Grant Title: A Multimedia Social Support Intervention: Adherence to HIV Care in South Africa (SMART+SA)

Funding Source and Period: NIMH R34-MH082654, 9/26/07-8/31/10

Key HIV Center Personnel:

Principal Investigator:  Robert H. Remien, Ph.D. (HIV Center)

 

Project Overview

HIV is a major threat to the health and psychosocial well-being of infected people, particularly in low-resource countries that have had limited access to antiretroviral treatment (ART). South Africa (SA) has one of the highest HIV prevalence rates in the world. Recently, a national plan was initiated to make ART widely available in SA which will result in a growing population of people living with HIV who survive and must live with HIV disease as a chronic, stigmatizing, and transmittable illness, with the potential for significant public health consequences. The goal of this study is to adapt and pilot test a counselor- and multimedia-driven social support intervention to promote optimal medical care adherence for adult patients accessing ART in SA community based clinics.

 

The original intervention (SMART Couples) was developed and tested in the US with HIV+ adults and their serodiscordant partners. We are using community-based participatory research methods (CBPR) to modify the existing curriculum and to specify procedures for intervention and assessment delivery. Through the use of CBPR, we are building consensus about which components of the existing SMART intervention are relevant to the SA context and add local techniques that are deemed more relevant, but that also allow us to retain fidelity to core intervention components and our theoretical framework.

 

In Phase 2, 66 HIV-positive adult patients at Hout Bay Road clinic in the South Peninsula District of the Western Cape (False Bay, Victoria Hospital, and Retreat Clinic) are participating in a pilot randomized controlled trial of the intervention. They are randomized either to the active intervention or to "standard of care." Participants are being assessed at three time-points (pre- and post-test intervention and 3-month follow-up) on adherence and other behavioral health outcomes, social support processes, and other self-regulation and contextual variables - guided by the SAT model. Process variables, including barriers and facilitators of feasibility and acceptability will be collected from patients and clinic staff. The findings can be used to inform larger-scale effectiveness studies in similar settings.

 

Publications from the SMART Couples Study:

 

Robert H. Remien, Michael J. Stirratt, Curtis Dolezal, Joanna S. Dognin, Glenn J. Wagner, Alex Carballo-Dieguez, Nabila El-Bassel and Tiffany M. Jung (2009) Couple-focused support to improve HIV medication adherence: a randomized controlled trial. AIDS 2005, Vol 19 No 8, 807-814.

 

Mark V. Bradley, Robert H. Remien, and Curtis Dolezal (2008) Depression symptoms and sexual HIV risk behavior among serodiscordant couples. Psychosom Med.  Vol. 70, No. 2, 186-9.

 

Robert H. Remien, Michael J. Stirratt, Joanna Dognin, Emily Day, Nabila El-Bassel, and Patricia Warne (2006) Moving From Theory to Research to Practice: Implementing an Effective Dyadic Intervention to Improve Antiretroviral Adherence for Clinic Patients.

J Acquir Immune Defic Syndr. Vol 43, Supplement 1, S69-S78.

 

Michael J. Stirratt, Robert H. Remien, Anna Smith, Olivia Q. Copeland, Curtis Dolezal,· Daniel Krieger, and the SMART Couples Study Team (2006) The Role of HIV Serostatus Disclosure in Antiretroviral Medication Adherence. AIDS Behav. Vol 10, 483–493.