Finding and Treating Newly Diagnosed or out of Care HIV Positive Substance Users: The Kaiser Community Based Test and Treat Initiative

Background and Purpose:  Recently, the CDC has asked health care providers to focus on identifying out of care HIV+ individuals through HIV testing so that they can be linked to care that can improve their health while reducing the likelihood of HIV transmission. Identifying out of care HIV+ individuals and effectively linking them to quality care remains a challenge. In order to improve early identification of new HIV cases and to increase the HIV care acquisition and maintenance of newly diagnosed individuals in minority communities disproportionately affected by the HIV epidemic, the Kaiser Foundation launched the Community Based HIV Test and Test Initiative (TTI). The North Jersey Community Research Initiative (NJCRI) was one of the community-based organizations that received funding from the Kaiser Foundation TTI. NJCRI implemented the Modelo de Intervención Psicomédica (MIP), an evidence based HIV intervention in Newark, NJ. The current study aimed to evaluate the effectiveness of the NJCRI’s intervention.

Method: A quasi-experimental evaluation design was used to conduct this research. One hundred and one newly infected or out of care HIV+ individuals struggling with substance abuse were recruited into the program. The experimental group received MIP, a holistic behavioral intervention informed by motivational interviewing, at NJCRI (n=43). The comparison group received treatment as usual at another community-based organization in Newark, NJ (n=58).  Treatment as usual consisted of pharmacotherapy and case management. Participants completed a baseline, 3 and 6 month follow-ups about their behaviors (e.g., sexual activity, substance use, risky health behaviors), services used (e.g., mental health service, social service, hiv linkage to medical care), and medical outcomes (e.g. viral load, cd4 count). ANCOVA and multi-level modeling for binary outcomes with generalized linear mixed model using PROC GLIMMIX were conducted to evaluate the intervention’s impact on treatment engagement (adherence to ART) and viral load.

Results: The intervention group had significantly lower rates of participants reporting being on ART (48.8% versus 87.9%) and significantly higher rates of illegal intravenous drug use (32.6% versus 17.2%). There was no significant differences in viral load between the two groups at follow up. The intervention group reported significantly higher rates of linkage to medical care and mental health services including substance abuse counseling.

Conclusions and Implications: Finding out of care or newly diagnosed HIV positive individuals and linking them to services is a challenging task, particularly those clients who also struggle with substance use disorders. MIP showed promise in increasing linkage to other health and mental health services and adherence to ART. However, no significant differences were found in actual viral suppression at follow-up. More research is needed to test the effectiveness of interventions to reduce viral load among people living with HIV and substance use disorders in marginalized communities.