# Intervention to Improve HIV Care Retention and Antiretroviral Adherence inStigmatized Environments

> **NIH NIH R01** · UNIVERSITY OF CONNECTICUT STORRS · 2021 · $632,422

## Abstract

The global scale-up of antiretroviral therapy (ART) is aimed to achieve 90% HIV suppression worldwide.
However, even with increased access to ART, many countries are not on track to achieving this goal.
Among the factors that impede retention in HIV care, ART adherence and HIV suppression is the social
stigmatization of HIV infection. HIV stigmas and behaviors intended to avoid stigma have the adverse
consequences of deterring people from seeking care, interfering with clinic attendance, and detracting
from taking ART. Interventions to increase HIV care retention and ART adherence have not thus far focused
on reducing the adverse effects of stigma in countries where HIV is most prevalent. This application proposes
to test a theory-based mobile-phone delivered counseling intervention designed to address HIV-stigma
concerns in order to improve HIV treatment retention and adherence in South Africa. The intervention is
grounded in Behavioral Self-Regulation Theory and the HIV Stigma Framework and was developed in
partnership with South African public health agencies. The intervention approach uses health decision-
making and problem-solving skills aimed at resolving social and structural barriers to care, and is delivered
by community health worker/lay counselors to increase its potential for scale-up. To test the efficacy of this
newly developed and fully pilot tested intervention model, we will conduct a randomized clinical trial designed
to tease-out the additive effects of directly addressing stigma concerns by augmenting a Behavioral Self-
Regulation Counseling with stigma management components. We will conduct a 3-arm clinical trial in a
resource limited township in South Africa that has shown evidence of high-HIV stigma to compare: (a)
Behavioral Self-Regulation + Stigma Management Counseling for HIV treatment retention and adherence,
vs. (b) Behavioral Self-Regulation Counseling for HIV treatment retention and adherence, vs. (c) Uniform
standard of care HIV patient education. The trial will enroll 1200 men and women with unsuppressed HIV
and receiving HIV treatment in South Africa’s HIV care system. Participants will be followed for 15-months
post-intervention to assess intervention effects on HIV care retention and HIV suppression (primary
outcomes) and ART adherence (secondary outcome). Conditional process modeling will determine
underlying mechanisms (e.g., self-efficacy, behavioral strategies, internalized stigma, anticipated stigma)
that account for intervention effects and how these mechanisms may vary by level of baseline experiences
with enacted HIV stigma. The trial will also perform implementation research activities to inform potential
scale-up should the intervention be shown efficacious. This newly developed intervention model is
designed for use with existing clinical resources in WHO defined systems of differentiated HIV care.

## Key facts

- **NIH application ID:** 10072084
- **Project number:** 5R01MH119913-02
- **Recipient organization:** UNIVERSITY OF CONNECTICUT STORRS
- **Principal Investigator:** SETH C KALICHMAN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $632,422
- **Award type:** 5
- **Project period:** 2019-12-16 → 2024-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10072084

## Citation

> US National Institutes of Health, RePORTER application 10072084, Intervention to Improve HIV Care Retention and Antiretroviral Adherence inStigmatized Environments (5R01MH119913-02). Retrieved via AI Analytics 2026-06-14 from https://api.ai-analytics.org/grant/nih/10072084. Licensed CC0.

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