as trajectories of secondary outcomes. There was significant evidence suggesting a different longitudinal trajectory of VLs for the two conditions. The control condition had improved VLs at about 12 months and then started to return to higher VLs. The stepped-care condition improved over the same time period and remained relatively stable. We estimated that the average VL was lower in the stepped care condition at 24 months, but we cannot claim a statistically significant difference between conditions. Both intervention groups appeared to have positive intervention impacts suggesting some benefits of the AMMI intervention. The improvement in VL at 24 months for stepped care compared to the control condition are suggestive of a viable intervention strategy that warrants further study.