JMIR Publications

ABSTRACT

Background:

The majority of new HIV infections are attributed to male-to-male sexual contact in the United States (US). However only two-thirds of sexual minority men (SMM) living with HIV achieve an undetectable viral load (VL), which is important to both optimize individual health and to substantially reduce onward HIV transmission. We tested a web-based antiretroviral therapy (ART) adherence intervention, called Thrive with Me (TWM), with core features that included medication self-monitoring and feedback, HIV and ART information, and a peer-to-peer exchange.

Objective:

We assessed the efficacy of TWM on undetectable VL among adult (18+ years) SMM. As a secondary analysis, we assessed the impact of overall engagement and engagement with specific intervention features on undetectable VL.

Methods:

401 SMM (Mean = 39 years old; 72% racial/ethnic minority) in New York City were recruited between October 2016 and December 2019 and randomized to receive TWM (intervention) or a weekly email newsletter (control). Assessments occurred at baseline and months 5, 11, and 17. The primary outcome was a dichotomous measure of undetectable VL (<20 copies). Generalized Estimating Equations with robust standard errors were used to assess the effect of the TWM intervention on undetectable VL over follow-up in an unadjusted model, a model adjusted for baseline differences, and then stratified by baseline urinalysis (i.e., positive vs negative drug use). In secondary analyses, Generalized Linear Models were utilized to estimate risk differences of the association of overall engagement with TWM and engagement with specific TWM components on VL throughout the 17-month intervention period.

Results:

Retention at each time point was: 88% (month 5), 82% (month 11), and 78% (month 17). No difference in DVL was found between those randomized to receive TWM or the control, or when stratified by baseline recent drug use. However, those TWM-assigned participants with high levels of engagement (in the 25th percentile) were more likely to have an undetectable VL at the end of the 5-month active intervention period compared to those with low engagement (below the 75th percentile) or no engagement in the intervention. Moreover, high engagement with the peer-to-peer exchange was associated with undetectable VL over time in unadjusted models.

Conclusions:

TWM did not have overall impacts on viral suppression, however it may be beneficial to SMM who engage at high levels with this web-based intervention. Clinical Trial: ClinicalTrials.gov NCT02704208