The Fenway Institute is pleased to announce Stronger Together, a new study at Fenway Health

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Stronger Together is a randomized control trial funded by the National Institute of Health addressing HIV in male partnerships. The multi-site study will be recruiting male-male couples in Boston, Atlanta and Chicago, and offering these couples the opportunity to test for HIV and STIs together. The study will examine the efficacy of the Stronger Together intervention, which includes Couples HIV Testing and Counseling (CHTC) and Partner STEPS, a curriculum developed at Fenway aimed at improving adherence in HIV positive people and serodiscordant couples.

Fenway aims to recruit over 800 male-male couples in the following years, and couples who test as serodiscordant or concordant positive will continue with the study. These couples will then be randomized into two separate arms. Those in the control arm will continue to be tested for HIV and STIs separate from their partner at 6, 12, 18, and 24 month follow up visits. Couples randomized to the intervention arm will receive CHTC at 6, 12, 18, and 24 month follow up visits and complete two sessions of Partner STEPS. Partner STEPS, developed by Drs. Matthew Mimiaga and Angela Robertson, along with Kirkpatrick Fergus (Senior RA) and staff from the other study sites, is adapted from Dr. Steven A. Safren’s Life-Steps. Life-Steps is an adherence intervention that has been shown to improve HIV positive persons’ adherence levels through cultivating problem solving skills. These skills allow people on treatment to overcome some of the barriers and obstacles that prevent them from obtaining and taking their medication regularly (1). Partner STEPS includes additional “steps” that help couples problem solve as a dyad. These steps include facilitating communication surrounding adherence, the effect of ART on the couple, and improving adherence through the support of the relationship.

Adherence to ART is critical as resultant viral suppression is correlated with increased health and reduced likelihood of HIV transmission to HIV-negative persons, as demonstrated by the results of the HPTN 052 trial (2-5). Among a study population of serodiscordant couples, HIV-negative partners of HIV-positive persons who began ART with CD4 counts of 350-550 cells/mm3 were 96% less likely to have a virologically linked HIV seroconversion compared to the partners of persons who began ART with CD4 counts of 250 cells/mm3 (2). Though a wide range of adherence rates (53% – 89%) have been documented in varied populations, the average rate of ART adherence is thought to be approximately 70% in the US (6-17). There is evidence that dyadic interventions increase ART adherence when compared to individual adherence counseling (18). In a randomized control trial of 215 couples, including male-male couples, HIV-positive persons receiving ART adherence counseling with their partners had significantly higher levels of ART adherence (18). Based on this evidence, Stronger Together seeks to more fully understand the effect that adherence counseling and testing has on male-male couples.

Those that are eligible to participate in Stronger Together must meet the following criteria:

  • Cisgender male couples
  • Both partners are 18 years of age or older
  • Willing to test for HIV and STIs together
  • Have not tested for HIV in the last 3 months and have a presumed negative status

 

How can you get involved?

  • Tell your clients and colleagues about us.
  • Refer potentially eligible individuals.
  • Share our materials via social media, emails to you list-serve, and/or by making our materials visible around your office/ organization
  • Allow us to come flier, speak to your group/event, etc.
  • Provide us with your feedback,
  • Let us know how we can help you!

 

For more information, visit us at our website StrongerTogether.us. You can also email us at StrongerTogetherBoston@gmail.com or call us at 781.479.2330.

References

1)      Safren SA, Otto MW, Worth JL. Life-Steps: Applying Cognitive Behavioral Therapy to HIV Medication Adherence. Cognitive and Behavioral Practice. 1999 vol 6: 332-341.

2)      Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011 Aug 11;365(6):493-505.

3)      Hogg RS, Heath KV, Yip B, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998 Feb 11;279(6):450-4.

4)      Mocroft A, Ledergerber B, Katlama C, et al. Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet. 2003 07/05;362(9377):22-9.

5)      Palella FJ, Jr., Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998 Mar 26;338(13):853-60.

6)      Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000 07/04;133(1):21-30.

7)      Ammassari A, Murri R, Pezzotti P, et al. Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection. J Acquir Immune Defic Syndr. 2001 Dec 15;28(5):445-9.

8)      Arnsten JH, Demas PA, Farzadegan H, et al. Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. Clin Infect Dis. 2001 10/15;33(8):1417-23.

9)      Bangsberg DR, Hecht FM, Charlebois ED, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000 03/10;14(4):357-66.

10)  Barroso PF, Schechter M, Gupta P, Bressan C, Bomfim A, Harrison LH. Adherence to antiretroviral therapy and persistence of HIV RNA in semen. J Acquir Immune Defic Syndr. 2003 Apr 1;32(4):435-40.

11)  Golin CE, Liu H, Hays RD, et al. A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med. 2002 10/;17(10):756-65.

12)  Howard AA, Arnsten JH, Lo Y, et al. A prospective study of adherence and viral load in a large multi-center cohort of HIV-infected women. AIDS. 2002 11/08;16(16):2175-82.

13)  Ickovics JR, Meade CS. Adherence to HAART among patients with HIV: breakthroughs and barriers. AIDS Care. 2002 06/;14(3):309-18.

14)  Mannheimer SB, Matts J, Telzak E, et al. Quality of life in HIV-infected individuals receiving antiretroviral therapy is related to adherence. AIDS Care. 2005 01/;17(1):10-22.

15)  McNabb JC, Cappa JA, Ross JW. Disorders of iron metabolism associated with protease inhibitor therapy. Clin Infect Dis. 2001 08/01;33(3):413-4.

16)  29 Wagner GJ, Kanouse DE, Koegel P, Sullivan G. Adherence to HIV antiretrovirals among persons with serious mental illness. AIDS Patient Care STDS. 2003 04/;17(4):179-86.

17)  Cohen S, Van Handel M, Branson B, Hall I, Hu X, Koenig L. Vital signs: HIV prevention through care and treatment—United States. MMWR Morb Mortal Wkly Rep. 2011;60:1618-23.

18)  Remien RH, Stirratt MJ, Dolezal C, et al. Couple-focused support to improve HIV medication adherence: a randomized controlled trial. AIDS. 2005 05/20;19(8):807-14.
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