UCLA-led study is the first to establish efficacy of a behavioral intervention to enhance HIV treatment outcomes among youth living with HIV

A five-year-long study found that a stepped care, behavioral and technology-based intervention for adolescents living with HIV enhanced their adherence to antiretroviral therapy by greater than 30 percent and improved their viral load suppression by 74 percent over common standards of care. 

“This is the first published behavioral intervention for youth living with HIV to demonstrate efficacy in a full-scale randomized controlled trail with respect to both behavioral and biomedical outcomes of antiretroviral therapy adherence, or ART, and viral suppression,” said study lead-author Dr. Matthew Mimiaga, professor and vice chair of the Department of Epidemiology at the UCLA Fielding School of Public Health. “Very importantly, these effects achieved were also sustained over the 12-month follow-up period.” 

Mimiaga, who also serves as professor of Psychiatry & Biobehavioral Sciences at UCLA’s David Geffen School of Medicine, led the multisite study – centered on a care plan known as "Positive STrategies to Enhance Problem-Solving Skills,” or Positive STEPS - published May 1 in the peer-reviewed Journal of Acquired Immune Deficiency Syndromes (JAIDS). The study team includes researchers from UCLA Fielding, Northwestern University, Brown University, and The Fenway Institute, and was funded by the U.S. National Institutes of Health. 

“Advances in medical treatment, particularly antiretroviral therapy, or ART, have led to significant reductions in HIV-related illnesses and deaths, allowing young people living with HIV to manage their condition as a chronic disease,” said Mimiaga, who serves as director of the UCLA Center for LGBTQ+ Advocacy, Research & Health (C- LARAH). “Nonetheless, ensuring high levels of treatment adherence is vital for treatment success, and promoting adherence remains an essential aspect of contemporary HIV care.” 

HIV is a virus that attacks the cells in the body that help fight infection, making a person more vulnerable to other illnesses. If an individual with HIV is not virally suppressed, HIV can be transmitted through condomless sexual contact when the HIV negative partner is not protected by antiretroviral pre-exposure prophylaxis (PrEP); perinatally from mother to child during childbirth unless the mother is taking ART; or by sharing used needles with an HIV negative individual who is not protected by PrEP. If left untreated, HIV can lead to AIDS, a serious condition that significantly weakens the immune system. However, if taken as prescribed, ART for HIV treatment can reduce the amount of virus in the blood to an undetectable level, allowing those with HIV to live long, healthy lives, and eliminates the risk of passing the virus to others. 

According to the Centers for Disease Control and Prevention, in 2022, the largest number of new HIV infections (12,700) occurred among people aged 25–34 years. Those aged 13–24 years accounted for 20% (6400) of the estimated 31,800 new HIV infections in 2022. Of every 100 youths aged 13–24 years diagnosed with HIV in 2021, only 55% were retained in HIV care, and 35% had unsuppressed viremia, or viral presence. 

“Poor adherence to ART can lead to the development of drug resistance, disease progression, and increased risk of sexual transmission,” said study senior-author Dr. Robert Garofalo, founding chief of the Division Adolescent & Young Adult Medicine at Lurie Children's Hospital and Potocsnak Family Professor of Pediatrics at Northwestern University’s Feinberg School of Medicine in Chicago. “Those realities really highlight the critical need for effective interventions to improve medication adherence in this vulnerable population.” 

The research team worked with more than 120 adolescents living with HIV, split between Boston, Chicago, and Providence, R.I., from 2018-2023. In the present study, an innovative stepped-care model was conducted, which prioritizes the delivery of the least resource-intensive intervention initially, with only those who do not show improvement receiving the more resource-intensive intervention component. This streamlined approach is purposefully designed to allocate resources while ensuring that participants receive effective interventions. 

“Overall, our findings suggest that the positive STEPS intervention has the potential to yield long-lasting benefits for this age group; again, and very importantly, these effects were maintained throughout the follow-up period,” said Mimiaga, who is also an affiliated senior research scientist at The Fenway Institute, Fenway Health, Boston, one of the recruitment sites for the study. “Moving forward, it will be important to assess the real-world applicability of Positive STEPS across diverse settings, including in both rural and urban locations, as well as assessing various modes of delivery.” 

Summary: Study Design, Participants, and Funding 

The researchers conducted a randomized controlled trial from March 2018 to March 2023 of the efficacy of a behavioral and technology-based intervention for improving ART adherence and viral suppression among youth living with HIV ages 16–29 years. Participants gave written informed consent, and Institutional Review Board approval was granted. The funder, the National Institutes of Health, had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript. 

The UCLA Fielding School of Public Health, founded in 1961, is dedicated to enhancing the public's health by conducting innovative research, training future leaders and health professionals from diverse backgrounds, translating research into policy and practice, and serving our local communities and the communities of the nation and the world. The school has more than 1,000 students from 25 nations engaged in carrying out the vision of building healthy futures in greater Los Angeles, California, the nation and the world.