Individualized Web-Based Attention Training With Evidence-Based Counseling to Address HIV Treatment Adherence and Psychological Distress: Exploratory Cohort Study.

Eric Houston,Nina T Harawa,Sukrit Mukherjee,Chris Argueta,Javad Salehi Fadardi

doi:10.2196/18328

Abstract

BackgroundThe prevalence of mood, trauma, and stressor-related disorders is disproportionately higher among people living with HIV than among individuals without the virus. Poor adherence to HIV treatment and heightened psychological distress have been linked to symptoms associated with these disorders.ObjectiveThe objective of this exploratory pilot study was to develop and implement an intervention that combined individualized web-based attention training with evidence-based counseling to promote HIV treatment adherence and reduce psychological distress among people living with HIV. The study targeted African American and Latino young men who have sex with men, two population groups in the US that continue to experience disparities in HIV treatment outcomes.MethodsStudy participants with elevated symptoms of depression and suboptimal adherence to antiretroviral therapy were recruited primarily through referrals from Los Angeles health and social service providers as well as postings on social media. Participants enrolled in the 4-week intervention received weekly counseling for adherence and daily access to web-based attention training via their personal mobile devices or computers.ResultsOf the 14 participants who began the intervention, 12 (86%) completed all sessions and study procedures. Using a pretest-posttest design, findings indicate significant improvements in adherence, depressive symptoms, and attention processing. Overall, the proportion of participants reporting low adherence to antiretroviral therapy declined from 42% at baseline to 25% at intervention completion (P=.02, phi=0.68). Mean depressive symptoms measured by the 9 item Patient Health Questionnaire (PHQ-9) showed a substantial reduction of 36% (P=.002, Cohen d=1.2). In addition, participants’ attentional processing speeds for all types of stimuli pairings presented during attention training improved significantly (P=.01 and P=.02) and were accompanied by large effect sizes ranging from 0.78 to 1.0.ConclusionsOur findings support the feasibility of web-based attention training combined with counseling to improve antiretroviral therapy adherence among patients with psychological distress. Future research should include a larger sample, a control group, and longer-term follow-up.

Highlights

People living with HIV are disproportionately affected by depression and posttraumatic stress disorder (PTSD) [1,2]
The sample consisted of participants recruited for Project STEP (Steps Toward Embodying Positivity), an intervention designed to address HIV treatment adherence and depressive symptoms among African-American and Latino young men living with HIV in the Los Angeles metropolitan area
Individuals who expressed interest in joining the study were screened in person or by phone to determine if they met the following 4 eligibility criteria: (1) African American or Latino male living with HIV; (2) 18- 29 years old, inclusive; (3) self-identified as gay, bisexual, or same-gender loving; and (4) depressive symptoms at mild or higher levels of severity based on self-report measures or suboptimal antiretroviral therapy adherence, two psychological and behavioral risk factors for poor HIV treatment outcomes that the intervention was designed to address

Summary

Introduction

People living with HIV are disproportionately affected by depression and posttraumatic stress disorder (PTSD) [1,2]. Compared to the general population, studies have estimated prevalence rates among people living with HIV at two to three times higher for depression and up to nine times higher for PTSD [3,4] While both disorders adversely affect adherence to antiretroviral therapy, symptoms of depression and PTSD, even at subclinical levels, weaken an individual’s ability to effectively self-regulate the attention and cognitive processes required for consistent goal-directed behavior, such as following a long-term treatment regimen [5,6,7]. Attention training procedures have demonstrated efficacy in addressing several mental health problems for both adults and adolescents, including anxiety disorders and major depression [18,19,20,21] Such approaches provide structured training designed to strengthen an individual’s ability to shift his or her attentional focus away from stimuli that provoke thoughts and memories associated with treatment avoidance and psychological distress and toward stimuli that promote treatment engagement and emotional well-being. Future research should include a larger sample, a control group, and longer-term follow-up

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