Evaluation of a Peer-Led, HIV Self-Management Program for People Living with HIV

Background and Purpose: HIV-related, health-promoting behaviors (e.g., antiretroviral therapy [ART] adherence) are critical to maintaining the health of people living with HIV (PLWH) in addition to the success of the “treatment as prevention” initiative, which seeks to decrease the rate of HIV transmission through increasing viral suppression among PLWH. Self-management interventions that provide PLWH with the skills to develop and sustain health-promoting behaviors are therefore critical to optimizing HIV health outcomes and preventing new HIV infections. In response to the need for health promotion services for PLWH, the New York City Department of Health and Mental Hygiene, in collaboration with the HIV Health and Human Services Planning Council of New York, developed and implemented The Positive Life Workshop (TPLW), a 7-session, peer-led HIV self-management program. This evaluation assessed: (1) participation patterns in TPLW; and (2) the effect of TPLW on HIV-related knowledge, treatment beliefs, social support, patient self-advocacy, confidence for self-management, ART adherence, and viral load suppression.

Methods: The overall sample included 1620 PLWH who registered to participate in TPLW between 3/2015 and 2/2018. Attendance data were used to measure indicators of workshop participation including initial engagement (completing the first session) and graduation (completing six out of the seven sessions). Outcome surveys were administered before and after the program and at three months following program completion. Outcome analyses examined changes from pre-test to both post-test (n=1020) and 3-month follow-up (n=775) using non-parametric tests. Subgroup analyses were conducted for 298 participants with ≥1 characteristics of the priority population for TPLW (i.e., PLWH with recent HIV diagnosis, no ART prescription, suboptimal ART adherence, and/or recent unsuppressed viral load).

Results: Of the individuals who registered to participate in TPLW, most were male (63%), Latino/a or Black (94%), age 50 or older (52%), and educated at or below high school level (59%). Only 26% (n=418) of registered individuals had ≥1 characteristics of the priority population for TPLW at intake. Among those, the most common characteristic was unsuppressed viral load (65%, n=273), followed by a recent HIV diagnosis (35%, n=148), and not being prescribed ART (21%, n=88). Of the registered participants, 74% (n=1200) attended the first session, and of these, 85% (n=1020) graduated from at least one workshop cycle. In the overall and priority population samples, there were statistically significant improvements in HIV-related knowledge, social support, confidence for self-management, and ART adherence between pre-test and both the post-test and 3-month follow-up assessments. Analyses for both the overall and the priority populations showed statistically significant increases from pre-test to 3-month follow-up in the proportion of participants who were virally suppressed (82.9% to 88.3%, p=0.0055, and 37.7% to 73.2%, p<0.0001, respectively).

Conclusions and Implications: Results demonstrated that TPLW participants experience short-term knowledge, psychosocial, and health outcome improvements. Compared to the overall sample, the priority population sample showed a greater magnitude of change from pre-test to 3-month follow-up in both ART adherence and viral suppression. These findings suggest the importance of ensuring HIV self-management interventions reach PLWH who struggle with initiating and maintaining HIV-related health-promoting behaviors.