Methods. Participants (N=353 of 512 recruited to date) are adult AABLH PLWH with poor engagement in HIV care and detectable HIV viral load (indicating insufficient medication use). Five promising culturally salient intervention components are being tested using an efficient fractional factorial design. Components are grounded in self-determination theory, motivational interviewing, and social-cognitive counseling approaches, designed to address theoretical mediators, and delivered by trained social workers. They are: individual counseling sessions, pre-adherence skill/habit building, peer mentoring, focused support groups, and patient navigation. Participants engage in structured assessments, laboratory tests, intervention components, and qualitative interviews over 12 months.
Results. Participants were mostly male (72%), African American/Black (70%), from low-SES backgrounds, 47 years old on average (SD=11 years), and had lived with HIV for 19.7 years on average (SD=9.1 years). Average log10 HIV viral load (VL) at enrollment was 4.07 pp/mL (SD=1.09 pp/mL). Stopping and starting antiretroviral therapy was common (mean=11.2 times [SD=19.6 times]). Results from qualitative analyses highlighted that participating in distinct, diverse components delivered by different interventionists (to prevent contamination) was feasible, acceptable, engaging, and motivating. Consistent with hypotheses, participants found specific aspects of the components useful. Preliminary quantitative analysis found a significant reduction in HIV VL across all components at the first follow-up period (t(99) = 6.17, p < .001; mean reduction in VL = 0.91 log10 VL). In the next phase of the study, the most cost-effective combination of components will be identified, which will comprise the “optimized” multi-component intervention.
Conclusions and Implications. Innovative, efficient, and culturally salient intervention approaches are needed to reduce racial/ethnic disparities in HIV. The MOST framework is acceptable and feasible for this population, and the culturally salient intervention components are promising.